Description
Over 40% of the population may experience tinnitus at some point in their lives; older individuals are the most common victims. The perception of sound in the absence of outside stimuli is known as tinnitus. A patient's quality of life, both physically and psychologically, may be significantly impacted. The goal of gathering information from the clinical history is to determine whether the symptoms are unilateral or bilateral, pulsatile or nonpulsatile, and if there is any concomitant hearing loss. Referral to an otolaryngologist is advised for tinnitus that is unilateral or pulsatile, as these characteristics may be linked to more significant underlying disorders.
Résumé
- Breast screening aims to detect cancer early in asymptomatic individuals, reducing treatment needs and mortality. Key components include breast awareness, regular clinical exams by professionals, and imaging like mammography (with tomosynthesis) and, in specific cases, breast MRI. Breast awareness involves familiarity with one's own breasts and monthly self-examinations to detect changes.
- Breast cancer risk assessment is crucial for categorizing individuals as average or increased risk. Risk factors are modifiable (weight, activity, alcohol, hormone replacement therapy, breastfeeding, early childbirth) and non-modifiable (gender, age, genetic mutations, family history, prior chest radiation, early menstruation onset and late menopause, dense breast tissue).
- Increased risk individuals include those with strong family histories, prior thoracic radiation, high-risk model scores, atypical hyperplasia, or genetic predisposition. Screening for increased risk involves clinical exams every 6-12 months, genetic counseling referral, annual mammography/tomosynthesis (starting 10 years prior to the youngest affected family member), and possibly breast MRI.
- For average risk individuals aged 25-40, self-breast exams and clinical exams every 1-3 years are recommended. Those 40+ should undergo clinical exams annually and annual mammography, and self-breast exams. For symptomatic patients, evaluation depends on the presenting signs. Palpable symptoms under 30 warrant ultrasound if clinically suspicious, while those over 30 require scanning and ultrasound.
- Further diagnostic steps depend on findings, including BiRADS categorization and potential biopsies. Nipple inversion, discharge, skin changes, and axillary masses require specific evaluation protocols, incorporating imaging, clinical examination, and tissue sampling. Management also hinges on mammographic and ultrasound BiRADS categories to determine appropriate next steps, from continued screening to core biopsies.
- Familial risk assessment also is guided by existing genetic predispositions and can influence management. Elements contributing to higher risk are family history, age, ethnicity, lifestyle factors, BMI, hormone replacement therapy, atypical hyperplasia, density of breasts and thoracic radiation. Factors that lower risks are early menopause, breastfeeding, managing BMI, exercising, and prior risk-reducing therapy.
- Risk reduction agents, specifically, pre-menopausal patients are offered cylindrical trials or tomoxifen medication. Post-menopausal patients are offered tomoxifen, raloxifine, or aromatic inhibitors. Continuous surveillance and assessment are also necessary due to side effects. Genetic testing, counseling on lifestyle modifications and risk-reducing surgeries are also incorporated.
Exemple de certificat
À propos des intervenants
Dr Bushra Khan
Chirurgien spécialisé dans le cancer du sein, Star Cancer Hospital, Hyderabad
Divulgation financière
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