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Assistant Professor
Dr. Hiwa Omer Ahmed
Why Evaluate Breast Masses?
Breast cancer
most common malignancy in women
lifetime risk = 1:8
2/3 of cases arise post-menopause, but
15% occur before the age of 40
Screening earlier detection BUT has
not changed mortality rate significantly
Nipple Discharge
– persistent, spontaneous. Not associated c
breastfeeding.
Localized Mastalgia
Non-invasive Malignant DDx
DCIS – a premalignant, non-invasive carcinoma
LCIS – a marker of malignancy (usually DCIS) in either or both
breasts
Paget’s Disease
Invasive Malignant DDx
Favorable (85% 5 yr survival)
• Tubular cancer (grade 1 intraductal)
• Colloid/mucinous Cancer
• Papillary Cancer
Less Favorable
• Medullary Cancer
• Invasive Lobular Cancer
• Invasive Ductal Cancer
Least Favorable (30% 5 yr survival)
• Inflammatory Breast Cancer
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Progesterone (ng/ml)
Day 14 - ovulation
Estradiol (pg/ml)
300 Ovulation 15
200 10
100 5
0 0
1 3 5 7 9 11 13 15 17 19 21 23 25 27
Day of cycle
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Hunter-
Factor gatherers Americans
Age at menarche 16.1 12.5
Age at first birth 19.5 24.0
Menarche to first birth (yrs) 3.4 11.5
Yrs of lactation per birth 2.9 0.25
Completed family size 5.9 1.8
Age at menopause 47 50.5
Total number of
ovulations 160 450
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Male 1%
Treatment of Breast Cancer
Non-surgical
• Local Radiation
– Similar to mastectomy in overall survival.
• Systemic Chemotherapy
– Eradicates occult metastasis in Stages I/II.
• Neoadjuvant Therapy
– Chemo before surgery for debulking of tumor.
• Hormonal Therapy
– Anti-estrogen (tamoxifen)
Treatment of Breast Cancer
Surgical
• Breast Conservation
• Lumpectomy
• Axillary Lymphadenectomy
• Sentinel Node Biopsy
• Post-Op Radiation
• Modified Radical Mastectomy (Patey’s)
• Halsted Radical Mastectomy
• Simple Mastectomy
Haagensen Criteria of Inoperability:
• Extensive edema of breast; Satellite nodules of CA;
Inflammatory CA; Parasternal node tumor; Supraclavicular
mets; Edema of Arm; Distant Mets
Surgical Treatments
Lumpectomy