Treatment Guideline Chart
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


  • 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 lobular hyperplasia (ALH)

  • Previous history of epithelial ovarian or exocrine pancreatic cancer at any age, or prostate cancer at any age with metastatic, intraductal or cribriform histology, those belonging to high- or very high-risk group, or with the following family history: Ashkenazi Jewish ancestry, ≥1 close relative with breast cancer at ≤50 years of age or ovarian, pancreatic, metastatic, or intraductal/cribriform prostate cancer at any age, or ≥2 close relatives with breast or prostate cancer at any age 
  • 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 (<30 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
    • Woman ≥35 years with a 5-year risk ≥1.7% for invasive breast cancer assessed using the modified Gail model
      • Modified Gail model calculates the 5-year and lifetime probabilities of developing invasive breast cancer which can be used to identify women at increased risk by evaluating the risk of invasive breast cancer as a function of age, menarche, age at 1st live birth or nulliparity, number of 1st-degree relatives with breast cancer, number of benign breast biopsies, atypical hyperplasia in a previous breast biopsy and race  
    • 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
  • Individuals with characteristics for Li-Fraumeni syndrome (LFS) or Cowden syndrome/PTEN hamartoma tumor syndrome testing criteria 
  • 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
    • Lack of exercise
    • Alcohol consumption (eg beer) of >10 g/day especially in postmenopausal women has increased risk for invasive breast cancer

Risk Factors for Disease Recurrence

  • Palpable mass
  • Larger mass size
  • Higher grade tumors
  • Close or involved margins
  • Age <50 years
  • Presence of lymphovascular space invasion
  • Lymph node involvement
  • Human epidermal growth factor receptor 2 (HER2) status of the cancer cells
  • Proliferative marker Ki67 index
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