Medical brain notes 42

  ANATOMY   The adult female breast is actually a modified sebaceous gland, located within the superficial fascia of the chest wall (Fig. 31.1). Histologically, the breast is composed primar-ily of lobules or glands, milk ducts, connective tissue, and fat. The relative amounts of these tissue types vary con-siderably with age. In younger women, the breast con-sists predominantly of glandular tissue. With age, the glands involute and are replaced by fat, a process accel-erated by menopause. Differences in palpable consis-tency and in radiographic density between the glands and fat are key components of breast cancer detection programs.   Architecturally, the breast is organized into 12 to 20 lobes, with a disproportionate amount of the glandular or lobular tissue in the upper outer quadrants of each breast. This disproportionate distribution of glandular tis-sue accounts for why breast cancer most commonly arises in the upper outer quadrant. The lobules consist of clusters...

  EVALUATION OF BREAST SIGNS AND SYMPTOMS   A timely evaluation of the patient who presents with a breast complaint is important if for no other reason than to relieve patient anxiety. A systematic approach to evalu-ating a breast-related complaint will efficiently yield the proper diagnosis.     The two most common presenting complaints related to the breast are pain and concern about a mass.  Gynecologistsshould be aware of the different etiologies of breast pain and be able to offer reassurance, follow-up, and potential treatment. One study has found that breast cancer was diagnosed in 6% of patients with breast complaints (most commonly a mass). Therefore, it is important that breast signs and symptoms be properly evaluated. Patient History   The patient interview is considered the single most impor-tant step in the initial evaluation of any disease process. In the case of complaints related to the breast, questions that will aid in deciding the next st...

  BENIGN BREAST DISEASE   Benign breast disease  includes a large number of condi-tions that can significantly affect a woman’s quality of life. With accurate diagnosis, many benign breast conditions can be effectively treated with medications or other mea-sures. Women presenting with a breast mass should also be evaluated for their risk of breast cancer.   Mastalgia   Mastalgia,  or breast pain, can be divided into three categories:cyclic, noncyclic, and extramammary (nonbreast) pain.  Cyclicmastalgia  begins with the luteal phase of the menstrualcycle and resolves after the onset of menses. The pain is generally bilateral and often involves the upper outer quadrants of the breast.  Noncyclic mastalgia  is not associated with the menstrual cycle and includes such eti-ologies as tumors, mastitis, cysts, and a history of breast surgery. In some women, noncyclic mastalgia is idiopathic and no cause is found. Noncyclic pain has also been as...

  BREAST CANCER   Breast cancer is the second most common malignancy in women, ranking only behind skin cancer.  In addition, it is the secondleading cause of cancer-related death in women. According to the National Cancer Institute, there were 178,500 new cases and approximately 40,500 deaths related to breast cancer in 2007. The steady increase in the incidence of breast cancer can be attributed to the increased use of mammography screening, which has enabled the detection of smaller invasive lesions and the earlier diagnosis of in-situ lesions. Advances in treatment have also helped maintain the downward trend in overall breast cancer mortality.   Nevertheless, breast cancer is a serious health con-cern in the United States. It is estimated that the United States spends approximately $8.1 billion annually on treat-ing breast cancer. The lifetime risk of developing breast cancer in the United States is approximately 12.5% (1 in 8), while the lifetime risk of dying ...