The breast is mainly made up of three components: lobules, ducts, and fatty tissue. Breast cancers that arise from the epithelial cells lining these ducts and lobules are called carcinomas and account for the majority of all breast cancer cases.
Carcinomas of the breast can be found to have either invaded into surrounding tissues (invasive or infiltrating) or not (in situ). In situ carcinomas, such as ductal carcinoma in situ (DCIS), are treated very differently and much less aggressively than its invasive counterpart. The most common breast cancer is the invasive ductal carcinoma and is the focus of this document.
While the primary focus for breast cancer is on women, men can get breast cancer as well. In 2013, there was an estimated ~2200 new cases of invasive breast cancer expected in men in the US
Change in the look or feel of the breast or nipple; breast lump or mass; swelling in all or part of the breast; skin irritation or dimpling; breast or nipple pain; nipple retraction; redness, darkening, warm, scaliness, or thickening of the nipple or breast skin; nipple discharge; swollen lymph nodes under the arm or around the collar bone.
Medical guidelines recommend those at general population risk for breast cancer to have regular screening. Beginning in the 20s, these include: clinical breast exam every 1-3 years, and self-awareness of breast changes. Beginning at age 40-50 these include: annual clinical breast exams, annual mammograms, self-awareness of breast changes.
For those at increased risk (e.g., >20% lifetime risk of breast cancer), the following screening changes may be warranted: clinical breast exams every 6-12 months, annual mammograms and MRIs beginning at age 30 and consideration of other risk reduction strategies. Individuals with greater breast cancer risk may require a more intensive medical management plan.
There are no screening recommendations for men at average-risk but breast self-exam, regular CBEs and mammography screening (particularly in those with gynecomastia) may be considered in men with increased risk.
|Early-advanced stage cancer||
Treatment for small and localized breast tumors typically involve breast-conserving surgery where only the cancer and nearby tissues are removed (lumpectomy). This is often followed by lymph node dissection and/or therapy to reduce the risk of the cancer returning.
More extensive surgery such as removing nearly all breast tissue (modified radical mastectomy) with or without breast reconstruction may be an option.
Radiation, chemotherapy with or without hormone therapy, hormone therapy alone, and/or targeted therapy can all be used as adjuvant treatments. Choices of therapy depend on individual factors such as the presence of hormone receptors. If the breast cancer is not immediately operable, neoadjuvant chemotherapy may be recommended.
|Metastatic stage cancer||
The primary treatment is with systemic therapy, which may include hormone therapy, chemotherapy, targeted therapies, and/or some combination of these treatments. Palliative interventions are often used in patients with metastatic cancers in order to prevent/ relieve symptoms.
Demographics: Older age; female gender
Lifestyle: Obesity; alcohol consumption; physical inactivity
Medical History: Previous history of breast cancer, LCIS, proliferative breast conditions with or without atypia; dense breast tissue; post-menopausal estrogen and progesterone hormone therapy; previous chest wall radiation exposure; diethylstilbestrol (DES) exposure; nulliparity; age of first pregnancy >30 years
Risk reduction options: Multiple pregnancies; pregnancy >age 30; breastfeeding; physical activity; preventive mastectomy; pre-menopausal oophorectomy; chemopreventive drugs such as Tamoxifen and Raloxifene
Inherited: Family history of disease; inherited genetic syndromes
Associate Genes: BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, PALB2, CHEK2, CHEK2 Biallelic, ATM, NBN, BARD1, NTHL1 Biallelic
Associated Myriad MyRisk™ Genes: BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, PALB2, CHEK2, ATM, NBN, BARD1, BRIP1, RAD51C