Breast Problems

Surgery

Assumptions

Student understands benign changes within the breast and their relevance to breast cancer surveillance. Student understands the topographic and structural anatomy of the breast. Student understands the hormonal changes that effect the breast.

Knowledge Objectives

Through their reading and patient care experiences, at the end of the rotation students should be able to:

Develop a differential diagnosis for a 20-year-old patient with breast mass and a 45- year-old patient with breast mass. Consider benign vs. malignant, vs. abscess.
Describe the diagnostic work-up and sequence:
Discuss importance of the patient's history: estimated duration of illness, nipple discharge, breast cancer risk factor assessment.
Discuss physical findings to look for.
Discuss in-office procedures for evaluation and treatment (FNAC, needle aspiration, incision & drainage, core needle biopsy) and their diagnostic/therapeutic implications.
Discuss the importance of such breast imaging studies as ultrasound and mammography.
Discuss the diagnosis and management of the patient with an abnormal mammogram (consider microcalcifications)
Discuss the rationale for management with specific emphasis on:
Clinical staging of breast CA
The various possible malignant, pre-malignant, and benign pathology results (including hormonal receptor analysis, tumor DNA analysis)
The follow-up for a patient with a benign lesion (alterations in lifestyle, imaging studies, cancer risk)
The role of incision and drainage and antibiotics in breast abscess treatment.
Current recommendations for screening mammography.
Therapeutic options for the patient with breast CA
role of surgery/when to consult a surgeon for further diagnosis & treatment
role of radiotherapy
role of chemotherapy (adjuvant or neoadjuvant)
role of hormonal therapy
surgical options including reconstruction
Stress current recommendations for screening mammography.
Stress importance of self-exam.
Discuss hormone replacement therapy.
Discuss role of genetic screening.