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45-year old lady-mass in right breast, [2. Red flags: A new breast lump…
45-year old lady-mass in right breast
History Questions:
When did you first notice the lump?
Has it changed in size over time? (progressive, static, regressed)
Is the lump painful or tender?
Do you feel the lump is mobile or fixed?
Any changes in the nipple?Retraction/inversion?
Discharge? If yes: Color (bloody, serous, purulent)?
Is it unilateral or bilateral?
Spontaneous or only with pressure?
Any associated breast swelling or enlargement?
Do you have any axillary or supraclavicular swelling?
Any recent trauma to the breast?
Pregnancy, use of OCP
Alcohol consumption/smoking
Family history of breast cancer
Diet
Risk factors for breast CA can be characterized as well-established, probable and possible risk factors.
WELL-ESTABLISHED RISK FACTORS INCLUDE:
• Age > 50 years
• History of breast cancer
• History of breast cancer in a first-degree relative
• Hormone therapy
• Nulliparity
• First childbirth after age 30
• BMI > 30
PROBABLE RISK FACTORS INCLUDE:
• Alcohol intake
• Hormonal contraception therapy
• Increased mammographic density of breast tissue
• Menarche before age 12
• Menopause after age 45
• Elevated endogenous estrogen levels
POSSIBLE RISK FACTORS INCLUDE:
• Diet high in fat
• Diet low in beta carotene, folate, vitamin A & C
Initial investigations include
:star:
Bilateral mammogram
Breast ultrasound (especially in women <35 or with dense breasts)
FNAC or Core Needle Biopsy of the mass
Ultrasound of axilla (for lymph nodes)
Further investigations/If cancer suspected
:star:
MRI breast (in select cases)
Staging investigations
: :pen:
Chest X-ray or CT chest
Abdominal ultrasound or CT abdomen/pelvis
Bone scan or PET-CT (if metastasis suspected)
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2. Red flags:
A new breast lump or lump in axilla with
• bloody discharge
• Nipple distortion, erythema, edema
• Unilateral, non-tender, hard mass with irregular margins
• Distortion of normal breast architecture and surrounding skin changes
• Mass larger than 5cm
• Rapidly enlarging mass
• Constitutional symptoms like fever, weight loss, anorexia, anemia