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  • • Higher incidence in women who have delayed childbearing, those with family history of breast cancer, and those with a personal history of breast cancer or some types of mammary dysplasia

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Early Findings

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  • • Single, nontender, firm-to-hard mass with ill-defined margins

    • Mammographic abnormalities

    • No palpable mass

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Later Findings

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  • • Skin or nipple retraction

    • Axillary lymphadenopathy

    • Breast enlargement, redness, edema, pain

    • Fixation of mass to skin or chest wall

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Late Findings

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  • • Ulceration

    • Supraclavicular lymphadenopathy

    • Edema of arm

    • Bone, lung, liver, brain, or other distant metastases

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Epidemiology

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  • • 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

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Symptoms and Signs

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  • • 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

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Laboratory Findings

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  • • 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

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Imaging Findings

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  • • 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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  • • Risk factors include:

    • -Family history of breast cancer (especially premenopausal or bilateral ...

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