Why are most patients referred for assessment?
Most patients are referred for assessment after abnormalities are detected on routine mammography screening. Alternatively, young women, who are not routinely screened, may present with a mass they have found during self-examination.
Describe the overall approach to suspected breast cancer.
Involves clinical assessment, radiographic imaging, and, if necessary, biopsy
In the case of a confirmed breast cancer diagnosis, imaging of both breasts, receptor and tumor marker testing, and staging of the mass should be performed.
Clinical assessment: Differentiating between suspicious and benign lesions.
Regarding the further management of a patient with suspicious findings of breast cancer: how should women < 30 and > 30 be managed?
Women < 30 years of age should undergo breast ultrasound; higher breast tissue density makes detection of breast abnormalities with mammography more difficult.
Women ≥ 30 years of age should undergo mammography.
What are advantages of breast ultrasound?
Allows solid lesions to be differentiated from benign cysts
Includes the evaluation of axillary, supraclavicular, and infraclavicular lymph nodes
Ultrasound findings of benings vs. malignant breast lesions (table).
Describe the furhter management of suspicious findings in ultrasound.
Fine needle aspiration or core needle biopsy
Describe mammography in general.
Two low-dose x-rays of the breast are obtained (mediolateral oblique and craniocaudal) to screen for breast abnormalities.
Used for early detection of breast abnormalities: Mammography detects the majority of cancers and can detect lesions ∼ 2 years before they are clinically evident.
Mammography findings benign vs. malignant lesions.
Can mammography be used in pregnancy?
In general, mammograms are considered safe during pregnancy because they only involve a small amount of radiation.
Radiation is focused on the breast tissue and a lead shield is placed over the belly to prevent radiation exposure.
Summary of approach.
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