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1. Mastalgia — Causative factors, etiopathogenesis chart, clinical features, investigations, complications, management algorithm
2. Fibroadenoma — Causative factors, MED12/RARA pathogenesis chart, clinical features, triple assessment, complications, management algorithm
3. Carcinoma Breast — Risk factors, multi-step carcinogenesis chart (in-situ → invasive → metastatic), clinical features by stage, TNM staging, pharmacological table, surgical options, comprehensive treatment algorithm

Key Highlights for Exam

MASTALGIA

• Cyclic (2/3 of cases): bilateral, premenstrual, 3rd–4th decade → estrogen-driven
• Non-cyclic (1/3): unilateral, constant/burning, 4th–5th decade → harder to treat
• Only FDA-approved drug: Danazol (synthetic androgen)
• First line: well-fitted bra + exercise + reassurance
• Second line: topical/oral NSAIDs
• Third line: Tamoxifen or Ormeloxifene (SERMs)
• Fourth line: Danazol → Bromocriptine

FIBROADENOMA

• Most common benign breast tumor; MED12 mutations in 2/3 of cases
• "Breast mouse" — firm, rubbery, freely mobile, non-tender
• 15% spontaneous regression; 5–10% grow; NOT a cancer precursor
• Management: observation if classic imaging + benign FNAC; excise if >3 cm, growing, or atypical
• Minimally invasive: vacuum-assisted biopsy or cryoablation

CARCINOMA BREAST

• BRCA1/2 → 50–85% lifetime risk (autosomal dominant)
• Triple assessment = Clinical + Imaging + Histology (core needle biopsy for receptor status)
• Molecular subtypes: Luminal A (best) → Triple Negative (worst prognosis)
• BCS + radiotherapy = MRM in survival terms (Stages I–II)
• Sentinel lymph node biopsy before axillary dissection
• Adjuvant: Tamoxifen (premenopausal ER+); Aromatase inhibitors (postmenopausal ER+); Trastuzumab (HER2+); Pembrolizumab + AC-T (TNBC)
• Metastatic HR+: CDK4/6 inhibitors (Palbociclib + Letrozole); BRCA mutated: PARP inhibitors (Olaparib)