🩺 MSRA Revision Guide: Breast Cancer & Key Breast Conditions
- examiner mla
- Jul 13
- 4 min read
Updated: Jul 14
🔍 Introduction
Breast conditions—particularly breast cancer—are a high-yield topic in the MSRA. This guide synthesizes the most exam-relevant information, including:
Family history referral criteria
Risk reduction advice
Common benign and malignant presentations
Surgical options
Diagnostic pathways
Key pharmacology and receptor implications
This is crafted to help you tackle any breast-related MSRA scenario with confidence and speed.
1️⃣ Breast Cancer Family History – When to Refer
✅ Refer to Genetics/Breast Clinic if ANY of the following apply:
1st-degree female relative diagnosed < 40 years
Male breast cancer in a 1st-degree relative
Bilateral breast cancer (with first primary < 50 y)
≥ 2 affected relatives on the same side of the family, with at least one 1st-degree
Breast and ovarian cancer in the same family
≥ 3 relatives diagnosed with breast cancer at any age
🚫 Do NOT refer if:
Only one 1st- or 2nd-degree relative diagnosed > 40 y
None of the red-flag features are present
🚩 Red Flags – Always Refer if Present:
Bilateral breast cancer
Ovarian cancer in the family
Male breast cancer
Jewish ancestry (especially Ashkenazi)
Soft-tissue sarcoma < 45 y
Glioma or adrenal cortical carcinoma in a child
Complex clusters of multiple early cancers
≥ 2 relatives on the paternal side
🔑 Memory aid: “BOOMS-JO”Bilateral, Ovarian, Other early cancers, Male, Sarcoma, Jewish, Out-of-pattern clusters
2️⃣ Risk Reduction & Contraception Counselling
Promote breast awareness and regular screening (starts at age 50 in UK)
Lifestyle advice:
Limit alcohol
Maintain healthy BMI
Encourage breastfeeding
CHC (Combined Hormonal Contraception) is not contraindicated by family history alone
Known mutation carriers: CHC use should be discussed with genetics team
HRT in moderate/high-risk women: requires specialist advice
3️⃣ Mammary Duct Ectasia
📌 Key Features:
Commonest cause of green or foul-smelling nipple discharge
Discharge may be thick and occasionally blood-stained
Can mimic malignancy but does not increase cancer risk
May have peri-areolar lump, nipple inversion, or pruritus
🔎 Investigation:
Triple assessment (clinical exam, imaging, biopsy if needed)
🛠️ Management:
Reassure; advise not to squeeze the nipple
Use simple analgesia
Persistent cases: Consider microdochectomy or total duct excision
🧠 Memory Tip: “Green = Ectasia” (like mossy-green blocked ducts)
4️⃣ Lymphoedema After Breast Cancer Therapy
Most commonly due to axillary node dissection or radiotherapy
Presents with painless, non-pitting, unilateral arm swelling
Can occur weeks to years after treatment
❗ Bilateral swelling = consider systemic causes (heart failure, hypoalbuminaemia)❗ Painful swelling = suspect DVT🔑 Memory: “Lymph-O-edema” → O for One arm (post-op side only)
5️⃣ Breast & Axillary Surgeries – At a Glance
Procedure | Indication | Key Points / Complications |
Wide Local Excision | Small, focal tumours | Requires 1 cm margin; followed by radiotherapy |
Simple Mastectomy | Multifocal disease, high tumour:breast ratio, recurrence | Chest wall muscles preserved; skin varies with reconstruction |
Sentinel Node Biopsy | Node-negative axilla | Uses blue dye ± radioisotope to guide clearance need |
Axillary Node Clearance | Confirmed nodal spread | Risks: lymphoedema, seroma, sensory nerve damage |
6️⃣ Paget’s Disease of the Nipple
Presents with eczema-like changes to the nipple and areola: itching, erythema, flaky skin, bloody discharge
Often unilateral
May mask or indicate underlying invasive carcinoma
Can also appear on mastectomy scars
🛠️ Management:
Breast-conserving surgery: remove nipple–areolar complex ± oncoplastic repair
Mastectomy if disease is extensive
🧠 Memory Tip: “Paget’s = Paint-chip Nipple” (flaky + bleeding)
7️⃣ Core Breast Cancer Facts for MSRA
🔬 Pathology & Presentation
Upper outer quadrant is most common site
Classic cancer signs: painless, hard lump, irregular borders, immobile, skin dimpling, nipple retraction
🔎 Triple Assessment:
Clinical examination
Imaging
< 40 y: Ultrasound
≥ 40 y: Mammography
Tissue diagnosis
FNA (cytology) or core biopsy (histology; preferred)
8️⃣ Receptor Status & Systemic Therapy
Receptor | Implications |
ER/PR+ | Favourable prognosis, use tamoxifen or aromatase inhibitors |
HER2+ | Treated with trastuzumab (Herceptin); requires cardiac monitoring |
🔍 Hormonal Therapy Comparison
Feature | Tamoxifen | Aromatase Inhibitors |
Indicated for | Premenopausal ER+ patients | Postmenopausal ER+ patients |
Risks/Side Effects | Endometrial cancer, DVT | Osteoporosis, arthralgia |
Benefit | Bone protection | No uterine stimulation |
9️⃣ Specific Malignant Types
DCIS (Ductal Carcinoma In Situ)
Non-invasive
Seen as microcalcifications on mammogram
Risk of invasive carcinoma if untreated
LCIS (Lobular Carcinoma In Situ)
Risk marker for bilateral breast cancer
Often not seen on imaging
Inflammatory Breast Cancer
Rapidly progressive with erythema, swelling, warmth, peau d’orange
Poor prognosis
Requires urgent treatment
Male Breast Cancer
Rare
Associated with BRCA2 mutations and Klinefelter’s syndrome
🔟 NHS Breast Screening (UK)
Offered to women aged 50–70 every 3 years
Women with increased risk may start earlier (from age 40) with genetic screening input
🧠 Final Memory Aids
BOOMS-JO = Red flags for genetic referral
Green = Duct Ectasia
Paint-Chip Nipple = Paget’s disease
Lymph-O-edema = Unilateral swelling post-op
HQ = UOQ = Upper Outer Quadrant is cancer HeadQuarters
📌 Conclusion
Breast cancer and benign breast disease form a foundational component of MSRA, particularly in Primary Care and Risk Stratification. Mastering:
Referral thresholds
Red flag identification
Hormonal therapy indications
Triple assessment and surgical options
📚 References
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