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Benign Breast Disease: Surveillance, Diagnosis and Treatment Helen Krontiras, M.D. Assistant Professor of Surgery Co-Director UAB Breast Health Center Co-Director Lynne Cohen Preventive Care Program for Women’s Cancers at UAB

Risk factors for breast cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Familial Breast Cancer Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BRCA 1 and 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Familial Breast Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]

General Family History Risk Factors for Carrying a BRCA1 or BCRA2 Mutation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Probability of developing breast cancer by age ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: National Cancer Institute Surveillance, Epidemiology, and End Results Program, 1995-1997

Continuum of Breast Cancer Development Normal Hyperplasia Atypical hyperplasia Ductal carcinoma in situ Invasive Ductal carcinoma RR 1.5-2.0 RR 4-5 RR 8-10

Benign breast disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Atypical Hyperplasia Lobular carcinoma in situ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gail Model ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Limitations of Gail Model ,[object Object],[object Object],[object Object],[object Object],[object Object]

Surveillance Average Risk for Breast Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mammography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],RCC LCC RMLO LMLO

Mammography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Benefits of Screening Mammography ,[object Object],[object Object]

Limitations of Screening Mammography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ultrasound ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Breast Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Self Breast Exam ,[object Object],[object Object],[object Object],[object Object]

Options for Management of Women at Moderate Risk for Breast Cancer ,[object Object],[object Object],[object Object],[object Object]

Chemoprevention Tamoxifen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fisher et al, J Natl Cancer Inst 1998

Prevents Breast Cancer & Inhibits Recurrence Increases Thromboembolic Events Increases Incidence of Uterine Cancer Preserves Bone Density Lowers Circulating Cholesterol Tamoxifen Actions Increases incidence of hot flashes Increases incidence vaginal dryness

Options for Management of Women at Increased Risk for Inherited Breast Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Breast MRI ,[object Object],[object Object],[object Object]

Rationale for MRI Screening of Populations at Increased Risk for Inherited Breast Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Palpable Mass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Palpable Masses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

Changing frequencies of discrete breast lumps with age % of total < 20 21-30 31-40 41-50 51-60 >60 10 20 30 50 40 60 70 90 80 0 Cancer Benign breast change Fibroadenoma Cyst Abscess Dixon 1995 Age

Algorithm to Evaluate Dominant Mass or Thickening

Palpable Mass ,[object Object],[object Object],[object Object],[object Object]

Palpable Mass ,[object Object],[object Object],[object Object],[object Object],[object Object],Donnegan, NEJM 1992

Abnormal Mammogram ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BIRADS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],American College of Radiology (ACR) Breast Imaging Reporting and Data System Atlas (BI-RADS® Atlas). Reston, Va: © American College of Radiology; 2003.

Abnormal Mammogram ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Nipple Discharge ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nipple Discharge ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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