By J. Michael Dixon
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Additional info for ABC of Breast Diseases, 3rd edition (ABC Series)
01 0 0 1 2 3 4 5 6 7 Time (years) Effect of HRT on risk of breast cancer. Data from women’s health institute (WHI) study, a randomised trial comparing combined HRT with placebo. Data are based on women who were taking HRT. 5 Risk of breast cancer related to type of HRT. Adapted from the Million Women Study, Lancet 2003;362:419–27 Weight Obesity is associated with a twofold increase in the risk of breast cancer in postmenopausal women, whereas before the menopause it is associated with a slightly reduced incidence.
Such patients may undergo many investigations and operations before the nature of the disease is recognised. The diagnosis is difficult to establish but should be considered when the clinical situation does not conform to common appearances or pathological processes. There is often a history of multiple visits to both general practitioner and hospital with various symptoms. Psychiatric referral may help in establishing the diagnosis but there is no recognised effective therapy. Factitial disease is caused by repetitive trauma.
Breast infection Other infections and inflammatory conditions Tuberculosis of the breast is now rare and can be primary or, more commonly, secondary. Clues to its diagnosis include the presence of a breast or axillary sinus in up to half of patients. The commonest presentation of tuberculosis nowadays is with an abscess resulting from infection of a tuberculous cavity by an acute pyogenic organism such as S aureus. An open biopsy is often required to establish the diagnosis. Treatment is by a combination of surgery and antituberculous chemotherapy.