Transcript Update on the Management of Breast Disease: Cancer, Yes or

The Symptoms of Breast Disease
A practical approach to assessment and management
Jill Donnelly
Consultant Breast Surgeon
Hereford County Hospital
England
Principles:
1.
Breast cancer yes or no?
2.
Are the other symptoms due to disease?
3.
What works for my patients may not
work for yours.
UK Breast Cancer Statistics:
1 in 8 lifetime risk
44,000 women / year
12% increase in last 10 years
80% 10 year survival
55% in 1990
Hereford County Hospital Statistics
2008: 214 cases breast cancer
1500 patients referred with breast symptoms
Therefore, 15 % of women seen will have cancer
Symptoms of breast disease:
Lump
Pain
Nipple discharge / inversion / rash
Change in breast shape
Axillary lump
NB 30% of breast cancers are diagnosed at screening
ie are asymptomatic
Lump and / or Pain:
(90% of patients)
Is there a true lump?
If the patient says there is a lump, she is right 50% of times
If the patient has pain & denies a lump, she is right 95% of times
Examination and usound symptomatic quadrant
If a discrete lesion, usound-guided core biopsy
Management pathway:
Lump & / or pain
(90% cases)
Examination
Ultrasound symptomatic quadrant
Discrete
Cyst
No abnormality
Solid
Discharge
(role for MMG ?)
Aspirate
MMG
Discharge
MMG
Core biopsy (+/- cytology )
Benign
See 3 /12, Discharge
Malignant
Common breast lumps:
Age
Fibrodenoma
20s
Benign breast change
30s
Cyst
40s
Cancer
50s +
Others – fat necrosis, lymph node, lipoma, abscess
Can get any of the above at any age.
Management pathway:
Nipple symptoms
If associated lump, lump pathway
Inversion: MMG. If normal: discharge
Usually due to duct ectasia
Discharge: if clear or bloodstained: MMG and cytology
if cytology suggests papilloma: surgery
usually benign due to duct ectasia
Rash: punch biopsy
usually eczema
occasionally Paget’s
Management pathway:
Change in shape
If palpable lump: lump pathway
If no lump: MMG and discharge
Usually benign.
NB lobular cancer
Axillary lump
If palpable breast lump: lump pathway
If no breast lump: MMG and core biopsy lump
Differential diagnosis: lymph node (reactive, malignant)
axillary breast tissue
All cancers and equivocal cases are discussed at weekly
Multidisciplinary Meeting
My approach to breast pain
History and clinical examination
If localised to one quadrant: ultrasound
(MMG ? – no role)
Discuss with patient – this is not
cancer
this is not a disease
Properly supporting bra
Simple analgesia
No other treatment
This works for my patents, will it for yours?
Thank you for your attention