what does lactational mastitis pre-dispose a woman to
candida infection of the nipple
what is puerperal [lactational] mastitis
a condition characterized by the inflammation of the breast tissue, typically presenting in lactating, postpartum women.
how is lactational mastitis managed
- analgesia + warm compresses.
- Abx - broad spec given if:
- infected nipple fissure,
- no improvement of sx after 12-24 hrs of milk removal OR
- +ve milk culture
- continue pumping of breastfeeding.
- surgical drainage if an abscess forms
how is candida of the nipple managed
anti fungal on the nipple + oral treatment for baby e.g. nystatin
what does HER2 stand for
Human Epidermal growth factor Receptor 2
what drugs could you use in oestrogen +ve breast cancer
- class name and who gets what
- MoA
- SEs
- aromatase inhibitors in post menopausal women - letrozole or anastrazole
- Inhibits the enzyme aromatase found in fat tissue, preventing conversion of androgens to oestrogen. This is the main source of oestrogen in post-meno pts
- Risk of osteoporosis and vaginal dryness.
- selective oestrogen receptor modulator - tamoxifen in premenopausal women
- Selective oestrogen receptor modulator(SERM). It blocks oestrogen receptors in the breast tissue and stimulates those in the uterus and bones
what is triple negative breast cancer
Triple-negative breast cancer is a subtype of breast cancer that is negative for oestrogen receptor, progesterone receptor, and HER2 expression
how is triple negative BC treated
- neoadjuvant chemotherapy
- surgery: e.g. lumpectomy, mastectomy axillary node clearance
- adjuvant therapy: radiotherapy, chemo or both
tamoxifen MoA
It blocks oestrogen receptors in the breast tissue and stimulates those in the uterus and bones
∴ prevents osteoporosis BUT ↑ risk of endometrial cancer.
should you refer a pt with a fibroadenoma
YES
<30yo: routine referral
>30yo: urgent referral
definitive Mx for a breast abscess
- incision and drainage - especially if >3cm and systemic sx.
- Abx
MC BC
invasive ductal carcinoma
followed by invasive lobular carcinoma
key feature of fibroadenoma
cyclical in nature as they are rich in oestrogen receptors therefore they grow and shrink throughout the menstrual cycle and shrink after menopause
key differential for fibroadenoma
phyllodes tumour
- rare stromal tumour
- Large and fast growing
- May ulcerate when advanced
- can be benign, borderline or malignant
- Mx = WLE ± chemo for malignant cases
key features of pagets disease of the nipple
- eczema like rash on nipple
- Bloody nipple discharge
- Burning sensation, increased sensitivity, or pain in the nipple
- Changes to the nipple, such as retraction or inversion
- ± palpable breast lump or ulceration.
when would you not refer for a triple assessment
- a breast cyst
- a USS or mammogram can be used to visualise the cyst
- the cyst can then be aspirated and the fluid sent for cytology to rule out malignancy.
- this also serves as Mx
Also an abscess
lymphoedema is characterised by…
Lymphoedema, characterized by swelling, joint stiffness, arm weakness, and skin changes
seroma =
A seroma is an accumulation of fluid under the skin at the site of a surgical incision.
what is fibrocystic breast disease
- a common benign condition that affects women predominantly between the ages of 20 to 50.
- It is characterised by bilateral “lumpy” breasts, breast pain and cyclical symptoms that typically peak in the week before menstruation.
- caused by cumulative effects of hormones –> breast tissue changes and cyst formation.
who gets a mammogram and who gets a USS and why
- USS in pts <40 yrs as they have denser breasts that mammograms can’t image well
- Mammogram in pts >40 as their breasts are less dense.
RFs for BC
- alcohol
- ↑ oestrogen exposure (obesity, early menarche and later menopause)
- female
- BRCA gene mutation [Fam hx 1st degree relative]
- Late pregnancy/nulliparity
- smoking
protective factors for BC
multiparity + breast feeding
Big RF for mastitis and why
Smoking as substances within tobacco smoke can cause damage to the breast tissue.
how does breast carcinoma show up on mammogram
- opaque, high-density mass on a mammogram
- soft tissue opacitiy with or without associated calcification
