Sandbox:Shadan: Difference between revisions
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Revision as of 16:29, 7 December 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Overview
Classification
Classification of breast lumps based on epithelial hyperplasia[1]
- Approximately 65% of all benign breast disease considered as nonproliferative(NP)with relative cancer risk of 1.2, 1.4 times:
- Simple cyst
- Fibrosis
- Fibroadenoma (simple)
- Columnar alteration (Simple)
- Apocrine metaplasia (simple)
- Mild ductal hyperplasia
- Approximately 30% of total are classifed as proliferative disease(PD) with relative cancer risk of 1.7, 2.1 times
- Usual ductal hyperplasia
- Sclerosing adenosis
- Columnar hyperplasia
- papilloma
- Radical scar
- Approximately 5% to 8% of the rest regarded to PD with atypia with relative cancer risk more than 4 times
- Atypical lobar hyperplasia
- Lobular carcinoma in situ
- Atypical ductal hyperplasia
- Unclear risk
- Mucocele like tumor
- Apocrine atypia
- Secretory atypia
Classification of benign breast lesion regarding to histological region:[2]
- Terminal and lobular ducts
- Acinar distention
- Cyst
- Intralobular connective tissue proliferation
- Sclerosing adenosis
- Fibroadenoma
- Phyllodes tumor
- Hamartoma
- Epithelial changes in terminal duct lobaular units (TDLU)
- Apocrine metaplasia
- Ductal and lobular hyperplasia, usual and typical
- Papillomatosis
- Intracystic papilloma
- Acinar distention
- Ductal system
- Ductal ectasia
- Intraductal papilloma
- Lesion of different origin
- Fatty tissue lesion
- Lipoma
- Liponecrosis
- Fibrous tissue lesions
- Focal fibrosis
- Diabetic mastopathy
- Pseudoangiomatous stromal hyperplasia (PASH)
- Myofibroblastoma
- Vascular origin
- Hemangioma
- Inflammatory origin
- Mastitis/abscess
- Tuberclosis and sarcoidosis
- Foreign body granuloma and siliconoma
- Lymph node origin
- Inflammatory lymoh nodes
- Fatty tissue lesion
Risk factors
Associated risk factors leading to female breast cancer[3]
- Age: probability of breast cancer from birth to 39 years; 1 in 202, from 40 to 59 years; 1 in 26, from 60 to 69 years; 1 in 28.
- Personal history of breast cancer
- Breast pathology: PD with atypia has greater risk of developing to breast cancer in comparison of PD.
- Family history: greater breast cancer risk in women with first degree relatives with breast cancer under 50 years old.
- Genetic predisposition
- High risk
- BRCA1
- BRCA2
- Moderate risk
- Homozygous ataxia-telangiectasia (ATM)
- Somatic mutation in CHEK2
- BRCA1 modifier gene: BRIP1
- BRCA2 modifier gene: PALB2
- Low risk
- These alleles have not designated yet.
- High risk
Endogenous hormone exposure and reproductive factors:
- Early menarche;under age of 13 years
- Parity; nulliparous is associated with incresed risk of breast cancer
- Age at first full term pregnancy; younger age may decrease risk of breast cancer
- Breast feeding; decreased risk of breast cancer
- Testostrone; increased relative risk to 2.86-3.28
- Age at menopause;older menopausal age associated with greater risk of breast cancer
Exogenous hormone exposure
- long term exposure> 5 years; increases chances of breast cancer
- Time of usage;nearly menopausal age associated with development to breast cancer
Lifestyle These factors may increase risk of developing breast cancers
- Alcohol consumption; even as 5.0 to 9.9 per day, approximately 3 to 6 drinks per week, developed with relative risk 1.15
- Inactivity
- Obesity; BMI:25-29.9 and BMI>30 have relative risk about 1.28
- Previous history of radiation;at the age< 35years old
Screening
The Screening methods of breast lesions[3]:
- Breast examination
- Self breast examination
- Although this is controversial, most clinicians recommend women to perform self examination monthly
- Clinical breast examination
- Women with age> 40 years is recommended for clinical breast examination annually
- Self breast examination
- Ultrasound
- whole breast ultrasound detects lesions in dense breast tissue which could not be diagnosed by mammography [4]
- Mammography
- Gold standard of screening
- Early detection of non-palpabale masses
- Regarding to 2013 NCCN guidelines annual screening in average risk women aged≥ 40 years
- Regarding to 2013 NCCN guidelines annual screening in high risk women from age of 25 years
- Sensitivity of 0.33-0.39 and specificity of 0.95
- Magnetic resonance imaging (MRI)
- Significant method for detection, assessment and management of breast cancer
- Sensitivity of 0.77-0.79 and specificity of 0.86-0.89
- Based on 2013 NCCN guidelines annual MRI for individuals with > 20% risk of developing breast cancer in lifetime starting at age of 25 years
- Beneficial modality in high risk individuals
- Valuable in individuals with equivocal results from other screening tests
- Usable for individuals with ineffective mammography results due to breast augmentation
History and symptoms
History
By clinical history, the cancer risk can be evaluated [3]
- Age at menarche
- Menopausal status
- number of pregnancies
- Previous history of radiation
- History of oral contraceptives or hormone replacement therapy
- Past history of breast cancer and age at time of diagnosis
- Familial history of breast cancer or ovarian cancer in first-degree relatives
- Other associated breast disease or possible biopsies
Symptoms
- Breast Pain
- Cyclic pain
- Occurring at the late luteal phase of menstural cycle, relieving at the onset of menstural phase
- Non- cyclic pain
- Fat necrosis from trauma
- stretching cooper's ligament
- Mastitis( focal or periductal)
- Cyst
- Mondors's disease
- Hidradenitis supporativa
- Non-breast pain
- Chest-wall pain
- Non chest-wall pain
- Cyclic pain
- Nipple discharge
- Presence of galactorrhea
- Hyperprolactinemia from pituitary tumor
- Hyperthyroidism
- Drugs
- Absence of galactorrhea
- Fron one duct
- Intraductal papilloma
- Ductal carcinoma in situ
- Paget's disease
- From multiple ducts
- Fron one duct
- Presence of galactorrhea
- Malaise
- Body pain
- Weight loss
References
- ↑ Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K; et al. (2005). "Benign breast disease and the risk of breast cancer". N Engl J Med. 353 (3): 229–37. doi:10.1056/NEJMoa044383. PMID 16034008.
- ↑ Lanyi, M (2003). Mammography : diagnosis and pathological analysis. Berlin New York: Springer-Verlag. ISBN 9783540441137.
- ↑ 3.0 3.1 3.2 Shah R, Rosso K, Nathanson SD (2014). "Pathogenesis, prevention, diagnosis and treatment of breast cancer". World J Clin Oncol. 5 (3): 283–98. doi:10.5306/wjco.v5.i3.283. PMC 4127601. PMID 25114845.
- ↑ Kelly KM, Dean J, Comulada WS, Lee SJ (2010). "Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts". Eur Radiol. 20 (3): 734–42. doi:10.1007/s00330-009-1588-y. PMC 2822222. PMID 19727744.