• Single, nontender, firm-to-hard mass with ill-defined margins
• Mammographic abnormalities
• No palpable mass
• Skin or nipple retraction
• Axillary lymphadenopathy
• Breast enlargement, redness, edema, pain
• Fixation of mass to skin or chest wall
• Supraclavicular lymphadenopathy
• Edema of arm
• Bone, lung, liver, brain, or other distant metastases
• Most common site of cancer in women
• Second to lung cancer as a cause of death from cancer in women
• Mean and median age for breast cancer is between 60 and 61 years
• About 182,460 new cases in 2008
• About 40,480 deaths in 2008
• Lifetime risk is between 1 in 8 and 9
• 90% of patients have no family history
• About 50% of patients will have involved axillary nodes at presentation
• 35-50% of breast cancers are found on mammogram alone
• 33% of abnormalities seen on mammogram are found to be malignant
• Distribution of cancers by quadrant: 45% in upper outer, 15% in upper inner, 5% in lower inner, 10% in lower outer, 25% in subareolar
• 1-3% of persons with ductal carcinoma in situ have an associated invasive carcinoma; untreated, invasive ductal carcinoma will eventually develop in the ipsilateral breast in 40-60% of women with DCIS
• An invasive malignancy develops (in either breast) in 20% of persons with lobular carcinoma in situ
• 1-2% of breast cancers occur during pregnancy or lactation
• Malignant pleural effusions develop in nearly 50% of patients with metastatic disease
• Palpable mass (90% detected first by patient)
• Pain (less common for malignant disease than benign disease)
• Nipple discharge, especially bloody
• Nipple erosion
• Breast erythema or edema
• Skin or nipple retraction/dimpling
• Thickening in a portion of the breast
• Adenopathy: Axillary or supraclavicular
• Pathologic analysis of tissue sample taken via fine-needle aspiration, core needle biopsy, stereotactic core needle biopsy, or open excision biopsy
• Serum markers for advanced breast cancer or metastatic disease include elevated ESR, elevated alkaline phosphatase, hypercalcemia, carcinoembryonic antigen, CA 15-3, CA 27-29
• Mammographic abnormality of increased density with microcalcifications and irregular border
• US demonstration of solid mass (versus cyst—usually benign)
• Chest film may show pulmonary metastases
• CT scan of the liver or brain may demonstrate metastases
• Bone scan may show increased uptake reflecting disease metastatic to bone
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