••• Chapter 41^ Breast Disorders^409
❍ What conditions are associated with gynecomastia?
Puberty, medications, cirrhosis, malnutrition, primary or secondary hypogonadism, testicular tumors,
hyperthyroidism, renal disease, or idiopathic.
❍ What medications can cause gynecomastia?
Estrogens, antiandrogens, ketoconazole, metronidazole, cimetidine, omeprazole, ranitidine, methotrexate,
alkylating agents, amiodarone, captopril, digoxin, diltiazem, enalapril, nifedipine, spironolactone, verapamil,
diazepam, haloperidol, tricyclic antidepressants, reglan, phenytoin, and theophylline.
❍ What are the most common types of breast masses in premenopausal women?
Fibroadenomas, fibrocystic changes, cysts, abscesses, and carcinomas.
❍ What factors affect fibrocystic change?
The changes are believed to be associated with ovarian hormones since the condition usually subsides with
menopause and may vary in consistency and symptomatic intensity during the menstrual cycle.
❍ What is the incidence of fibrocystic change?
The incidence is estimated to be over 60% of all women and is lower in women taking birth control pills.
❍ Is there an increased risk of subsequent development of cancer in fibrocystic change?
The risk of development of carcinoma is related to the degree and type of epithelial hyperplasia present.
Proliferative or atypical fibrocystic changes increase the risk of breast carcinoma.
❍ What histologic pattern of the epithelial component of phyllodes tumor is useful in differentiating it from a
fibroadenoma?
The epithelial component in phyllodes tumor is characteristically “leaf-like” with a branching pattern. The stroma in
phyllodes tumor is also more cellular and mitotically active and has more atypical cells, including multinucleated cells.
❍ What are some risk factors for the development of carcinoma of the breast?
Increasing age, female gender, genetic factors (BRCA1/2, ataxia-telangiectasia, CHEK-2, Li-Fraumeni syndrome),
family history, personal history, Caucasian race, previous chest irradiation, early menarche, late menopause,
exposure to diethylstilbestrol (DES), nulliparity, and hormone replacement therapy (HRT).
❍ What is the recommended screening for breast cancer in average-risk patients?
Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
Clinical breast examination should be performed every 3 years for women in their 20s and 30s, and every year for
women 40 and over.
❍ What is the recommended screening for breast cancer in high-risk patients?
Women at increased risk should start screening 10 years younger than the age of the youngest affected first-
degree relative when they were diagnosed with breast cancer. These women may be screened with mammography,
ultrasound, or MRI as appropriate. They should perform breast self-examinations monthly and have clinical breast
examinations every 6 months.