Benign Breast Disease - Amazon Web Services：乳腺良性疾病的亚马逊网络服务.ppt

Nipple Discharge Spontaneous Unilateral, single orifice Clear or blood-tinged Progresses over time DDX: Duct ectasia, intraductal papilloma, DICS 10% malignant Elicited, intermittent Multiple ducts, bilateral Green, murky, white May stop if abstain from manipulation Biopsy if abnormal imaging or progressive Same DDX Evaluation of Nipple Discharge History Prolactin, TSH if suspect galactorrhea Mammogram, ultrasound Ductogram optional Surgical consultation, Mammary duct excision is diagnostic and stops discharge Vacuum assisted core needle biopsy may also stop the discharge Sonogram of breast abscess Non-lactational breast abscess: The median age at presentation was 40yr (range 22-71). Among cases, 17 of 19 (89%) were smokers with a mean exposure of 24.4 pk-yr each. In the control group, 9 of 42 (21%) were smokers with a mean exposure of 17.7 pk-yr each (p=0.001, chi-square test of independence). Ten of the 19 required surgical drainage and one of these revealed carcinoma associated with the abscess, necessitating mastectomy. Conclusions: Smoking and Breast Abscesses Subareolar abscess is strongly associated with cigarette smoking, with the average patient presenting at age 40 after smoking more than 20 years. Aspiration and antibiotics, the preferred treatment for lactational abscess, had less than a 50% success rate in this population. Carcinoma must be ruled out in both surgically and conservatively managed patients. Smokers who present with subareolar abscess should be urged to quit for this and other health reasons Hormone Replacement Therapy and Breast Cancer Risk Years of HormoneTreatment 20 yr cumulative breast cancer rate /1000 women None 5 20 45 10 47 51 57 Cancer Prevention Quit smoking: More women die of lung cancer than breast cancer Maintain a healthy balance of exercise, recreation, rest, and weight control Chemoprevention: for women at increased risk (family history, abnormal biopsy) * This is a typical spiculated density representing ca