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Duke PA CM - GYN
A&P, CA, Breast,
Question | Answer |
---|---|
pelvic cavity is bounded superiorly by | abdominal cavity |
pelvic cavity is inferiorly bounded by | pelvic floor |
pelvic cavity develops as these three bones | Ilium, Pubis, Ischium |
Pelvic girdle also includes | sacrum |
The False pelvis (=inferior abdomen)and true pelvis are separated by the | pelvic inlet (“linea terminalis”) |
Anterior margin of pelvic girdle | pubic symphysis |
Posterior margin of pelvic girdle | sacral promontory |
Inferior margin of pelvic girdle; Partly bony/ partly ligamentous | pelvic outlet |
Parietal peritoneum drapes over | pelvic viscera |
Sacrotuberous ligament & Sacrospinous ligament | Form greater/ lesser sciatic foramina |
Hormones released during pregnancy (e.g., relaxin) contribute to | loosening of ligaments and increase mobility of joints |
Female pelvis | Ilium more flared; Pelvic inlet circular; Wider sub-pubic angle |
Male pelvis | Ilium more upright; Heart shaped pelvic inlet; Acute sub-pubic angle |
Roots of external genitalia & the openings for urogenital system form the | Urogenital triangle |
AKA vaginal corona | Hymen |
Thickest in infants and may be redundant and protruding (although perforated); Appearance is highly variable | Hymen |
Crura attach along pubic arch | Corpora cavernosa |
Anchored to perineal membrane | Bulbs of the vestibule |
Female Erectile Tissues | Corpora cavernosa, Bulbs of the vestibule, Glans clitoris |
AKA paraurethral glands; 10 and 2 o’clock in vestibule | Skene’s glands |
AKA greater vestibular glands; 4 and 8 o’clock – prone to abscess | Bartholin’s glands |
Attached to pubic arch, Inferior to pelvic diaphragm, Attachment for external genitalia, Openings for urethra and vagina | Perineal membrane |
Connective tissue structure to whichpelvic floor muscles and perinealmembrane attach | The Perineal Body |
Often injured during childbirth | The Perineal Body |
1st degree- injury of Perineal Body | vaginal epithelium/perineal skin |
2nd degree- injury of Perineal Body | perineal body (fascia+ muscle) |
3rd degree- injury of Perineal Body | vaginal epithelium/perineal skin; perineal body (fascia+ muscle); + ext. anal sphincter |
4th degree injury of Perineal Body | vaginal epithelium/perineal skin; perineal body (fascia+ muscle); + ext. anal sphincter; + rectal mucosa |
Collectively referred to as the uterine adnexa (may also include ligaments) | Uterine tubes & Ovaries |
Fetus undifferentiated before | 6 weeks |
male ducts | Wolffian (aka mesonephric) |
female ducts | Müllerian (paramesonephric) ducts |
s | female |
Secretion of ____ causes development of male ducts, and regression of female ducts | testosterone |
Muscular and membranous tube; Anterior wall contacts bladder; Posterior wall contacts rectum; Recto-uterine pouch; Upper portion separated into fornices; Corrugated inner surface (rugae) | Vagina |
Innervation of vagina | Upper 2/3 visceral sensory, Lower 1/3 somatic sensory |
Blood Supply: Vaginal a./v. | to vagina |
Incomplete fusion of urogenital sinus (lower 1/3) and Mullerian ducts (upper 2/3s)can result in | transverse vaginal septum |
Gartner’s duct- remnant of Wolffian duct system; May give rise to | Gartner’s duct cysts |
Separated into: External os; Cervical canal; Internal os, Non-muscular, collagenous tissue | The Cervix |
Cervical glands may form these which are Mucus filled & usually disappear on their own | Nabothian cysts |
Blood Supply: Uterine a./v. | The Uterus |
3 layers of tissue: Perimetrium (aka Serosa), Myometrium, Endometrium | The Uterus |
Position is variable: Normally lays superior to bladder, with slight anteflexion (1) May be severely anteflexed, retroverted (2) or retroflexed (3) | The Uterus |
Three stages of development of uterus | 1. Appearance of ducts 2. Fusion of ducts 3. Resorption of septa |
Approximately 7 classes of anomalies of uterus | 1. Hypoplasia/ agenesis 2. Unicornuate uterus 3. Didelphys uterus 4 Bicornuate uterus 5. Septate uterus 6. Arcuate uterus 7. Diethylstilbestrol-related anomaly |
prescribed to prevent miscarriage from 1945-1971 | Diethylstilbestrol (DES) |
