Breast Cancer, Female

• • 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

Early Findings

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

  • Mammographic abnormalities

  • No palpable mass

Later Findings

• • Skin or nipple retraction

  • Axillary lymphadenopathy

  • Breast enlargement, redness, edema, pain

  • Fixation of mass to skin or chest wall

Late Findings

• • Ulceration

  • Supraclavicular lymphadenopathy

  • Edema of arm

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

Epidemiology

• • 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

Symptoms and Signs

• • 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

Laboratory Findings

• • 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

Imaging Findings

• • 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

• • Risk factors include:

  • -Family history ...