IN THE NAME OF GOD BREAST DISEASE E.Naghshineh M.D

Decrease if : screening Most common cancer in women Lifetime risk of breast cancer: 12.5% (1 in 8) Lifetime risk of death :3.6% (1 in 28 ) Decrease if : screening ( G.P ) or ( ob . Gyn ) 6 E.Naghshineh M.D

Risk factors - Age (most important) -family history ( BRCA1 – BRCA 2 ) 5-10 % all breast cancer . E.Naghshineh M.D

Atypical Ductal hyperplasia Atypical lobular Hyperplasia - personal history Atypical Ductal hyperplasia Atypical lobular Hyperplasia Lobular carcinoma insitu E.Naghshineh M.D

Contra lateral breast cancer 0.5-1% /year Ipsilateral recurrence (lumpectomy –Radiation ) 10 % or more in 10 year E.Naghshineh M.D

-Reproduction history Early menarche Late menopause Nulliparity E.Naghshineh M.D

Age at first pregnancy (<30 yrs---30%, <20 yrs---50%) breast – feeding (>24 months) Bilateral oophorectomy E.Naghshineh M.D

Not recommended for prevention of osteoporosis -HRT HRT increase risk ( 10 %) HRT > 10 year increased Risk (E+P: highest risk) HRT smaller , less aggressive Breast cancer, lower mortality HRT Not recommended for primary nor secondary prevention of heart disease Not recommended for prevention of osteoporosis E.Naghshineh M.D

-prior exposure to radiation therapy -7-10 yrs after radiotherapy -breast cancer risk in 40 years: 35% E.Naghshineh M.D

Other factor Jewish Black women Japanese Asian Diet (animal fat ) E.Naghshineh M.D

Alcohol (dose dependent) -BRCA1 , BRCA 2 -45 % Early onset in Breast cancer -90 % hereditary Ovarian cancer E.Naghshineh M.D

History & Physical Exam Family History Menarche Previous pregnancies Breast – feeding HRT E.Naghshineh M.D

Trauma Surgery nipple discharge Breast mass E.Naghshineh M.D

Breast self Examination Bilateral Exam after menses & before ovulation Supraclavicular -axilla E.Naghshineh M.D

Inflammatory appearance After Antibiotic therapy: Biopsy Mammography (screening & fallow up ) E.Naghshineh M.D

Mammography mediolatenal Oblique (MLO), Craniocaudal(CC) views Screen of Asymptomatic patient Diagnose of breast cancer in early stage mediolatenal Oblique (MLO), Craniocaudal(CC) views Radiation Dose<0.1 Rad per study E.Naghshineh M.D

Negative mammogram not R/O Breast cancer False Negative 10-15% If clinically positive Biopsy Screening mammography at 40 years 20-30 % Mortality After 40 years: every 1-2 yrs E.Naghshineh M.D

BI-RADS CLASSIFICATION 0:Need Additional imaging evaluation Assessment is incomplete 1:Negative 2:Benign finding 3:Probably benign finding Short interval follow-up suggested 4:Suspicious abnormality Biopsy should be considered 5:Highly suggestive of malignancy Appropriate action should be taken E.Naghshineh M.D

D.Dx of Solid from cystic lesion Guide for biopsy No screening use Breast ultrasound D.Dx of Solid from cystic lesion Guide for biopsy No screening use ( Not micro-calcification Dx) E.Naghshineh M.D

Ultrasound complement mammography in a young patient with dense Breast E.Naghshineh M.D

MRI No role in cancer screening High sensitivity(86-100%) Low specificity(37-97%) Expensive E.Naghshineh M.D

MRI Rupture of Breast implant pectoralis extension in extensive breast cancer Post lumpectomy fibrosis Dense breast screening ? E.Naghshineh M.D

FNA Palpable thickening – mass DDx solid & cystic mass 21-25 needle,10 cc,3cc False negative 3-35% Atypical cells Biopsy False positive < 0.1 % E.Naghshineh M.D

Fibrocystic change Most common Benign breast disease 20-50 year Mastodynia – bilateral – pre menstrual phase DDx: neuralgia, myalgia, chronic costochondritis E.Naghshineh M.D

Etiology: ? Methylgesantins cAMP, cGMP increase No risk for breast cancer E.Naghshineh M.D

Fibro Adenoma Second common Most common < 25 ys Smooth, mobile, painless, Palpable mass E.Naghshineh M.D

Become Larger – atypia in FNA – patient desire Dx: -Physical exam -sonography –Mammography FNA Surgery if : Become Larger – atypia in FNA – patient desire E.Naghshineh M.D

Mastitis Breast feeding Staph Oreos – strep Continue Breast feeding Tx:Dicloxacillin– Penicillin G If not cure: Biopsy R/O inflammatory carcinoma E.Naghshineh M.D

Ductectasia Pre-post menopause Hard erythematous mass adjacent to the areola with burning . itching – sensation of pulling in the nipple area . Tx: Excisional Biopsy E.Naghshineh M.D

Fat Necrosis Benign, uncommon Trauma Hard mass – irregular - skin retraction E.Naghshineh M.D

Multiple calcification in mammography No increase risk of breast cancer DDx : carcinoma E.Naghshineh M.D

Nipple discharge 10-15% Benign, 2.5- 3 % malignant (milky – green – bloody – serous- cloudy – purulent ) bilateral- unilateral E.Naghshineh M.D

Mass increase risk of cancer If nipple discharge : Unilateral Single duct Menopause Mass increase risk of cancer E.Naghshineh M.D

Breast cancer Most common: sup-lat (38.5%) Most metastases: axilla, same side E.Naghshineh M.D

Pathology Ductal carcinoma Paget Disease Lobular carcinoma insitu Invasive ductal carcinoma Infiltrating lobular carcinoma Inflammatory carcinoma Metastases from Extramammary tumors (lung,ovary,uterus,…) E.Naghshineh M.D

Treatment Mastectomy Breast conservation therapy Chemotherapy Radiation therapy E.Naghshineh M.D

E.Naghshineh M.D