Snapshot A 51-year-old woman presents to her primary care physician with a lump in her right breast. She says it has been there for around a year. Mammography shows a dominant mass with an irregular fibrotically stranded boundary, with some of the strands seeming to extend toward the nipple. A core biopsy was done and showed the following histology. Introduction Overview most common type of breast cancer infiltrating ductal carcinoma accounts for ~76% of breast cancer cases forms a solid tumor most common cancer diagnosis in women Epidemiology Demographics commonly women in mid-30s to late-50s Incidence 260,000 cases per year in U.S. 40,000 deaths per year Risk factors increasing age female sex breast cancer can occur in men < 3,000 cases per year in U.S. Caucasian race obesity in post-menopausal women hormone replacement therapy ETIOLOGY Genetics inheritance increased risk with BRCA1 and BRCA2 gene mutation mutations cancer cells can be estrogen (ER)-positive, progesterone (PR)-positive, or HER2/neu-positive guides targeted treatment Presentation Symptoms asymptomatic breast lump most often in upper/outer quadrant nipple discharge Physical exam firm immobile, painless lump +/- inverted nipple +/- skin changes redness ulcerations edema nodularity login to view 1 more bullet axillary lymohadenopathy more advanced cases breast skin edema with dimpling ("peau d' orange") is a finding with a poor prognosis represents obstruction of the lymphatics cancer See Breast Cancer General Imaging Mammography indications regular screening mammography evaluation following detection of a breast lump findings mass with an irregular, fibrotically stranded border Core or excisional biopsy indications diagnosis findings gross pathology login to view 1 more bullet histology login to view 3 more bullets Stage with TNM Staging System Studies Serum calcium level may be elevated Alkaline phosphatase elevation may indicate metastasis Hormone receptor tests ER PR Her2/neu Differential Invasive lobular carcinoma key distinguishing factors gross pathology login to view 1 more bullet histology login to view 2 more bullets Ductal carcinoma in situ (DCIS) key distinguishing factor no evidence of invasion on biopsy Treatment Medical chemotherapy indications login to view 3 more bullets modalities login to view 2 more bullets hormone therapy indications login to view 1 more bullet modalities login to view 3 more bullets radiation indications login to view 1 more bullet Surgical modified radical mastectomy indications login to view 6 more bullets lumpectomy indications login to view 2 more bullets always followed by postoperative radiation therapy sentinel lymph node biopsy indications login to view 3 more bullets Complications Metastasis Recurrence majority of recurrences occur within first 5 years Death Prognosis Tumor size is most important prognostic factor Metastasis associated with poorer prognosis Second most common cause of cancer-related death in women