1. Jeannie Harper, PhD, RN

2.  Approximately 50% of women have breast problems  Palpable mass most common sign, detected with self-breast exam  Emotional responses

3.  Fibrocystic changes  Fibroadenoma  Cysts  Atypical hyperplasia-elevated risk of breast cancer

4.  Lumps with or without tenderness consisting of fibrous tissue and cysts  Occur in a woman’s 20’s and 30’s  Caused by normal hormone variations

5.  Pain usually occurs around menstruation  Dull, heavy pain, sense of fullness and tenderness in the upper outer quadrant  May palpate excessive nodularity but are soft, well-differentiated and moveable

6.  First: ultrasound to see if fluid filled  If fluid: fine needle aspiration (FNA) and monitoring  If solid: mammogram  Biopsy may be necessary

7.  Diet and Vitamins:  Eliminate caffeine, tobacco, & alcohol; decrease sodium, vitamin E supplements  Medications:  NSAIDS, oral contraceptives, Danazol, bromocriptine, & tamoxifen  Evening primrose oil  Surgical removal in rare cases

8.  Most common type of tumor in adolescents  Small, solitary lumps  Can increase in size during pregnancy and decrease as woman ages  Diagnosis:  Physical exam and history  Mammogram, ultrasound, or MRI to determine type  FNA to determine cause Treatment: Surgery if suspicious; otherwise monitoring

9.  Mostly normal variation but must be evaluated for endocrine disorder or malignancy  Galactorrhea:  normal during pregnancy  May also be caused by thyroid disorder, pituitary tumor, coitus, stress, trauma, chest wall surgery, and certain medications  Diagnosis:  Prolactin level, examination of discharge, thyroid profile, pregnancy test, & mammogram  Prolactin level should be drawn in the morning and not after breast exam, sexual activity or exercise

10.  Inflammation of ducts behind the nipple  Cause unknown; most often in perimenopause  White, brown, green or purple thick, sticky discharge  Burning pain, itching or mass behind nipple  Diagnosis: mammogram, FNA and culture of fluid  Could become infected or develop abscess

11.  Rare, benign condition in nipple ducts  Cause unknown  Too small for palpation  Unilateral serous, serosanguinous, or bloody discharge  Soft mass may be palpable near the nipple  Diagnosis: ductogram, mammogram or biopsy  Excision if benign  Common age 45-50

12.  Fluid-filled lesions  Caused by obstruction, involution or aging of the ducts within the breast  Palpable or non-palpable; simple or complex  Most common during luteal phase  No malignant change and no increased risk of cancer  1/3 of women age 35-50  Ultrasound-guided cyst aspiration or FNA for diagnosis

13.  Presence of pain  Symptoms increase with menses  Diet or smoking habits  Oral contraceptives or hormone therapy  Personal and family history of breast cancer  Self breast exam teaching and when to receive mammograms

14.  Best to perform after menses  Perform while lying down and standing in front of mirror  Be sure to check underarm, between breasts, and up to collarbone and to the shoulder  See pg. 65 & 66  Can lead to false positive if not done properly http://www.breastcancer.org/symptoms/testin g/types/self_exam/bse_steps

15.  New lump or mass  Swelling  Skin irritation or dimpling  Breast or nipple pain  Nipple retraction or changes  Redness, scaliness, or thickening of skin  Nipple discharge other than breast milk

16.  Only screening done for age 20-39 with normal risk  Used with mammogram age 40+  Includes visual inspection with palpation

17.  Dimpling  Change of skin, areola or nipple  Nipple inversion or retraction, discharge  Tenderness  Adenopathy- enlargement of the lymph nodes

18.  Note:  Position in breast  Shape and size  Borders  Consistency  Mobility  Thickening

19.  Inspection:  Pt seated with arms relaxed  Raise arms overhead  Sit with hands pressed tightly on hips  Palpation:  Use pad of middle 3 fingers in a vertical strip pattern  Start at axillae, include chest wall, skin and incision if mastectomy  Include upper outer quadrant & under areola and nipple  Use 3 levels of pressure: light, medium and deep

20.  Average risk:  45-54 annually  >55 biennial  Give pts the opportunity to begin at 40-44  Clinicians are concerned with overdiagnosis and false positives leading to additional imaging and biopsy  Weigh balance of benefit to harm  Cancer risk increases with age up to 75-79