Chapter 20 - Breasts

What are some things to ask during subjective data collection?

• lumps/swelling?

• skin changes?

• size/firmness changes?

• pain?

• nipple discharge?

• health and family hx?

• lifestyle + meds?

• screenings/self-awareness?

Are lumps in the breast always abnormal?

No, they can be present in benign breast conditions (fibrocystic breast disease, fibroadenomas)

Dimpling/retracting of the breasts/nipples may indicate _____

possible cancer

One-sided increase in size/firmness may indicate ___

inflammation, pregnancy, or abnormal growth

If a pt complains of lumps/swelling in breast, what should you always ask?

If the lump changes during the menstrual cycle; this is often related

Describe abnormal nipple discharge

spontaneous, unilateral, bloody

What factors in a persons health hx increase risk of breast cancer?

• prior breast dx/surgery/trauma

• early period (before age of 12)

• late menopause (after 52)

• first child after 30

What is the best time to do a breast exam?

1 exam after menstruation

What are some lifestyle habits that increase the risk of breast cancer?

• high fat diet

• alcohol consumption (>2 a day)

• smoking

• caffeine intake (worsens fibrocystic symptoms)

What is galactorrhea

a condition where the breasts leak milk when a person is not pregnant or nursing a baby

What are meds/treatments that cause breast changes or galactorrhea?

• hormones

• oral contraceptive pill

• antipsychotics

• opioids

• radiation/chemical exposure (increase risk of cancer)

What are important screening measures?

• self-exam

• mammogram baseline and annually after 40

In what position should the breasts be palpated?

Lying supine w/ back shoulder blade slightly elevated and arm overhead

How do you palpate the breasts?

Use pads of your 3 fingers. Go from light to med to deep palpation in each location

What is an important area to palpate? Why?

The Axillary Tail of Spence because most breast cancers develop there. This region has the highest volume of glandular and ductal tissue

What are the common palpation patterns?

Vertical strip, spokes on a wheel, concentric circles

And of course - include tail of spence!!!!

What findings in the lymph nodes in axillae likely indicate cancer?

Not painful, irregular borders

What are major risk factors for breast cancer?

• alcohol use

• BRCA1/BRCA2 gene

• strong family hx

• obesity or low bmi

• no pregnancy or first child after 30

• early period/late menopause

List abnormal breast findings that suggest malignancy

• Peau d’orange

• Dimpling

• Nipple inversion

• Nipple discharge (seen in carcinoma, paget’s disease)

• Retracted breast tissue

What are other abnormal breast findings that don’t indicate malignancy?

Lactation disorders (plugged duct, abscess, mastitis)

Male breasts (gynecomastia)

What’s the difference b/w a radical mastectomy and modified radical mastectomy?

Radical mastectomy - removes the entire breast, underarm lymph nodes, and chest muscles

Modified radical mastectomy - removes the breast and underarm lymph nodes but leaves the chest muscles intact

What is fibrocystic breast disease?

Benign breast disease marked by round, elastic, defined, tender, and mobile cysts

Fibrocystic breasts are normal two weeks prior to period, then lumps decrease in size during period and a week after

At what age is fibrocystic breast disease most common?

From age 30 to menopause, then it decreases

Describe cancerous tumors

Irregular, firm, hard, not defined masses that can be fixed or mobile

At what age do cancerous tumors typically occur?

After age 50

What are fibroadenomas?

Lobular, ovoid, or round lesions

Firm and well-defined, rarely tender, singular and mobile

At what age are fibroadenomas common?

B/w puberty and menopause

How often do you perform breast self exam?

Monthly, one week after period

Describe Paget’s disease

Form of cancer that affects the nipple and surrounding areola. Looks like a red, scaly, crusty skin rash