T-shaped uterine cavity | Diethylstilbestrol-related anomaly |
aka fallopian tubes, oviduct | Uterine tubes |
4 structures of the Uterine tubes | Isthmus, Ampulla, Infundibulum, Fimbrae |
Ovaries are suspended by | broad ligament |
Remnant of gubernaculum, Attaches ovary to uterus | Ovarian ligament |
~3cm long, On lateral wall of true pelvis, Blood supply: ovarian a./v. | The Ovaries |
Where germ cells develop in ovaries, Follicles | Outer cortex |
Arteries and veins are found in ovary | Inner medulla |
Peritoneum draped over uterus, uterine tube, and ovary | broad ligament |
ligament of the ovary (infundibulopelvic ligament), Contains ovarian a./v. | Suspensory ligament |
Aka tranvserse cervical ligament, Contains uterine a./v. | Cardinal ligaments |
Ligaments of the Uterus | Cardinal ligaments, Uterosacral ligament, Pubocervical ligament |
Off of aorta below renal artery | Ovarian arteries |
From anterior trunk of internal iliac a. | Uterine/ vaginal arteries |
Drain directly to lateral aortic nodes | Ovaries |
Internal/ external iliac nodes to lateral aortic nodes | Pelvic cavity |
L4 - S4 spinal levels | L4 - S4 spinal levels |
Weakness or damage to pelvic floor muscles (and urethral and anal sphincters) can result in | urinary or fecal incontinence |
prolapse of bladder thru anterior wall of vagina | Cystocele |
prolapse of rectum thru posterior wall of vagina | Rectocele |
prolapse of intertine into vagina | Enterocele |
prolapse of uterus thru vaginal cavity | Uterine prolapse |
Complex series of biologic transitions during adolescence. development of secondary sexual characteristics is one aspect | Puberty |
Maturational increase in adrenal androgen production, which begins at about 6 years of age in both girls and boys. Causes hair growth, body odor, skin oiliness, acne | Adrenarche |
Seems to be unrelated to the pubertal maturation of the neuroendocrine-gonadotropin-gonadal axis | Adrenarche |
Beginning of breast development usually age 8 or beyond | Thelarche |
First menstruation; Averages 2.5 years after onset of puberty | Menarche |
Cyclical changes in hormones from hypothalamus, anterior pituitary and ovaries | Menstrual cycle |
If no fertilization | menses occur |
Menstrual cycle Produces one ______ which is ovulated mid cycle | fully mature oocyte |
Day 1: Bleeding starts | Menses |
ovarian follicles develop leading to mature graafian follicle; estrogen levels rise | Follicular/proliferative phase |
Follicular phase= | estrogen |
After ovulation; Mature follicle transforms into corpus luteum secreting progesterone and estrogen | Luteal Phase |
Luteal Phase = | progesterone |
Mature follicle transforms into corpus luteum secreting | progesterone and estrogen |
released by the hypothalamus in pulses | Gonadotropin releasing hormone (GnRH) |
Initiates release of both LH and FSH by the anterior pituitary | Gonadotropin releasing hormone (GnRH) |
High tonic levels GnRH supress the cycle used medically Lupron can induce a | “medical menopause” |
Released by the anterior pituitary; Essential for early ovarian follicle growth, Negative feedback on GnRH secretion | Follicle stimulating hormone (FSH) |
Induces proliferation of granulosa cells in the follicle that secrete estrogen | Follicle stimulating hormone (FSH) |
Induces granulosa cells to become sensitive to LH leading to ovulation | Follicle stimulating hormone (FSH) |
Secreted by the anterior pituitary; this “Surge” induces ovulation of the dominant follicle. Surge triggered by increasing estrogen from dominant follicle | Lutenizing hormone (LH) |
Induces androgen synthesis by the | follicular theca cells |
LH surge needed, around day 14; Midcycle, estrogen induces further release of LH rather than being suppressive | Ovulation |
Cause proteolysis of dominant follicle now a Graffian follicle with layers of granulosa and theca cells and release of egg | Ovulation |
Ovulation kits detect | LH surge |
Steroid hormone, made predominantly by ovarian granulosa cells | Estrogen |
help by producing androgens | Theca cells |
convert androgens to estrogen | Granulosa cells |
