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Last updated on 23 Jul 2015 at 5:21 PM (Repro08)
Breast lump and screening
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
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 MÄ•ori
Inequities in breast cancer incidence rates, stage at diagnosis and mortality for
MÄ•ori compared with non MÄ•ori, and application of this to clinical decision
making and management.
Differential performance of the breast cancer screening programme for MÄ•ori
Understanding of the role of kaupapa MÄ•ori 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
Common
(invasive/metastatic adenocarcinoma, lobar carcinoma
in-situ, ductal carcinoma in-situ), mastitis, breast
abscess, sebaceous cyst, lipoma, normal breast tissue
peau d'orange, inflammatory breast cancer, papilloma
Less common but
'important not to miss'
fat necrosis, duct ectasia
Uncommon