What is the Lifetime Risk of breast cancer in a Male?
1 in 1,000
Gynecomastia & when it can occur?
Nub of breast tissue under areola (of males) – feels like a large grape
May normally have enlargement in adolescence (usually unilateral & temporary) - excess testosterone is converted to estrogen
May occur in the aging male (unilateral or bilateral); Occurs when testosterone levels drop and estrogen becomes unopposed; May also be due to medication effects (e.g., Cimetadine) or a pituitary tumor
What is an initial symptom of breast cancer?
Pain that can be Localized or Generalized
What are the characteristics of Breast Pain?
Burning, pulling, vague discomfort
What are the common causes of Cyclic Breast Pain?
OCs (oral contraceptive) & fibrocystic changes
What are associated factors to Breast Pain?
underwire bras & exercise
Fibrocystic (non cancerous) lumps
May enlarge and become more tender prior to the menstrural period
Caffeine intake may increase size and tenderness of cystic lumps
Associated skin changes (Lumps)
Needs evaluation, e.g., prolactin levels
Clear discharge (Nipple)
May be due to meds:
Tricyclic antidepressants [amitriptyline]
Or a pituitary tumor
Milk discharge associated with a pituitary tumor
Bloody discharge or thick yellow with blood (Nipple)
(always significant, especially when associated with a lump) – may indicate ductal cancer
(advanced ductal CA) - starts as a small crust on the nipple with surrounding erythema
Clinical Breast Exam
Breast Self Exam (BSE)
Yearly starting at age 40 (ASC)
Biennial (every 2-years) between ages 50 – 74 (USPSTF)
Clinical Breast Exam
20 – 30 years old - Q 3 years
≥ 40 years old - Yearly
Breast Cancer (Stats)
2nd major cause of cancer death in women; lung CA #1
1 in 8 women will develop breast CA before age 45 (incidence increases with age)
Incidence increases with age (80% of breast CA after age 40)
Need to identify early & treat early for good results
How many more times will a female get breast cancer compared to a male?
Age as a Risk Factor (breast cancer)
1 in 8 before age 45 & progressively increases with age
If cancer in one breast, how many times is chance in other breast?
increases risk 3-4 x
1st degree relative
Family Hx of breast cancer before age 50
What % of breast cancer pts have a Family Hx?
20 - 30%
How many % of females do not have Family Hx of breast cancer?
Gene mutations for breast cancer (men & women)?
BRACA 1 or BRACA 2
Are breast symmetric or asymmetric?
Asymmetric - left breast larger than rt
Peau d' orange (orange peel skin)
Caused by blocked lymph ducts
Common with CA
Edema may exaggerate hair follicles causing bumpy texture & large pores appearing like an orange peel
High into axilla
Down chest wall
Supraclavicular and infraclavicular areas (metastatic nodes)
Suspect malignancy if a recent change & unilateral
2 nipples along the mammary ridge at MCL
Occurs in 1% of men and women
Appear like a nevus
Observe breasts with hands at sides
Lift arms overhead
Push hands on hips
Push palms together
Lean forward (to see underside of large
What are you looking for when performing the Retraction Maneuvers?
Observe changes in contour, symmetry, retraction, & dimpling associated with CA