Negative feedback to pituitary for FSH secretion. Causes proliferation of the endometrial glands | Estrogen |
Steroid hormone made by the corpus luteum = hormone factory left in ovary after ovulation | Progesterone |
Slows endometrial proliferation induces secretion of glands in endometrium in preparation for implantation and early pregnancy maintenance | Progesterone |
Progesterone level over 4 at day 21 of cycle is indicative that | ovulation occurred |
Proliferation, straight glands, no glycogen | Endometrium- follicular phase |
Secrete glycogen, mucous, Glands become tortuous, Length constant at 14 days | Endometrium luteal phase |
Spiral arteries rupture, functional endometrium is shed, Averages 2-8 days , 25-60 cc | Menstrual endometrium |
Cervical mucous- Thinner | proliferative phase |
Cervical mucous- Thicker | luteal phase |
Symptoms: acne, breast swelling, fatigue, GI disturbance, insomnia, bloating headache, food cravings, depression/anxiety/irritability. Onset 2 weeks before menses and resolve with menses | Premenstrual syndrome |
Severe form of PMS. 5 or more of sxs: sadness/despair/suicidal, tension/anxiety, panic attacks , irritability that affects others, mood swings /crying, disinterest in daily activities, binge eating/craving , physical sxs | PMDD |
Treatment for PMS & PMDD | Exercise, regular sleep habits, stress mgt, eat properly avoid caffeine, sugar, salt , OCPs? PMDD- antidepressant, counseling |
Average age 47.5; Average 4 years prior to menopause | Perimenopause |
Irregularity of cycles, Heavy bleeding and clots, Anovulatory cycles, Variable cycle length | Perimenopause |
Definition is no menses for > 1 year | Menopause |
FSH >35 is widely used ( no negative estrogen feedback to pituitary), State of estrogen deficiency; Average age 51, pathologic <40 | Menopause |
First symptoms are often menstrual irregularities, Cycles shorten or lengthen. Hot flashes and vasomotor instability -sudden sensation of warmth, skin of face | Menopause |
Sleep/mood disruption in Menopause | The time it takes to fall asleep is longer. Total length of time asleep is shorter. Depression/crying spells may develop. |
is lost at a rate of 1-2% per year after menopause | Bone density |
after menopuse, Risk of hip and vertebral fracture | increases |
after menopuse Total cholesterol | increases |
after menopuse HDL cholesterol | decreases |
after menopuse LDL | increases |
after menopuse the risk of heart attack and stroke | increases |
Loss of collagen & adiposity in vulva; Clitoris loses protective covering; Vaginal surface thinner, less elastic; more friable; Vaginal dryness/genital tract atrophy; Vaginal mucosa and endometrium become thin and dry | Vulvovaginal changes after menapause |
Symptoms of Vulvovaginal changes | Itching, Burning, Dyspareunia |
Pale, smooth, or shiny vaginal epithelium. Loss of elasticity or turgor of skin. Sparsity of pubic hair. Dryness of labia. Fusion of labia minora. Introital stenosis. Friable, unrugated epithelium. | Signs of Vulvovaginal changes |
Pelvic organ prolapse. Vulvar dermatoses/ lesions. Petechiae of epithelium | Signs of Vulvovaginal changes |
Preceded by VIN | Vulvar cancer |
VIN--presenting complaints | Vulvar pruritus, Chronic irritation, Raised lesions, often white or grey. Most frequent on posterior vulva and perineum. |
Treatment early VIN | local cauterization (cryo, electro, laser) |
Treatment in higher grade VIN | wide local excision with or without laser or simple vulvectomy |
Fiery red lesions with white hyperkeratotic areas | Paget Disease |
Higher incidence of underlying carcinoma, esp colon and breast. Age group over 65 | Paget Disease |
Paget Disease Treatment | wide local excision or vulvectomy (wide margins) |
Raised, irritated, pruritic, pigmented lesion | Melanoma/Vulva |
Only 5% of all vulvar malignancies. Wide local excision. Excisional biopsy mandated with this type of lesion. | Melanoma/Vulva |
Another reason to avoid an overall tanning booth tan! | Melanoma/vulva |
4% of all gynecologic malignancies | Vulvar cancer |
most common Vulvar cancer | Epidermoid |
Typically postmenopausal woman, but can occur in 30 to 40 year olds | Vulvar cancer |
