Breast cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Breast cancer was first described in Egyptian literature. In 1976, mammography became officially recommended by the American cancer society for screening breast cancer. Breast cancer may be classified according to anatomy into 4 subtypes: ductal, lobular, sarcoma, and lymphoma. Genes involved in the pathogenesis of breast cancer include BRCA1, BRCA2 and p53. On microscopic histopathological analysis, minimal tubule formation marked pleomorphism, and numerous mitotic figures are characteristic findings of breast cancer. Breast cancer must be differentiated from other diseases that cause mass in the breast such as fibroadenoma, fibrocystic disease of the breast, mastitis, galactocele, traumatic fat necrosis, intraductal papilloma, and lipoma. The prevalence of breast cancer is approximately 124.8 per 100,000 women per year. The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data. Common risk factors in the development of breast cancer are family history, dense breast, obesity, radiation therapy, older age at first birth or never having given birth, hormone replacement therapy, and alcohol. Symptoms of breast cancer include a lump in the breast, discharge from the nipple, and thickening of the skin. A breast biopsy may be helpful in the diagnosis of breast cancer. Breast cancer chemotherapy refers to the use of cytotoxic drugs (chemotherapy) in the treatment of breast cancer. The aim of chemotherapy is to prevent the growth of micrometastatic disease that is responsible for systemic disease recurrence. Surgery is the mainstay of treatment for breast cancer.
Historical Perspective
Breast cancer was first described in Egyptian literature. In 1976, mammography became officially recommended by the American cancer society for screening breast cancer.
Classification
Breast cancer may be classified according to anatomy into 4 subtypes: ductal, lobular, sarcoma, and lymphoma.
Pathophysiology
Genes involved in the pathogenesis of breast cancer include BRCA1, BRCA2 and p53. On microscopic histopathological analysis, minimal tubule formation marked pleomorphism, and numerous mitotic figures are characteristic findings of breast cancer.
Causes
The cause of breast cancer is not yet known exactly, though many risk factors can increase the chance of developing breast cancer.
Differentiating Epithelioid sarcoma from other Diseases
Breast cancer must be differentiated from other diseases that cause mass in the breast such as fibroadenoma, fibrocystic disease of the breast, mastitis, galactocele, traumatic fat necrosis, intraductal papilloma, and lipoma.
Epidemiology and Demographics
The prevalence of breast cancer is approximately 124.8 per 100,000 women per year. The number of deaths was 21.9 per 100,000 women per year, based on 2010-2012 data.
Risk Factors
Common risk factors in the development of breast cancer are family history, dense breast, obesity, radiation therapy, older age at first birth or never having given birth, hormone replacement therapy, and alcohol.
Screening
According to the U.S. Preventive Service Task Force (USPSTF), screening for breast cancer by a mammogram is recommended for women aged 50-74 years, twice a year.
Natural history, Complications and Prognosis
If left untreated, 22% of patients with breast cancer may regress. Common complications of breast cancer include metastasis. Prognosis is generally good with treatment.
Staging
Breast cancer may be classified according to anatomy into 4 subtypes: ductal, lobular, sarcoma, and lymphoma.
History and Symptoms
Symptoms of breast cancer include a lump in the breast, discharge from the nipple, and thickening of the skin.
Physical Examination
Patients with breast cancer usually are generally well appearing. Physical examination of patients with breast cancer is usually remarkable for a lump in the breast, peau d'orange, an inverted nipple.
Laboratory tests
An elevated concentration of serum alkaline phosphatase is diagnostic of bone metastasis of breast cancer.
Mammography
Mammography may be performed to detect breast cancer.
MRI
MRI may be performed to detect metastases of breast cancer and to determine anatomic boundaries.
Ultrasound
Breast ultrasound may be helpful in the diagnosis of breast cancer, especially, to further evaluate an abnormal mammogram and to distinguish between solid and cystic lesions. Ultrasonography is the first-line imaging method in pregnant women and women less than 30 years old with focal breast sign and symptoms. AlthoughUltrasonography might be used as an adjunct to mammography in women with increased breast density, it has not been shown to decrease mortality from breast cancer. Nevertheless, using ultrasound may increase the risk for false-positive findings, unnecessary breast biopsy, and follow-up imaging.
It has been shown that heart failure is prevalent in women being treated with this novel treatment. As a potentially serious side effect of this novel treatment, serial Echocardiography is recommended in all patients treated with trastuzumab.
Other Imaging Studies
Other diagnostic studies for breast cancer include modified MRI utilities (high-field strength MRI, magnetic resonance spectroscopy, and diffusion weighted imaging, breast-specific gamma imaging, positron emissionmammography, scintimammography, thermography and bone scan.
Other Diagnostic Studies
Other diagnostic studies for breast cancer is hormone receptor testing.
Biopsy
Breast biopsy the only definite way to diagnose breast cancer. Hence, every patient with a suspicious lesion in her/his breast needs a biopsy to evaluate the nature of the mass precisely. Nevertheless, a large number of biopsy samples taken from breast lumps are found to be benign.
Chemotherapy
Breast cancer chemotherapy is a combination of cytotoxic drugs (chemotherapy), hormonal therapy, hormonal receptor modulators, aromatase inhibitors, monoclonal antibodies, and growth factor receptor tyrosine kinase inhibitors
Surgery
Surgery is the mainstay of treatment for breast cancer.
Bone Metastasis
- Bone is the most common site of breast cancer distant spread. Bone metastases due to the breast cancer cause major morbidity, decrease survival and reduce the quality of life of many patients. Rather than systemic chemotherapy, bisphosphonates like Pamidronate, Alendronate, Ibandronate, Risedronate, and Zoledronic acid , RANKL-RANK inhibitors like Denosumab, also has been recommended and studied for the treatment of bone metastases..Additionally, External beam radiotherapy (EBRT) has been, and continues to be, the mainstay for the treatment of painful, uncomplicated bone metastases.
Primary Prevention
Avoiding risk factors and increasing protective factors may help prevent cancer.
Future or Investigational Therapies
Medical investigational therapies are a wide range of new generations of targeted therapy, cancer vaccines, oncolytic virotherapy, gene therapy, and immunotherapy. Novel surgical and radiation techniques are also under investigation. A new generation of clinical trials (adaptive trials) are already being used in the war against breast cancer (i.e. I-SPY 2).