IN THE NAME OF GOD

Breast Disease Dr.F Behnamfar MD

Introduction Early detection is improved by risk assessment, breast examination, and screening mammography The most common benign breast problem include fibrocystic change and mastalgia, best treated by reassurance Spontaneous unilateral bloody discharge requires histologic evaluation but usually is caused by benign condition Benign Breast disease is a complex entity of its own with a range of physiologic changes and clinical manifestations that have an impact on a woman health

Detection Nipple discharge Breast mass Breast pain Association of symptoms with menstrual cycle Change in breast shape ,size or texture Previous breast biopsies

Risk factors for breast cancer Increasing age Age of menarche<12 Menopause>55 Nuliparity or first pregnancy after 30 Family hx especially premenopausal or bilateral disease Number of first degree relatives with breast cancer Family hx of male breast cancer BRCA1,BRCA2 positive Other malignancies

Physical Exam Breast cancer usually is asymptomatic and is discovered only by physical exam or screening mammography Inspection Symmetry contour skin appearance erythema skin dimpling nipple retraction

Palpation Entire breast axillary and supraclavicular area Temprature Texture tickness of skin generalized or focal tenderness Nodularity Density Assymetry dominant masses nipple discharge

Breast Self Examination Most breast cancers are detected by women themselves Teach SBE early so that it becomes habitual Essential components of SBE Seven P: position palpation, pad of fingers, pressure, perimeter , pattern of search patient education

Breast Self Examination Premenopausal, monthly 7-10 days after onset of menarche Post menopausal, specific calendar date monthly

Breast Imaging Screen film mammography, best method Digital: lower radiation, optimal view, higher detection rate Slow growing cancers ,identified 2years before being palpated Indications Screen Evaluate mass Baseline Search for occult cancer in metastatic disease Before cosmetic operations Monitor breast cancer patients

Mamography Calcification distribution Number of calcifications Description of calcification Mass margin and shape Density and associated findings

Mamography Mamography is never a substitute for biopsy when a dominant or suspicious mass is present Senitivity 75% Specificity 92.5% Purpose ,detection of<1CM tumors 20-30%mortality decreased >50 Y 10-50% mammo detected cancers not palpable American geriatric society, annual or at least biennual mamography up to 75 y and then every 2-3 y Earlier for high risks

Ultrasosograghy FNA: palpable lesion or under sonography Ultrasosograghy :Dense Breast, Lactation, Pregnancy, Age <30,ambigous mamography FNA: palpable lesion or under sonography High accuracy ,low false negative(10-15%) and rare false positive, if clinic or Xray suspicious for malignancy, core needle or excisional biopsy Core needle ,more tissue, ER-PR For nonpalpable mass, uder sono or mammo guide

Open Biopsy Small mass: excision Large mass: FNAC or Core needle