|
 | Presentation
 | 35 yo woman, good health, finds lump while showering |
| 60 yo woman, same as above |
| 58 yo woman, calcification found on routine mammo, no
palpable mass |
| 48 yo woman, h/o fibrocystic breasts, now has lump |
|
| History
| When and how found |
| Pain, nipple discharge, menstrual history |
| Previous mammogram? |
| Ask about RISK FACTORS
 | FH or breast or ovarian cancer |
| Age of menarche |
| Never been pregnant or past 30 |
| Smoking, EtOH, diet, caffeine |
| Fibrocystic breast disease |
| Medications, including OCPs |
|
|
| PE
| Complete breast exam |
| Diagram findings |
| Percuss spine for bone pain! |
|
| Laboratory
| Mammogram |
| Coags ordered before biopsy |
| Needle biopsy if cystic on ultrasound
| Clear fluid = cyst |
| Bloody = send for cytology, pathology |
| Solid = excisional biopsy (+ node biopsies?) |
|
| If biopsy +, check LFTs, BMP, bone scan, CXR. |
| Excisional biopsy if solid on ultrasound. Check
nodes. |
|
| Treatment if breast cancer is found
| Everyone
| Lumpectomy, axillary node dissection |
| Modified radical mastectomy and radiation |
| Adjuvant chemotherapy if + nodes or mets |
|
| Post-menopausal women or ER +
| Tamoxifen |
|
|
|