Vulvar pruritus. Red or white ulcerative or exophytic lesion, but not necessarily. Posterior 2/3 of labium majus. | Vulvar cancer |
Remains localized for long periods of time then spreads lymphatically. Inguinal lymphadenopathy | Vulvar cancer |
s | deep lymphatics in pelvis |
Vulvar cancer diagnosis | Biopsy positive. Work up CXR, IVP, cysto, procto. Adjunctive postoperative radiation |
Vulvar cancer 5-year surivival | 75% |
Presents: abnormal bleeding, pain, mass, dyspareunia | Vaginal cancer |
Rare. Risk factors HPV: squamous cell. DES: clear cell. Colposcopy, biopsy to excision. | Vaginal cancer |
Most common gyn cancer | Endometrial carcinoma |
Presents as abnormal bleeding | Endometrial carcinoma |
Begins as endometrial hyperplasia, then atypia, then carcinoma. Younger perimenopausal women. History of unopposed estrogen. More favorable prognosis | Estrogen-Dependent Endometrial carcinoma |
Progestin withdrawal or OCs as treatment. Why “naturally not having a period” is not OK | Estrogen-Dependent Endometrial carcinoma |
Occurs spontaneously. Thin, older postmenopausal women without unopposed estrogen. Atrophic endometrium. Cancers less well-differentiated. Poorer prognosis | Estrogen-independent Endometrial carcinoma |
to assess endometrial stripe, doppler flow | Transvaginal ultrasound |
Greater than 5 mm stripe, mass, fluid | warrants biopsy |
<5 mm stripe reassuring on Transvaginal ultrasound, but does not exclude | non estrogen-dependent carcinoma |
Treatment of Endometrial carcinoma | Primary surgical treatment is cornerstoneTAH/BSO. Node dissection dependent on invasion depth. Adjunctive postoperative radiation. Medroxyprogesterone for recurrence |
2nd most common gynecologic malignancy | Ovarian cancer |
Most common cause of death due to gyn cancer | Ovarian cancer |
5th leading cause of cancer deaths in women in US & is Associated with repeated ovulation | Ovarian cancer |
90% of Ovarian cancers are | epithelial tumors |
Ovarian Cancer: Risk Factors | Family history. History of breast cancer. Nulliparity or poor reproductive history. Infertility. Early menarche, late menopause, PCOS, Genetic (BRCA, others),Endometriosis, Obesity |
Ovarian cancers: protective factors | Oral contraceptives. Multiparity. Tubal ligation, breastfeeding |
Ovarian malignancy: Symptoms | Symptoms are vague. Pelvic pain, bloating, urinary tract symptoms. “Clothing too tight,” “Abdomen enlarging” |
Postmenopausal gyn exam | Palpable adnexal mass. Rectovaginal exam important. Ultrasound with doppler blood flow. CA 125 (not good marker), CT/MRI |
Probably Benign | Mobile. Cystic. Unilateral. Smooth |
Possibly Malignant | Fixed. Solid. Bilateral. Nodular |
<10 cm. Minimal septations. Unilateral | Probably Benign |
>10 cm. Solid. Multiple septations > 3 mm. Bilateral. Ascites. Doppler blood flow? | Possibly malignant |
Definition: any abnormal growth of tissue | Neoplasm |
Synonym: tumor | Neoplasm |
Key to neoplasms is | determining if benign or malignant |
Pruritus, burning, irritation or abnormal growth | Vulvar disease |
Common in women of all ages. Maintain high index of suspicion in peri- and postmenopausal women due to higher risk of malignancy | Vulvar disease |
Common Vulvar Dermatoses | Lichen sclerosus; Lichen simplex chronicus; Lichen planus; Psoriasis |
“An itch that rashes” | Lichen chronicus |
Vicious cycle of itch, scratch, itch. Original trigger often unknown. Progressive vulvar pruritus and burning. Thickened, white, unilateral/localized. Biopsy! Topical steroids (medium potency), hydroxyzine, SSRIs | Lichen chronicus |
Thin, white “onion skin” or “cigarette paper” | Lichen sclerosus |
Chronic, intense vulvar pruritus. Disfigurement, stenosis of vaginal introitus. Biopsy! Refer! Treatment potent topical steroids. Possibly topical testosterone, progesterone (not EBM) | Lichen sclerosus |
In Lichen sclerosus there is a 4-6% risk of | squamous cell cancer |
Violaceous, flat topped papules (erosive type) | Lichen planus |
White patches, ulcerations. May have oral, vaginal lesions. Chronic burning and itching-autoimmune. Biopsy, refer | Lichen planus |
