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Breast lump and breast cancer
Every breast lump is assessed by "triple assessment" — clinical examination, imaging and needle biopsy; breast cancer is treated along three axes: local surgery (breast conservation with radiotherapy, or mastectomy), nodal assessment by sentinel node biopsy, and systemic therapy according to the receptors (ER, PR, HER2).
Why it matters in the exam
Breast questions begin with the work-up: which imaging suits a young woman (ultrasound) and which a woman over 30 (mammography and ultrasound), what each BI-RADS category means, and when a core needle biopsy is needed. A standard trap is a normal mammogram with a palpable lump — it does not exclude cancer, and the lump still needs investigation. Candidates are also asked about screening: mammography every two years at age 50–74 in the general population, and annual MRI for BRCA carriers.
The second part is treatment: breast conservation with radiotherapy is equivalent to mastectomy for survival; sentinel node biopsy is used when no nodes are palpable, and axillary dissection is usually unnecessary when 1–2 positive sentinel nodes are found at breast-conserving surgery with radiotherapy; endocrine therapy for hormone-receptor-positive tumours, anti-HER2 therapy for HER2-positive tumours, and chemotherapy (sometimes before surgery) for "triple-negative" tumours. Questions also cover DCIS, LCIS as a risk marker, inflammatory breast cancer, Paget's disease of the nipple and contraindications to breast conservation.
Key points
- Triple assessment: examination, imaging (ultrasound under 30, mammography and ultrasound above) and core needle biopsy.
- BI-RADS 3 — follow-up in 6 months; BI-RADS 4–5 — biopsy.
- Breast conservation with radiotherapy equals mastectomy; sentinel node biopsy for a negative axilla.
- ER/PR — endocrine therapy for 5–10 years; HER2 — trastuzumab; triple-negative — chemotherapy.
- Screening: mammography every two years at age 50–74; BRCA carriers — annual MRI.
Summary table
| Situation | Finding | Treatment |
|---|---|---|
| BI-RADS 3 | Probably benign finding (risk of malignancy 2% or less) | Imaging follow-up in 6 months |
| BI-RADS 4–5 | Suspicious or highly suspicious finding | Core needle biopsy |
| DCIS | Non-invasive cancer, often calcifications on mammography | Local excision with radiotherapy (or mastectomy); no axillary dissection |
| Early invasive cancer | Resectable tumour, clinically negative axilla | Breast conservation and radiotherapy or mastectomy, with sentinel node biopsy |
| Hormone-receptor positive | ER or PR positive | Endocrine therapy for 5–10 years: tamoxifen before the menopause, an aromatase inhibitor after it |
| HER2-positive or triple-negative | More aggressive tumour | HER2 — trastuzumab with chemotherapy; triple-negative — chemotherapy, often before surgery |
| Inflammatory breast cancer | Redness and skin oedema (peau d'orange) over a large part of the breast | Chemotherapy before surgery, mastectomy with axillary dissection, and radiotherapy |
A free exam question
בת 30 , נשאית מוטציה בגן TP53 . מה יהיה חלק מ פרוטוקול?המעקב אצל המטופלת (the question as examined, in Hebrew)
- א. גסטרוסקופיה כל 5 שנים
- ב. CT ראש כל שנה
- ג. בדיקת CA19-9 כל שנה
- ד. Whole-body MRI כל שנה
In the full version for subscribers
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Sources
- NCCN Clinical Practice Guidelines in Oncology: Breast Cancer; Breast Cancer Screening and Diagnosis, 2025 — Work-up of a breast mass, locoregional treatment and systemic therapy
- ACR BI-RADS Atlas, 5th edition (2013) — Assessment categories and management
- Israel Ministry of Health, national breast cancer screening programme, current — Mammography every two years at age 50–74
- Sabiston Textbook of Surgery, 21st edition (2022) — Diseases of the Breast
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.