Breast Disease

SUGGESTED READINGS BREAST DISEASE

1. Essentials of General Surgery, 4th Edition, Ch. 20.
2. Current Surgical Diagnosis & Treatment, 12th Edition, Ch. 17.

OBJECTIVES BREAST DISEASE

1. Identify and describe the major types of breast lumps (fibroadenoma, fibrocystic disease, carcinoma). 2. List four major risk factors for breast cancer.
3. List diagnostic modalities and their sequence in the work-up of a patient with a breast mass.
4. Describe current recommendations for screening mammography.
5. Describe the management for a fibroadenoma.
6. Describe the rationale for adjuvant chemotherapy, radiation, and hormonal therapy in the treatment of breast cancer.
7. Outline diagnosis and management for nipple discharge and breast infections.
8. Outline current treatment options for a patient with early breast cancer.

CASE HISTORIES BREAST DISEASE

1. A 63-year-old white female presents with a lump in the right breast that she discovered on recent self-examination. The lump is non-painful and she denies any nipple discharge. Her past history is remarkable for a breast biopsy of a suspicious lesion in the left breast 12 years ago that was consistent with fibrocystic disease. She is otherwise healthy with no medical problems. Her family history is remarkable in that her mother died of breast cancer at the age of 41. Physical exam reveals a slightly overweight 63-year-old white female in apparent good health. Blood pressure is 148/84, pulse is 82 and regular and she is afebrile. Examination of the left breast and axilla is unremarkable. Examination of the right breast reveals a 2.5 cm firm mobile mass in the upper outer quadrant. There are no overlying skin changes and no nipple discharge is noted. Examination of the left axilla reveals no adenopathy. The remainder of the patient’s physical examination is unremarkable.

2. An 18-year-old student presents with a small, smooth, movable, nontender well circumscribed breast mass.

3. A 39-year-old woman is noted to have a 1.5 cm simple cyst on ultrasound. The mass is not palpable but was seen on mammography.

4. A 46-year-old woman presents with nipple discharge and no palpable mass on exam.

5. A 44-year-old woman presents with an enlarged firm breast with erythema and skin edema of the central breast.

6. A 32-year-old lactating female presents with a painful breast mass and temperature of 101 degrees F.

7. A 66-year-old female presents with a 5 cm, rock-hard, fixed mass in the left breast with matted axillary nodes fixed to the chest wall.

8. A 41-year-old female has a diagnosis of intraductal cancer (cancer in situ) in a stereotactic biopsy performed for suspicious microcalcifications on mammography.

9. A 61-year-old male complains of a lump behind the left nipple. The left breast is enlarged and the nipple has been tender to touch over the last several months.

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