Definition
Malignant lesion of (predominantly) the female breast.
Key Points
- Breast lump: triple assessment, clinical, radiology, cytology.
- Early breast cancer treatment intent is curative.
- Late breast cancer treatment intent is palliative.
- HER2+ tumours to be treated with trastuzumab (Herceptin®).
Epidemiology
M : F 1:100. >30 years. 1 in 9 women develop breast cancer in their lifetime.
Aetiology
- Female gender, advanced age, personal or family history of breast cancer (genetic factors – BRCA1 or BRCA2 gene mutations).
- Early menarche and late menopause, nulliparity, HRT.
- Smoking, alcohol, fat consumption, lack of exercise and obesity.
- Higher socioecomnomic groups, developed world.
Pathology
- Histology: adenocarcinomas (glandular epithelium). Common types are invasive ductal (80%) or lobular (15%) carcinoma. Paget’s disease is ductal carcinoma-in-situ involving the nipple.
- Spread: lymphatics, direct, haematogenous (lung, liver, bone, brain, adrenal, ovary).
- Staging: TNM classification – important for treatment and prognosis. Also ductal carcinoma-in-situ (DCIS) and stages 0, I, IIA, IIB, IIIA, IIIB and IV (AJCC).
- Molecular subtypes: Luminal A (ER+/PR+/HER2–, low Ki67), Luminal B (ER+/PR+/HER2+ or HER2– high Ki67), Triple negative/basal-like (RE–/PR–/HER2–), HER2 type (ER–/PR–/HER2+).
Screening
- Women aged 50–70 years should be screened for breast cancer every 3 years by two-view (craniocaudal and mediolateral) mammography. Screening from 40 years in high risk groups.
- Participation in national screening programmes reduces breast cancer mortality by 35%.
Clinical Features
- Palpable, hard, irregular, fixed breast lump, usually painless.
- Nipple retraction and skin dimpling.
- Nipple eczema in Paget’s disease.
- Peau d’orange (cutaneous oedema 2° lymphatic obstruction).
- Palpable axillary nodes.
Investigations
- Triple assessment: clinical examination/imaging/cytology.
- Imaging: mammography: mass (irregular, spiculated), asymmetry, microcalcification, distortion. Not used <35 years unless strong clinical suspicion of carcinoma.
ultrasound: women <35 years or part of triple therapy
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