1. IN THE NAME OF GOD

2. Breast Disease
Dr.F Behnamfar MD

3. 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

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

5. 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

6. 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

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

8. 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

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

10. 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

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

12. 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

13. 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

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