breast disorders

• Fibroadenomas


  • Benign solid tumor
  • Well-defined mobile mass
  • Rubbery/ropelike
• Etiology of fibroadenomas


  If you have one, increased risk for more; increases in size with pregnancy/exogenous estrogen use
• Diagnostic methods for fibroadenomas

  • US (under 30yo)
  • Mammogram/US (over 30yo)
  • Biopsy not needed if under 2.5cm and clearly a fibroadenoma on imaging
• Mammogram findings for fibroadenomas

  • Circumscribed oval or round mass
  • Occasional coarse calcifications
  • Popcorn calcifications
• Ultrasound findings for fibroadenomas

  • Well circumcised
  • Homogenous
  • Hypoechoic
  • Round to ovoid mass that might have a capsule
• Fibrocystic breast disease


  • Painful/painless solitary palpable mass
  • Round/smooth
  • Painful if rapid increase in size
• Pathophysiology of fibrocystic breast disease

  Hormonal
• Types of fibrocystic breast disease

  • Simple
  • Complicated
  • Complex
• Simple fibrocystic breast disease


  • Well-circumscribed
  • Fluid filled
  • No vascular flow on imaging
• Complicated fibrocystic breast disease

  • Debris causes internal echoes on US
  • No solid components/septae
• Complex fibrocystic breast disease


  • Cystic/solid components
  • Thick walls/septa present
  • Malignant potential
• Mastitis


  Bacterial infection (staph aureus)
• Mastitis symptoms


  • Pain
  • Redness
  • Swelling
• Treatment for mastitis


  Antibiotics (cephalexin, dicloxacillin)
• Breast abscess risk


  Mastitis staph aureus with increased incidence of MRSA
• Treatment for breast abscess

  1. Antibiotics/drainage with US guided aspiration

  2. Maybe surgical
• Galactorrhea


  Increased prolactin/non-pathological discharge unrelated to pregnancy/breastfeeding
• Galactorrhea discharge


  • Typically milky white
• Causes of galactorrhea


  • Increased prolactin
  • Inhibition of dopamine
  • Antipsychotics
  • SSRIs
  • Opiates
  • H2 receptor antagonists
  • Antiemetics
  • Methyldopa
  • Pituitary adenoma
  • Hypothyroidism
  • Neurogenic stimulation
• Evaluation for galactorrhea


  1. Urine pregnancy test

  2. Prolactin test

  3. Thyroid function test
• Breast cancer etiology


  Prior chest radiation<|>Female<|>Exogenous hormone use<|>Advanced age<|>Genetic predisposition<|>Early menarche<|>Late menopause<|>Nulliparous<|>No breastfeeding<|>Obesity<|>Alcohol use<|>Sedentary lifestyle
• Decline in breast cancer incidence due to decreased HRT use and mortality due to screening/early detection
• Breast cancer management


  • AB mammogram/palpable abnormality evaluation by breast surgeon/maybe more imaging
  • BIRADs 3 monitor with serial exams or imaging
  • BIRADs 4/5 or suspicious exam without imaging correlate biopsy
• Biopsy findings


  • Atypia
  • LCIS abnormal but higher risk for future breast cancer
  • DCIS malignant cells have not crossed BM (won’t metastasize so is stage zero cancer)
  • Invasive cancer scored TNM and ER/PR status, HER2 status, tumor grade
• Mammogram findings for breast cancer

  • Spiculated soft tissue mass
  • Architectural distortion
  • Clustered microcalcifications
  • Linear branching calcification
• Treatment for breast cancer

  1. Stage I-IIIC surgery, radiation, systemic therapy (chemo, endocrine therapy, immune checkpoint inhibitors)

  2. Stage IV palliative treatment and radiation to metastatic lesions, systemic therapy
• Genetic risks for breast cancer

  • BRCA1
  • BRCA2
  • PALB2
  • ATM
  • CHEK2
  • STK11
  • PTEN
  • TP53
  • BRIP1
  • CDH1
  • BARD1
• High risk for breast cancer

  Genetic mutation carriers<|>Lifetime risk over 20% based on family history<|>Prior chest radiation between 10-30yo<|>LCIS history<|>Atypia history
• Average risk for breast cancer

  Women over 40yo
• Imaging for high risk patients

  Yearly MRI and mammogram
• Imaging for average risk patients

  1. 40-70yo mammogram

  2. Over 70yo screen if life expectancy is over 10 years, stop at 74yo; do yearly
• BIRADs categories


  • 0: incomplete
  • 1: normal- normal interval follow-up recommended
  • 2: benign abnormalities- normal interval follow-up recommended
  • 3: probably benign- short interval follow-up
  • 4: suspicious abnormality- consider biopsy
  • 5: highly suggestive of malignancy- biopsy recommended
  • 6: biopsy proven cancer
• Evaluation for a patient with galactorrhea

  1. Increased prolactin/inhib dopamine

  2. Antipsychotics

  3. SSRIs

  4. Opiates

  5. H2 receptor antagonists

  6. Antiemetics

  7. Methyldopa

  8. Pituitary adenoma

  9. Hypothyroidism

  10. Neurogenic stimulation
• Treatment plan for galactorrhea

  1. Patient reassurance

  2. Treatment of underlying causes

  3. Breast surgeon referral if associated breast mass, abnormal imaging, or pathological discharge (single duct, serous/bloody)