Breast cancer most common Second common Death 211300

Breast cancer -most common -Second common ( Death ) - 211300 new case ( 2003 ) diagnosed - Lifetime Risk 2. 5 % ( 1 -8 )

- Lifetime risk death 3. 6 % ( 1 -28 ) - Decrease if : ( screening ) - ( G. P ) or ( ob. Gyn ) ( screening )

Risk factor - Age -family history ( BACA 1 – BRCA 2 ) 5 -10 % all breast cancer.

+ personal history § Atypical Ductal hyperplasia § Atypical(lobular Hyperplasia ) § Lobular insitu cancinoma

§ Contra lateral breast 0. 5 - 1% § Ipsilateral recurrence (lumpectomy –Radiation ) 10 % in 10 year

Reproduction history § Early menarche § Late menopause § Nulliparity

§ Age at first pregnancy § Breast – feeding § Oophorectomy

HRT §HRT (E+P) §HRT B. C increase 10 % > 10 year §HRT increased Risk smaller , less aggressive No primary ( No secondary prevention of heart disease) Not recommended for prevention of osteoporosis

Perior exposure to radiation therapy

Other factor § Jewish § Black women § Japanese § Asian

§ Alcohol § BRCA 1 BRCA 2 45 % Early onset in B-C 90 % hereditary Ov – Ca

History & Ph – E §History §Menarche §Breast – feeding §HRT

§ Trauma § Surgery § nipple discharge B-S Examination § Bilateral Ex after means before ovulation

§ Supra clavicular - axilla § Inflammatory appearance After Antibiotic Biopsy § If Biopsy benign mass R/O Malignancy. § Mammography(screening )

Mammography § Screen of Asymptomatic patient § MLO (mediolatenal Oblique , Cranio cudal ) § Dose 0. 1 Rad per study ( 0. 025) Chest X Ray 0. 025 Rad per study.

§ Negative mamo not R/O B-C § False Negative 10 -15% § If clinically positive ( Biopsy ) § Screening mamo 40 years 20 -30 % Mortality § After 40 years 1 -2

Breast ultrasound + MRI § Solid – cystic lesion § No screening ( Not micro – Ca )

§Unltrasound cam complement mamo in a young pa with dense Breast

§ MRI No role in breast cancer screening sensitivity 86 -100 % specifity 37 -97 %

MRI § Breast implant for rupture Evaluation in pecroralis Extensive B-C § Post lumpectomy bed fibrosis § § Dense breast

FNA § Palpable thichening – mass 21 -25 needle 10 cc § False negative 30 -35% § Atypical cell Biopsy § False positive < 0. 1 %

Fibrocystic change § Most common Benign B. D § 20 -50 year § Mastalgia – bilateral – pre menstrual § Treatment

Fibro Adenoma § Second common § < 25 ys. O women § Palpable mass smooth mobile painless

§ Mamo – sono – FNA – surgery IF : Large – atypia in FNA – patient desire

Mastitis § Breast feeding § Staph – strep § Continue B-F § Dicloxacillin 250 mg / QID – Penicillin G § If No Better Biopsy

Ductectasia Pre-post menopause § Hard erythomatous mass adjacent to the areola with burning. itching – sensation of pulling in the nipple area. § Excision Biopsy §

Fat Necrosis § Benign un common ( trauma ) § Hard mass – irregular – skin retraction

Multiple calcification in mamo § No increase carcinoma § Differential diagnosis to carcinoma

Nipple discharge § 10 -15% Benign 2. 5 - 3 % malignant (milky – green – bloody – serous cloudy – purulent ) bilateral unilateral

Breast cancer + neutral History

Pathology § Ductal carcinoma § Paget Disease § Lobular carcinoma insitu Invasive dactal carcinoma § Infiltrating lobular carcinome § Inflammatory carcinoma § § Metastases from Extramammoy trauma

Treatment § Mastectomy § Breast conservation therapy § Chemotherapy

- High dose chemotherapy - Neoadjuant chemotherapy - Radiation –therapy

§ Stage – directed therapy § Breast reconstruction

Special Issur § Hereditary B-Ca § Chemo Prevention