Lichen planus treatment | Topical steroids, douches, suppositories. Vaginal estrogen cream if atrophic. Beware adhesions, introital stenosis. |
Benign uterine neoplasm | Leiomyomas (fibroids) |
Bleeding the most common presenting symptom | Fibroids |
Acute pain associated with “red degeneration” or torsion of pedunculated myoma | Fibroids |
Very often asymptomatic. Progressive increase in pelvic pressure, fullness. Pelvic pain | Fibroids |
Irregular, enlarged uterus. If large enough, palpable abdominally. Size referred to in gestational weeks pregnancy size | Fibroids |
Fibroids Diagnose by | ultrasound |
If calcified fibroid may show up on | X-ray |
Most frequently associated with pregnancy. Rapidly outgrow blood supply and die off. | Fibroids—red degeneration |
Must be differentiated from malignancy. Usually spontaneously regress. Very common. Also called “physiologic ovarian cysts” | Functional Ovarian Cysts |
Failure of ovulation, follicle continues to grow. May rupture and cause acute pelvic pain. Surgery not indicated. always do pregnancy test. | Follicular cysts |
May be felt on exam, refer to ultrasound, ultrasound no cyst but “free fluid in cul de sac” | due to rupture of cysts, |
Missed onset of menses. Corpus luteum fails to involute and continues to enlarge after ovulation. Secretes progesterone. Adnexal enlargement. One-sided pain | Persistent corpus luteum cyst |
Treatment: functional ovarian cysts (recurrent) | Symptomatic. No EBM for oral contraceptives to resolve or prevent (maybe it worked in the 1970s). Warnings: risk of torsion if large |
Asymptomatic, unilateral cystic adnexal mass. Mobile, nontender, often high in pelvis. | Dermoid (teratoma) |
Dermoid derivatives in cyst | cartilage, bone, teeth |
Hirsutism, acanthosis nigricans, acne. Oligo- or amenorrhea. Obesity (not always!). Infertility. Insulin resistance. | Polycystic ovary syndrome (PCOS) |
Complex genetic trait, related to type 2 DM. Hyperandrogenism. Insulin resistance, increased LH. | Polycystic ovary syndrome (PCOS) |
PCOS--treatment | Oral contraceptives. Medroxyprogesterone for W/D bleed if contraception not needed. Spironolactone for hirsutism, Yasmin. Weight loss. Metformin |
PCOS--complications | Type 2 DM. Hypertension. Hyperlipidemia. CV disease. Infertility, recurrent SABDepression. |
Modified sweat/ mammary gland; Function: Lactation | Female Breast |
10-20 surround the nipple. Glandular tissue | Lobes |
20-40 in each lobe. Contain milk producing cells | Lobules |
Thousands in each lobe. Lined with epithelial milk producing cells (acini) | Alveoli |
Color varies from pale pink to black. Muscular contractions cause erection | Pigmented erectile tissue of nipple |
Pigmented area, surrounds the nipple. Size varies between women | Areola |
Sebaceous (oil producing) glands. Protect and lubricate nipple (lactation) | Montgomery glands |
ACS Recommendation: Women at average risk should begin annual mammography at age | 40 |
The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Grade: | B |
The USPSTF recommends biennial screening mammography for women aged | 50 to 74 years. |
The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Grade: | C recommendation. |
survival benefit is "strongest for women aged | 50 to 69 |
CBE should be part of regular health maintenance, performed at least every three years for women age | 20-39 yrs |
Asymptomatic women __ should continue to receive CBE, preferable annually. | greater than 40 yrs |
about every 3 years for women in their 20s and 30s and every year for women 40 and over | Clinical breast exam (CBE) |
RCT data show combined mammograpghy and CBE= | lower breast cancer mortalilty |
there is moderate certainty that the harms outweigh the benefits. | For the teaching of BSE |
On breast exam be alert for | Dimpling, Color changes, Retraction, Skin thickening, Pronounced/ recent asymmetry, Spontaneous nipple discharge |
The USPSTF recommends against teaching breast self-examination (BSE).Grade: | D recommendation |
Supernumerary breasts. May be seen as normally shaped female breast. Usually in axilla or directly beneath normal breast. | Polymastia |
