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).

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 w/ genetic susceptibility to breast cancer include PTEN, TP53, CDH1, STK11, MLH1, MSH2, MSH6, & PMS2; genes currently being investigated include PALB2, CHEK2, ATM, RAD51C, RAD51D, & 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 Oncology - Malaysia digital copy today!
    Sign In To Download
    Editor's Recommendations
    Most Read Articles
    Natalia Reoutova, 21 Nov 2019

    Final analysis of the POEMS (Prevention of Early Menopause) study finds that breast cancer (BC) patients treated with the gonadotrophin-releasing hormone agonist (GnRHa) goserelin, in addition to chemotherapy, are more likely to avoid premature menopause and to become pregnant without negatively impacting disease-related outcomes.

    Dr. Jay Zhu, Dr. Lai Fung Li, Prof. Chae-Yong Kim, 27 Nov 2019
    The current standard of care for glioblastoma multiforme (GBM), an aggressive primary brain tumour with a rapid disease course, consists of maximum safe surgical resection followed by radiotherapy with concomitant temozolomide (TMZ) chemotherapy and subsequent TMZ maintenance. At the 16th Annual Meeting of the Asian Society of Neuro-Oncology (ASNO) in Taipei, Taiwan, experts reviewed the evidence and shared their clinical experience on the use of tumour treating fields (TTFields), a novel treatment modality for GBM.