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The Symptoms of Breast Disease A practical approach to assessment and management Jill Donnelly Consultant Breast Surgeon Hereford County Hospital England Principles: 1. Breast cancer yes or no? 2. Are the other symptoms due to disease? 3. What works for my patients may not work for yours. UK Breast Cancer Statistics: 1 in 8 lifetime risk 44,000 women / year 12% increase in last 10 years 80% 10 year survival 55% in 1990 Hereford County Hospital Statistics 2008: 214 cases breast cancer 1500 patients referred with breast symptoms Therefore, 15 % of women seen will have cancer Symptoms of breast disease: Lump Pain Nipple discharge / inversion / rash Change in breast shape Axillary lump NB 30% of breast cancers are diagnosed at screening ie are asymptomatic Lump and / or Pain: (90% of patients) Is there a true lump? If the patient says there is a lump, she is right 50% of times If the patient has pain & denies a lump, she is right 95% of times Examination and usound symptomatic quadrant If a discrete lesion, usound-guided core biopsy Management pathway: Lump & / or pain (90% cases) Examination Ultrasound symptomatic quadrant Discrete Cyst No abnormality Solid Discharge (role for MMG ?) Aspirate MMG Discharge MMG Core biopsy (+/- cytology ) Benign See 3 /12, Discharge Malignant Common breast lumps: Age Fibrodenoma 20s Benign breast change 30s Cyst 40s Cancer 50s + Others – fat necrosis, lymph node, lipoma, abscess Can get any of the above at any age. Management pathway: Nipple symptoms If associated lump, lump pathway Inversion: MMG. If normal: discharge Usually due to duct ectasia Discharge: if clear or bloodstained: MMG and cytology if cytology suggests papilloma: surgery usually benign due to duct ectasia Rash: punch biopsy usually eczema occasionally Paget’s Management pathway: Change in shape If palpable lump: lump pathway If no lump: MMG and discharge Usually benign. NB lobular cancer Axillary lump If palpable breast lump: lump pathway If no breast lump: MMG and core biopsy lump Differential diagnosis: lymph node (reactive, malignant) axillary breast tissue All cancers and equivocal cases are discussed at weekly Multidisciplinary Meeting My approach to breast pain History and clinical examination If localised to one quadrant: ultrasound (MMG ? – no role) Discuss with patient – this is not cancer this is not a disease Properly supporting bra Simple analgesia No other treatment This works for my patents, will it for yours? Thank you for your attention