From the Guidelines
Breast disease can be broken down into benign and malignant conditions, with malignant conditions focusing primarily on breast cancer, which requires a comprehensive approach including triple assessment, staging, and treatment options such as surgery, radiation, chemotherapy, and hormonal therapy based on receptor status, as outlined in the most recent guidelines 1.
Benign Conditions
Benign conditions of the breast include:
- Fibroadenomas, which present as firm, mobile masses in young women and are managed with observation or excision if symptomatic
- Fibrocystic changes, which cause cyclic breast pain and nodularity, treated with NSAIDs, evening primrose oil, or danazol 100-200mg daily for severe cases
- Mastitis, which requires antibiotics like dicloxacillin 500mg four times daily for 10-14 days, with abscess drainage if present
- Gynecomastia, which may resolve spontaneously or require tamoxifen 10-20mg daily for persistent cases
Malignant Conditions
Malignant conditions of the breast focus primarily on breast cancer, which:
- Requires triple assessment: clinical examination, imaging (mammogram/ultrasound), and tissue sampling (core needle biopsy)
- Is staged using the TNM system
- Has treatment options including surgery (breast-conserving therapy or mastectomy with sentinel lymph node biopsy or axillary dissection), radiation, chemotherapy, and hormonal therapy based on receptor status, as recommended by the NCCN Clinical Practice Guidelines in Oncology 1
- Includes special considerations for inflammatory breast cancer, which presents with skin changes and requires neoadjuvant chemotherapy before surgery, and Paget's disease, which manifests as nipple eczema with underlying DCIS or invasive cancer
- May benefit from risk-reducing strategies, including genetic testing for BRCA mutations, with prophylactic mastectomy reducing risk by 90% in high-risk patients, as supported by the latest guidelines 1
From the Research
Breast Disease Overview
- Breast disease encompasses a range of conditions, including benign and malignant lesions
- Benign lesions, such as fibroadenomas, are common and typically affect young women 2
- Malignant lesions, such as breast cancer, require timely and effective treatment
Benign Breast Disease
- Fibroadenomas are the most common type of benign breast tumor 2
- They typically present as palpable breast lumps, often with no associated nipple discharge
- Diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation
- Tamoxifen treatment has been shown to reduce the risk of benign breast disease, including fibroadenomas, by 28% 3
Breast Cancer Treatment
- Aromatase inhibitors are a standard treatment for postmenopausal women with estrogen receptor-positive breast cancer 4
- These inhibitors work by blocking the conversion of androgens into estrogens, resulting in low estradiol levels
- Common side effects of aromatase inhibitors include vasomotor symptoms, vaginal dryness, and bone loss
General Surgery Oral Boards
- Oral board exams are a standard method of evaluation for medical certification 5
- They provide a comprehensive understanding of a student's fund of knowledge and help prepare them for future board certifications
- Virtual oral exams have been shown to be effective, with high satisfaction rates and no difference in passing rates compared to in-person exams 6