Concerning gynecomastia, which of the following is true?
In gynecomastia, the ductal structures of the male breast enlarge, elongate, and branch with a concomitant increase in epithelium. During puberty, the condition often is unilateral and typically occurs between ages 12 and 15. In contrast, senescent gynecomastia is usually bilateral. Gynecomastia generally does not predispose the male breast to cancer. However, the hypoandrogenic state of Klinefelter syndrome (XXY), in which gynecomastia is usually evident, is associated with an increased risk of breast cancer. Gynecomastia is graded based on the degree of breast enlargement, the position of the nipple with reference to the inframammary fold and the degree of breast ptosis and skin redundancy:
Inflammatory conditions of the breast include all of the following EXCEPT:
Zuska disease, also called recurrent periductal mastitis, is a condition of recurrent retroareolar infections and abscesses. Hidradenitis suppurativa of the nipple-areola complex or axilla is a chronic inflammatory condition that originates within the accessory areolar glands of Montgomery or within the axillary sebaceous glands. Mondor disease is a variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast.
Lesions with malignant potential include all of the following EXCEPT:
Sclerosing adenosis is prevalent during the childbearing and perimenopausal years and has no malignant potential. Multiple intraductal papillomas, which occur in younger women and are less frequently associated with nipple discharge, are susceptible to malignant transformation. Individuals with a diagnosis of atypical ductal hyperplasia (ADH) are at increased risk for development of breast cancer and should be counseled appropriately regarding risk reduction strategies. Atypical lobular hyperplasia (ALH) results in minimal distention of lobular units with cells that are similar to those seen in lobular carcinoma in situ (LCIS).
Risk factors for the development of breast cancer include:
Increased exposure to estrogen is associated with an increased risk for developing breast cancer, whereas reducing exposure is thought to be protective. Correspondingly, factors that increase the number of menstrual cycles, such as early menarche, nulliparity, and late menopause, are associated with increased risk. Moderate levels of exercise and a longer lactation period, factors that decrease the total number of menstrual cycles, are protective.
Drugs useful in breast cancer prevention include:
The P-2 trial, the Study of Tamoxifen and Raloxifene (known as the STAR trial), randomly assigned 19,747 postmenopausal women at high risk for breast cancer to receive either tamoxifen or raloxifene. The initial report of the P-2 trial showed the two agents were nearly identical in their ability to reduce breast cancer risk, but raloxifene was associated with a more favorable adverse event profile. An updated analysis revealed that raloxifene maintained 76% of the efficacy of tamoxifen in prevention of invasive breast cancer with a more favorable side-effect profile. Aromatase inhibitors (Ais) have been shown to be more effective than tamoxifen in reducing the incidence of contralateral breast cancers in postmenopausal women receiving Ais for adjuvant treatment of invasive breast cancer.
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