Female Breast Carcinoma Flashcards
What is the incidence of carcinoma in breast?
1 in 8 women
Second most common cancer in women
Second leading cause of cancer death
Risk roses until early 60s and peaks in 70s, then declines
What are the risk factors?
Family history of breast or ovarian cancer. Parent, sibling or child. Especially bilateral breast cancer of premenopausal.
BRCA 1, BRCA2
Nulliparous or late first pregnancy after age 30
Early menarche under 12
Late menopause after 55
What screening test is used?
Mammography screening
Most reliable means of detecting breast cancer before a mass can be palpate
Most slow growing cancers can be identified by mammography at least 2 years before they are palpable
What are the timings for mammography?
Age under 40
No recommended for average risk women
Age 40-49
Shared decision making
Suggest screening every two years for women who elect
Age 50-74
Recommend every two years
Unless prior screenings indicate otherwise
Age 75 or older
Only recommend if life expectancy is greater than ten years
Is breast self examination recommended?
Has not been shown to improve survival
American cancer society no longer recommended
Patients should recognize and report any breast changes
What are the early symptoms of breast cancer?
70% of patients present with a usually painless lump
About 90% of these are discovered by patients
Less frequent symptoms
Breast pain
Nipple discharge
Erosion, retraction, enlargement or itching of the nipple
Redness, generalized hardness, enlargement or shrinking of the breast
What are the rare signs and symptoms?
Axillary mass or swelling
Back or joint pain
Jaundice
Weight loss
What physical exam findings will you have early on?
Single, non-tender, form to hard mass with Ill defined margins
Mammography abnormalities and no palpable mass
What are late physical exam findings?
Skin or nipple retraction
Axillary lymphadenopathy
Breast enlargement, erythema, edema, pain
Fixation of mass to skin or chest wall
What are some lab findings?
Alkaline phosphatase
Liver or bone metastases cause elevation
Serum calcium
Elevated with bone metastases
What are the treatments for breast cancer?
All breast masses should be referred to general surgery for further evaluation and work up.
Depends on stage of cancer.
Surgical resection with axillary node dissection
Breast conserving therapy
Mastectomy
Radiation
Systemic therapy
Chemotherapy
Targeted therapy
Biphosphonates
What is the prognosis?
Stage of cancer is most reliable indicator of prognosis.
More aggressive are associated with worse outcomes in younger women.
What is the follow up?
After primary therapy patients should be monitored long term in order to detect recurrences
Local and distant recurrences occur most frequently within the first 2-5 years
During first 2 years, most patients should be examined every 6 months
Annually thereafter
A primary breast malignancy will develop contra laterally in how many patients?
20-25%
