| Show Learning Points most relevant to Phase 1: |
Breast lump and screening
| Clinical Discipline(s)/Organ System(s) Anatomical Pathology, General Surgery, Oncology | Progress Test Topic(s) Women's health |
Description
A 51 year old NZ European woman, who is menopausal and taking combined hormone therapy, presents to her GP. She has a breast lump and is worried about cancer
Progress Test-Type Questions: Question 1Applied Science for Medicine
- Anatomy and function of the breast and how the breast changes during puberty, menstrual cycle, pregnancy, breastfeeding and menopause
- Biological and endocrinological changes during the menopausal transition phase
- Pathology of benign and malignant breast lumps
- Molecular genetics of breast cancer and other hormone-driven malignancies
- Genetics of familial breast cancer
- Explain the difference between grade and stage of a tumour
- Pharmacology of oestrogen replacement therapy
- Anatomy and function of the breast and how the breast changes during puberty, menstrual cycle, pregnancy, breastfeeding and menopause
- Biological and endocrinological changes during the menopausal transition phase
- Pathology of benign and malignant breast lumps
- Molecular genetics of breast cancer and other hormone-driven malignancies
- Genetics of familial breast cancer
- Explain the difference between grade and stage of a tumour
- Pharmacology of oestrogen replacement therapy
Clinical and Communication Skills
- History from a woman with a breast lump; include family history, gynaecological history, risk factors for breast cancer, mammogram profile to date
- Differential diagnosis of a breast lump and breast pain
- Discuss the risk of breast cancer associated with hormone replacement therapy, based on Women's Health Initiative Study
- Perform and record a breast and axillary examination
- 'Triple assessment' principle and how it is used; examination, imaging and biopsy
- Sensitivity and specificity of mammography and breast ultrasound
- Staging of breast cancer using TNM and how this impacts on treatment and prognosis; role of sentinel node biopsy
- Treatment options available for breast cancer and the factors involved in deciding which to use; include: surgical, hormonal, oncological (chemo- and biological therapies), palliative
- Complications of mastectomy, lymph node dissection
- The role of prophylactic treatment in those with a high risk of breast cancer
- Role of the GP in facilitating referral
- History from a woman with a breast lump; include family history, gynaecological history, risk factors for breast cancer, mammogram profile to date
- Differential diagnosis of a breast lump and breast pain
- Discuss the risk of breast cancer associated with hormone replacement therapy, based on Women's Health Initiative Study
- Perform and record a breast and axillary examination
- 'Triple assessment' principle and how it is used; examination, imaging and biopsy
- Sensitivity and specificity of mammography and breast ultrasound
- Staging of breast cancer using TNM and how this impacts on treatment and prognosis; role of sentinel node biopsy
- Treatment options available for breast cancer and the factors involved in deciding which to use; include: surgical, hormonal, oncological (chemo- and biological therapies), palliative
- Complications of mastectomy, lymph node dissection
- The role of prophylactic treatment in those with a high risk of breast cancer
- Role of the GP in facilitating referral
Personal and Professional Skills
- Intimate examination and use of a chaperone
- Counselling about lifestyle changes to reduce risk of breast cancer (weight loss, exercise, alcohol)
- Breaking bad news/discussions relating to cancer
- Reassuring patients when lesions are benign
- Role of the multidisciplinary team to diagnose, treat and follow up a woman with breast cancer
- Intimate examination and use of a chaperone
- Counselling about lifestyle changes to reduce risk of breast cancer (weight loss, exercise, alcohol)
- Breaking bad news/discussions relating to cancer
- Reassuring patients when lesions are benign
- Role of the multidisciplinary team to diagnose, treat and follow up a woman with breast cancer
Hauora Māori
- Inequities in breast cancer incidence rates, stage at diagnosis and mortality for Māori compared with non Māori, and application of this to clinical decision making and management.
- Differential performance of the breast cancer screening programme for Māori
- Understanding of the role of kaupapa Māori screening programmes in reducing inequalities
- Inequities in breast cancer incidence rates, stage at diagnosis and mortality for Māori compared with non Māori, and application of this to clinical decision making and management.
- Differential performance of the breast cancer screening programme for Māori
- Understanding of the role of kaupapa Māori screening programmes in reducing inequalities
Population Health
- Role of regular clinical breast examination and mammograms
- Science of screening tests
- Breast cancer screening; rationale, requirements for success and performance of the Breast Screen Aotearoa programme
- Hormone replacement therapy (HRT): risks, benefits, costs, regulation
- Epidemiology of breast cancer: lifetime risk, time trends, risk factors, opportunities for prevention
- The process of drug development, licensing and Pharmaceutical Management Agency (PHARMAC) funding
- Role of regular clinical breast examination and mammograms
- Science of screening tests
- Breast cancer screening; rationale, requirements for success and performance of the Breast Screen Aotearoa programme
- Hormone replacement therapy (HRT): risks, benefits, costs, regulation
- Epidemiology of breast cancer: lifetime risk, time trends, risk factors, opportunities for prevention
- The process of drug development, licensing and Pharmaceutical Management Agency (PHARMAC) funding
Conditions to be considered relating to this scenario
Common
fibroadenoma, fibrocystic change, breast cancer (invasive/metastatic adenocarcinoma, lobar carcinoma in-situ, ductal carcinoma in-situ), mastitis, breast abscess, sebaceous cyst, lipoma, normal breast tissue
fibroadenoma, fibrocystic change, breast cancer (invasive/metastatic adenocarcinoma, lobar carcinoma in-situ, ductal carcinoma in-situ), mastitis, breast abscess, sebaceous cyst, lipoma, normal breast tissue
Less common but 'important not to miss'
peau d'orange, inflammatory breast cancer, papilloma
peau d'orange, inflammatory breast cancer, papilloma
Uncommon
fat necrosis, duct ectasia
fat necrosis, duct ectasia
Resources
National Screening Unit: www.nsu.govt.nz