Supernumerary nipples. Often miniature compared to normally placed nipples and located in the milk line. | Polythelia |
trauma, breaks in skin integrity, insect bites, cosmetic surgery can lead to | cellulitis of the breast |
may be associated with diabetes, RA, steroid tx, trauma | Abscess |
Widening of breast ducts. Occurs in women near or past menopause. May have thick, sticky discharge and/or frequent itching around the nipple. Treat with warm compresses and antibiotics. | Duct Ectasia |
Firm, round lump which forms in an area of fatty tissue damage. | Fat Necrosis |
Benign breast pain. Most common breast complaint. Associated with hormonal changes. More intense in teens and 40’s. Usually ends with menopause. | Mastalgia |
Chest wall pain. Increases with deep inspiration. May be arthritic. Can occur at any age. Can result from cervical nerve compression. Rx: NSAIDS | Costochondritis |
bilateral pain with heaviness/ diffuse tenderness and occurs during luteal phase | cyclical breast pain |
uni or bilateral, sharp, burning pain, smoking hx, no relation to menses | non- cyclical breast pain |
unilateral and medical, sharp with deep inspirations and variable occurence | chest wall breast pain |
is a catch-all term for benign conditions of the breast. Grainy, palpable, small lumps. May fluctuate with menstrual cycle (progesterone changes?) | Fibrocystic disease |
Most frequent benign breast condition. Ages 30-50 most frequent incidence | Fibrocystic disease |
most frequent location for Fibrocystic disease | UOQ of breast |
Mobile, well-defined cystic masses. Bilateral single or multiple masses. Pain/ tenderness last half of cycle. | Fibrocystic disease |
differentiate cystic mass from solid mass | Aspiration and U/S |
If find mass on CBE | Order a diagnostic mammogram, unless age <30, then order U/S. |
The second most common benign breast condition. | Fibroadenoma |
More common in African American women. Occurs late teens, early adulthood | Fibroadenoma |
Hormone influenced abnormal growth of fibrous and ductal tissue. May grow rapidly during pregnancy. No significant correlation with breast cancer. | Fibroadenoma |
Well circumscribed lump. Usually firm, rubbery, round, mobile, non-tender, solitary. Usually UOQ. Generally 1-5 cm in diameter. | Fibroadenoma |
Fibroadenoma diagnosis | FNA (fine needle aspiration). Cytology study of bloody fluid or solid tumor aspirate. U/S to differentiate solid from cystic mass |
Fibroadenoma definitive diagnosis | excisional biopsy and tissue examination |
is a simple procedure that involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass | Fine Needle Aspiration (FNA) Biopsy |
obscure 10% of breast tissue on mammogram | Submuscular implants |
Cancer cells block lymph vessels in breast skin. Breast becomes red, swollen and warm. No palpable mass present. Usually grows rapidly with metastasis. uncommon. | Inflammatory breast cancer |
Nipple retraction & Peau d'orange are seen in | Inflammatory Breast Cancer |
Begins in breast duct and spreads to nipple and areola. Usually occurs with infiltrating ductal breast cancer. Gradual onset, rare | Paget’s Disease of the Nipple |
Scaly, crusty, eczema-like lesions on nipple area. Tingling, itching or burning in nipple area. Nipple discharge. Lump in nipple area | Paget’s Disease of the Nipple |
Diagnosis of Paget’s Disease of the Nipple | Biospy with tissue exam |
Treatment of Paget’s Disease of the Nipple | Lumpectomy. Mastectomy |
Advocate a threefold approach, with education: | Monthly BSE. CBE at recommended intervals. Annual mammography. |
Age <30yo, Palpable lump, still there after menses, order | unilateral breast ultrasound |
Age > 30yo, palpable lump, order | unilateral diagnostic mammogram & u/s |
If 40 or more, and due for screening mammo., get | mammo. on unaffected side at same time |
Women at high risk (greater than 20% lifetime risk) should get an | MRI and a mammogram every year |
Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of | adding MRI screening to their yearly mammogram. |
Yearly MRI screening is not recommended for | women whose lifetime risk of breast cancer is less than 15%. |