breast%20cancer
BREAST CANCER
Breast cancer is the presence of malignant breast nodule, mass or abscess.
Most common symptom of breast cancer is a new lump or mass in the breast. The lump or mass is usually painless, hard & irregular but it can also be tender, soft, rounded or painful.
Other signs & symptoms include breast pain or nipple pain, nipple discharge, nipple retraction and presence of breast skin changes (eg peau d' orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess).

Breast%20cancer Signs and Symptoms

Introduction

  • Refers to both invasive and in situ carcinoma of the breast
  • Most common and frequently diagnosed noncutaneous cancer in women

Signs and Symptoms

  • Presence of breast nodule, mass, or abscess
    • Most common symptom of breast cancer is a new lump or mass in the breast
    • Painless, hard, and irregular mass is more likely to be cancerous, but can also be tender, soft, rounded, or painful
  • Breast pain or nipple pain (very rare)
  • Nipple discharge
  • Nipple retraction
  • Presence of breast skin changes (eg peau d’ orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess)

Risk Factors

  • History of breast cancer
    • Previous history of breast cancer has an increased risk of developing new primary breast cancer
      • History of invasive breast cancer, lobular neoplasia [formerly called lobular carcinoma in situ (LCIS)] and ductal carcinoma in situ (DCIS) have the highest risk
      • Lifetime risk at >20% based on history of LCIS or atypical ductal hyperplasia (ADH)/atypical lobularhyperplasia (ALH)
    • Woman ≥35 years with a 5-year risk ≥1.7% for invasive breast cancer

  • Confirmed biopsy of benign proliferative breast disease
    • Breast tissue biopsy showing proliferative disease with and without atypical cells has an elevated risk of developing breast cancer
      • Patients with benign breast disease that presents with atypical hyperplasia carry the highest risk

  • History of high-dose radiation exposure
    • Multiple exposures of therapeutic radiation to the chest for cancer at an early age (<20 years old) increase the risk of breast cancer
    • Contralateral breast cancer has been shown to develop after high-dose radiation exposure
    • Patients with Hodgkin’s disease receiving radiotherapy at high doses are also at risk

  • Reproductive factors
    • Nulliparity or first full-term pregnancy at age >30 years
      • Breastfeeding for >12 months is protective against breast cancer
    • Menarche at age <12 years and menopause at age >55 years
    • Oral contraceptive use before the first full-term pregnancy, combination hormone replacement therapy, and long-term use of unopposed estrogen for >15 years by hysterectomized women have mild increased risk for breast cancer
      • Use of low-dose preparations poses a lower risk

  • Advanced age
    • Risk increases from 40 years old for premenopausal women and 50 years old for postmenopausal women

  • Family history of breast cancer
    • Increased risk in women with breast cancer among young first-degree relatives
      • Sister has a higher risk than a mother
    • Carriers of BRCA1 and BRCA2 genetic mutations are also at high risk
      • Women with these have increased risk of developing other cancers like ovarian cancer
      • Other genes associated with genetic susceptibility to breast cancer include PTEN, TP53, CDH1, STK11, MLH1, MSH2, MSH6, and PMS2; genes currently being investigated include PALB2, CHEK2, ATM, RAD51C, RAD51D, and BRIP1
  • Breast density
    • Higher breast density has increased risk
    • Lifestyle
      • Body mass index of >25 has an increased risk of developing breast cancer with higher death rate
        • 7 hours/week of moderate to vigorous exercise was shown to be inversely related to breast cancer development
      • Alcohol consumption (eg beer) of >10 g/day especially in postmenopausal women has increased risk for invasive breast cancer
    Digital Edition
    Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
    Sign In To Download
    Editor's Recommendations
    Most Read Articles
    01 Dec 2020
    Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
    Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
    Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
    Jairia Dela Cruz, 3 days ago
    Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
    3 days ago
    Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.