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乳腺癌医学培训课件FORBREASTCANCERAPROGRAMOFTHEUAMSCOLLEGEOFPHARMACYOVERVIEWOFBREASTCANCERJANKHASTINGSPHARMDBREASTCANCERTHEMOSTCOMMONFORMOFCANCERAMONGWOMENTHESECONDMOSTCOMMONCAUSEOFCANCERRELATEDMORTALITY1OF8WOMEN122ONETHIRDOFWOMENWITHBREASTCANCERDIEFROMBREASTCANCERRISKFACTORSFORBREASTCANCERFEMALE1MALEAGINGRELATIVEMOTHERORSISTERMENSTRUALHISTORYEARLYONSETLATEMENOPAUSECHILDBIRTHAFTERTHEAGEOF30EXOGENOUSESTROGENHORMONALREPLACEMENTTHERAPYHRT30INCREASEDRISKWITHLONGTERMUSEORALCONTRACEPTIVESOCRISKSLIGHTRISKRETURNSTONORMALONCETHEUSEOFOCSHASBEENDISCONTINUEDRISKFACTORSFORBREASTCANCERRADIATIONEXPOSUREBREASTDISEASEATPYICALHYPERPLASIAINTRADUCTALCARCINOMAINSITUINTRALOBULARCARCINOMAINSITUOBESITYDIETFATALCOHOLGENETICSBRCA1BRCA2P53RB1HER2NEUCERB2CMYCSTAGINGOFBREASTCANCERTHEAMERICANJOINTCOMMITTEEONCANCERAJCCHASDESIGNATEDSTAGINGBYTNMTTUMORSIZENLYMPHNODEINVOLVEMENTMMETASTASISSTAGE1TUMOR20CMINGREATESTDIMENSIONNONODALINVOLVEMENTN0NOMETASTASESM0STAGEIITUMOR205CMORIPSILATERALAXILLARYLYMPHNODEN1NOMETASTASISM0STAGEIIITUMOR5CMT3ORIPSILATERALAXILLARYLYMPHNODESFIXEDTOEACHOTHEROROTHERSTRUCTURESN2INVOLVEMENTOFIPSILATERALINTERNALMAMMARYNODESN3INFLAMMATORYCARCINOMAT4DSTAGEIVMETASTATICBREASTCANCERANYTANYNMETASTASISM1TYPESOFBREASTCANCERINSITUINTRADUCTALDCISINTRALOBULARLCISINVASIVEINFILTRATINGDUCTALCARCINOMATUBULARCARCINOMAMEDULLARYCARCINOMAMUCINOUSCARCINOMASYMPTOMSANDSCREENINGNORMALBREASTPHYSIOLOGYANDANATOMYSYMMETRYANDBALANCESIZEWEIGHTMENSTRUALCYCLEPREGNANCYANDLACTATIONTEXTURESHAPEAGEABNORMALSIGNSANDSYMPTOMSPUCKERINGDIMPLINGRETRACTIONNIPPLEDISCHARGETHICKENINGOFSKINORLUMPORKNOTRETRACTEDNIPPLEABNORMALSIGNSANDSYMPTOMSCHANGEINBREASTSIZEPAINORTENDERNESSREDNESSCHANGEINNIPPLEPOSITIONSCALINGAROUNDNIPPLESSOREONBREASTTHATDOESNOTHEALMETHODSOFDETECTIONCLINICALEXAMBYMDORNURSEMAMMOGRAPHYMONTHLYBREASTSELFEXAMBSECLINICALEXAMINATIONPERFORMEDBYDOCTORORTRAINEDNURSEPRACTITIONERANNUALLYFORWOMENOVER40ATLEASTEVERY3YEARSFORWOMENBETWEEN20AND40MOREFREQUENTEXAMINATIONFORHIGHRISKPATIENTSMAMMOGRAPHYXRAYOFTHEBREASTHASBEENSHOWNTOSAVELIVESINPATIENTS5069DATAMIXEDONUSEFULNESSFORPATIENTS4049NORMALMAMMOGRAMDOESNOTRULEOUTPOSSIBILITYOFCANCERCOMPLETELYMAMMOGRAPHYAMERICANCANCERSOCIETYRECOMMENDSWOMENASYMPTOMATIC40YEARSOFAGEANDOLDERSHOULDHAVEAMAMMOGRAMEVERYYEARMAMMOGRAPHYMOREGUIDELINESMAMMOGRAMFACILITYGUIDELINESAVOIDMAMMOGRAMWEEKBEFOREPERIODDONTWEARDEODORANTPOWDERORCREAMBRINGALISTOFTHEPLACESANDDATESOFOTHERMAMMOGRAMSBIOPSIESYOUVEHADBEFOREIFYOUDONTHEARFROMTHEMDWITHIN10DAYSCALLTHEFACILITYFREEMAMMOGRAMSMEDICAREARKANSASBREASTCANCERCONTROLPROGRAMBREASTANDCERVICALCANCERCONTROLPROGRAMOFTHEARKANSASDEPARTMENTOFHEALTHMEDICAREWOMENOVER65ARKANSASBREASTCANCERCONTROLPROGRAMSTARTEDIN1999ELIGIBILITYWOMEN40OROLDERNOINSURANCEINCOMEATORBELOW2TIMESTHEPOVERTYLEVELCALLCOUNTYORSTATEHEATHDEPARTMENLIGIBILITYFORABCCCPMAMMOGRAM50YEARSOROLDERANDATORBELOW200PERCENTPOVERTYORBETWEEN40AND49ANDABREASTCANCERSURVIVORORHAVEAMOTHERDAUGHTERORSISTERWHOHASBREASTCANCERANDATORBELOW200PERCENTPOVERTYBREASTSELFEXAMINATIONOPPORTUNITYFORWOMANTOBECOMEFAMILIARWITHHERBREASTSMONTHLYEXAMOFTHEBREASTSANDUNDERARMAREAMAYDISCOVERANYCHANGESEARLYBEGINATAGE20CONTINUEMONTHLYWHENTODOBSEMENSTRUATINGWOMEN5TO7DAYSAFTERTHEBEGINNINGOFTHEIRPERIODMENOPAUSALWOMENSAMEDATEEACHMONTHPREGNANTWOMENSAMEDATEEACHMONTHTAKESABOUT20MINUTESPERFORMBSEATLEASTONCEAMONTHEXAMINEALLBREASTTISSUEWHYDONTMOREWOMENPRACTICEBSEFEAREMBARRASSMENTYOUTHLACKOFKNOWLEDGETOOBUSYFORGETFULNESSCONCLUSIONPHARMACISTSHAVEARESPONSIBILITYASPATIENTADVOCATESFORBREASTCANCERAWARENESSBEFOREGETTINGINTOSYMPTOMSOFBREASTCANCERANDSCREENINGFORBREASTCANCERITHINKITISAPPROPRIATETOTALKJUSTALITTLEBITABOUTTHENORMALPHYSIOLOGYANDANATOMYOFTHEBREASTTHEBREASTISASEBACEOUSGLANDTHATISCOMPOSEDPRIMARILYOFFATTYTISSUEFORPURPOSESOFDESCRIPTIONTHEEXTERNALSTRUCTUREOFTHEBREASTCANBEDIVIDEDINTO4QUADRANTSTHEUPPERINNERQUADRANTTHELOWERINNERQUADRANTTHELOWEROUTERQUADRANTANDTHEUPPEROUTERQUADRANTTHEUPPEROUTERQUADRANTOFTHEBREASTISTHICKERTHANTHEREMAINDEROFTHEBREASTTHISQUADRANTCONTAINSAGREATERBULKOFMAMMARYTISSUETHANTHEOTHERQUADRANTSANDBOTHBENIGNANDMALIGNANTTUMORSOCCURMOSTFREQUENTLYTHERETHEBREASTBORDERSAREPROBABLYMOREEXTENSIVETHANYOUREALIZETHEUPPERBORDEROFBREASTTISSUEBEGINSATTHECOLLARBONETHELOWERBORDERISATTHEBASEOFAPROPERLYFITTEDBRATHEINNERBORDERISTHEEDGEOFTHESTERNUMANDTHEOUTERBORDERISTHEANTERIORAXILLARYLINEWHICHISTHEUNDERARMORARMPITSOMEWOMENHAVETAILSORAXILLARYPROJECTIONSOFBREASTTISSUETHATEXTENDFURTHERTHANTHEANTERIORAXILLARYLINESINTOTHEARMPITITISIMPORTANTTHISTHISAREABEINCLUDEDINTHEBREASTSELFEXAMINATIONTHEINTERNALSTRUCTUREOFTHEBREASTISDIVIDEDINTOLOBESALOTLIKEAGRAPEFRUITEACHLOBEHASACOLLECTIONOFDUCTSTHATEMPTYINTOCENTRALDUCTSANDTHECENTRALDUCTSEMPTYINTOLACTIFEROUSORTHEMILKSECRETINGDUCTSOFTHENIPPLEASSHERRYDISCUSSEDTHEPRIMARYTUMOROFBREASTCANCERSAREUSUALLYDESCRIBEDASLOBULARORDUCTALINGENERALBREASTSSHOULDAPPEARSYMMETRICALANDBALANCEDITSIMPORTANTTONOTEANYRECENTORUNUSUALCHANGEINSIZEORSHAPESIZEOFCOURSEVARIESAMONGWOMENBUTCANVARYONTHESAMEWOMANSLIGHTDIFFERENCESINSIZEANDSHAPEBETWEENBREASTSARENORMALSIZEOFTHEBREASTSCANVARYWITHWEIGHTANDANINCREASEORDECREASEINFATTYTISSUECAN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