Which organism is most common for causing breast abscesses and mastitis ?
Staph aureus
What is the cause of breast abscesses
- usually linked to mastitis which is caused by milk stasis (lactating women) or cracked nipple/infection in non lactating women
What are the risk factors for mastitis (and so breast abscess)?
- milk stasis due to poor feeding/ missed feeds
- damage to nipple
What is the presentation of a breast abscess ?
- red,hot, inflamed area of breast
- fever >38
- flu like symptoms
- painful lump
Common presentation of duct ectasia ?
- microcalcifications on mammogram
- nipple discharge often blood stained
- palpable sub areolar mass
- non cyclic breast pain
How should a breast abscess be investigated ?
- physical breast exam
- mammogram or ultrasound
- fine needle aspiration cytology
Treatment of breast abscess
- abx, most likely Flucloxacillin
- drainage, small = needle and syringe, big= incision
Which other condition presents similarly to breast abscess ?
Fibrocystic disease
What is the most common cause of breast lumps in women of reproductive age ?
Fibrocystic disease
What are the characteristics of a benign breast lump on physical examination ? (5)
- Three dimensional
- mobile
- smooth
- regular borders
- solid or cystic in consistency
What are the characteristics of a malignant breast lump on physical examination ? (4)
- firm
- irregular borders
- fixed to underlying tissue
- skin changes/nipple retraction
What are the three pathological classifications of benign breast disease and how do they affect future cancer risk ?
- Non-proliferative: no increased risk
- Proliferative disorders without atypia: mild to moderate increase in risk
- Atypical hyperplasia: substantial increase in risk
What are breast lumps in younger patients most likely to be ?
- cysts
- fibroadenoma
What is treatment of breast cysts ?
- if causing pain and are clearly palpable the should be aspirated
Who are ductal papilloma most common in ?
Women over 40
What is ductal papilloma of the breast ?
Wart like growth in the ducts, not cancerous
Presentation of ductal papilloma ?
- small lump close to nipple
- clear or bloodstained nipple discharge
- usually not painful
Treatment for ductal papilloma
Surgical removal of affected milk duct
What is the most common cancer in women (non smokers)?
Breast carcinoma
Where do most breast carcinomas arise from ?
The epithelial lining of the ducts
Major risk factors for breast cancer ?
- previous history of cancer
- increasing age
- family history
- not having children / not breastfeeding
- early menarche, late menopause
- HRT
Risk factors for breast cancer in men
- klinefelters syndrome
- gynaecomastia
- hormonal treatment of carcinoma of prostate
Presentation of breast cancer
- painless lump in breast
- lump under arm
- lump in other regional lymph nodes
- retraction or inversion of nipple
Common sites of metastases from breast cancer
- bone
- liver, lung, brain
