Return to Scenario ListShow 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
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 1
Applied 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
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
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
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
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
Conditions to be considered relating to this scenario
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
fat necrosis, duct ectasia

National Screening Unit: