ASPIRATION OF PALPABLE CYST

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1 CYSTS

2 ASPIRATION OF PALPABLE CYST

3

4 GALACTOCELE New lump in nursing mother-soft to firm non-tender Treatment Aspiration

5 FAT NECROSIS Usually there is a history of trauma - MVA, surgery. The fat dies and creates a hard lump. Biopsy to r/o malignancy.

6 MONDOR S DISEASE Thrombophlebitis of the breast-often related to trauma or surgery. Ropey firm, phlebitis of vein, skin retraction may occur. Mammogram, analgesics, warm moist compresses qid x 10 minutes

7 SKIN PROBLEMS SKIN CYSTS - subcutaneous lump-often assoc. with a visible dilated pore, mobile, can be grasped in the skin. Use warm moist compress qid and rubbing alcohol to resolve. IF large, persistent, or become infected please refer to dermatology or the lump & bump class in Surgery Dept.

8 MENOPAUSAL BREAST

9 Are usually becoming smoother, more fatty and thus easier for a mammogram to see into the tissue.

10 DERMATITIS Exzema - most common, avoid irritants. Topical corticosteroids. If not resolved after applying these measures, refer to Breast Clinic for biopsy. Psoriasis can occur on any area of the breast. WHEN TO WORRY unilateral nipple crusting, scaling, not resolved with corticosteroid : needs biopsy to r/o Paget s Disease.

11 1 in 7 women get breast cancer Less than 10% are due to a genetic mutation ie. Family history The biggest factor is likely our exposure to environmental toxins

12

13 SCREENING & DETECTION ANNUAL CLINICAL BREAST EXAM MONTHLY SELF BREAST EXAM ANNUAL MAMMOGRAM

14

15 MAMMOGRAPHY DIAGNOSTIC MAMMOGRAM: FOR PALPABLE MASS DUCTOGRAM AKA GALACTOGRAM FOR NIPPLE D/C

16 MAMMOGRAPHIC ABNORMALITIES MICROCALCIFICATIONS -B9 are usually coarse, radically different from suspicious-punctate STELLATE MASSES ASYMMETRIC DENSITIES ARCHITECHTURAL DISTORTION

17

18 THE RADIOLOGIST will automatically call back patients who need additional work up from an abnormal mammogram.

19 WHERE IS THE CANCER?

20

21 Nipple retraction & Mass

22 ULTRASOUND USED AS AN ADJUNCT NOT A SCREENING TEST HELPS TO VISUALIZE CYSTS, CLARIFY MASSES ON MAMMO or SEE MASSES THE MAMMOGRAM CAN T BUT THAT WE CAN FEEL

23 Findings on Mammo Calcifications - most are clearly B9 and require 6 month f/u only. Those considered indeterminate or suspicious get automatic work up. Positive biopsies done in Radiology are sent directly to Surgery Clinic CYSTS - non palpable, Seen only on mammo, do not need any further evaluation. Surgery does not aspirate non palpable cysts.

24 MEN WITH BREAST LUMPS GYNECOMASTIA - smooth, subareolar density, often asymetric, unilateral or bilateral, often tender-do not use anti-biotics. Common in teens and elders Rapid development and growth is red flag. Review meds that cause gynecomastia ex. Digitalis, cimetidine, cannibis, alcohol etc. Testicular exam to r/o mass/ atrophy Labs: TSH, ALK PHOS,ALT, LH, AFP,BHCG,TESTOSTERONE,PROLACTIN,ESTRADIOL

25 Gynecomastia cont. Does not require mammogram. If not resolving but increasing or of concern refer for surgery consult. Refer to Plastic Surgery for cosmetic issues. Breast cancer in men is 1/100 frequency compared to women Do not treat pain with antibiotics

26 Suspicious mass in men Hard, discrete, not smooth or spongey, subareolar, non tender, increasing in size.

27 MRI MRI has been found to be misleading AND no better than conventional imaging ie. Mammogram MRI IS NOT A SCREENING EXAM! MRI is still considered experimental

28 BRCA POSITIVE PLEASE BE SURE THESE PTS HAVE SEEN AN ONCOLOGIST FOR COUNSELLING AS RISK IS VERY HIGH

29 Cont. No hormones of any kind if BRCA + Having a BRCA 1 or 2 gene increases the risk of breast cancer more than any other known risk age %, age %, age %

30 What Are the Risk Factors for Breast Cancer? Welcome! Calculate Your Breast Cancer Risk (for women 35-84) What is a Clinical Trial? Why Should You Participate in a Clinical Trial? STAR Trial Profiles of STAR Participants About the NSABP Clinical Trial and Cancer Resources A Note About Genetic Testing General Information About Breast Cancer Tell Us How You Heard About This Site Home Disclaimer Privacy Policy

31 What puts me at risk? Risk for developing breast cancer is individual. It depends on a combination of lifestyle and personal traits known as "risk factors." The following risk factors are strongly related to the disease and can alert you and your physician to the need for careful follow-up: A family history of breast cancer, especially in your mother, sister(s), or daughter(s) Age -- in general, the older you are, the greater your risk Never having borne a child Having your first child after age 30 First menstrual period at an early age A history of benign breast disease that required biopsies Other breast conditions: lobular carcinoma in situ (LCIS) or atypical hyperplasia

32 Continue Calculate Your Breast Cancer Risk Background Information Date of Birth: Month Day Year (This information is required to generate your estimated breast cancer risk, since age is a risk factor. The program calculates risk for women ages 35 thru 84.) Race: (Race is a factor in determining your individualized risk. If you are of mixed racial/ethnic background, choose the category with which you most closely identify.) Family History (Include only her biological mother and daughter(s), and her biological sister(s) who share both her parents; information about half-sisters should not be included.) If adopted, click here Does/Did her mother have breast cancer? Does/Did her daughter(s) have breast cancer? Does/Did her sister(s) have breast cancer? yes no Not sure yes no Not Applicable/Not sure yes no Not Applicable/Not sure

33 EXCISIONAL VS. INCISIONAL BIOPSY

34

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