Breast Cancer

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Contents

More Specific Terms

Classification

  • carcinoma, NOS (not otherwise specified)
  • ductal
  • other
  • 10 distinct clinical subtypes based on genetic analysis [78]

Etiology

Epidemiology

  • most common cause of cancer-related death in women age 35-54
  • 10-12% of women will develop breast cancer
  • 3.5% will die of the disease
  • incidence is 20% higher in whites
  • mortality rates are 15% higher in blacks

Pathology

  • lymph nodes (60-80%)
  • liver (40-60%)
  • lung (66%)
  • bone (62%)
  • brain (23%);
  • ER(+): 0.7%; ER(-): 1.9% [46]
  • ER(-), PR(-), HER2(-): 9.6% (5-year incidence) [46]

Genetics

  • 10% incidence at age 47 within 2 years
  • overexpression in 15-25% of cases
  • overexpression predicts more aggressive disease

Clinical-manifestations

Laboratory

Radiology

Complications

Differential-diagnosis

Management

  • staging/prognosis
  • treatment modalities
  • standard of care for all patients with early disease [14]
  • hormonal ( tamoxifen or aromatase inhibitor) or chemotherapy not recommended for node-negative tumors < 0.5 cm in size
  • tamoxifen recommended for
  • Ca+2, vitamin D & bisphosphonate may be appropriate*
  • extending the duration of aromatase therapy beyond 5 years enhances disease-free survival & possibly lowers breast cancer-related mortality [43]
  • reduces risk of recurrence, 2nd primary cancer, & mortality
  • may benefit HER2/neu-positive (node-positive) patients [4]
  • aspirin & perhaps other NSAIDs appear to lower mortality in women with breast cancer [49]
  • prognosis
  • prognosis better with estrogen receptor positive tumors
  • prognosis worse with increasing age
  • prognosis worse after recent pregnancy [20]
  • prognosis improved by exercise [30], as little as 3-5 hours walking weekly at 2-3 miles/hour
  • comorbidities partly explains racial differences in survival [34]
  • see staging of breast cancer (5 year survival by initial staging)
  • 70% of symptomatic recurrences occur between scheduled exams [37]
  • prognosis for multicentric disease similar to unicentric disease [38]
  • invasive breast cancers may regress [43]
  • local tumor recurrence correlates with risk of distant metastases [51]
  • prognosis is improved with a multidisciplinary team approach [59], but cost-effectiveness is unknown

More General Terms

Additional Terms

Internet Database

OMIM: 114480

References

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  2. Northern California Kaiser Permanente Videoconference, Nov. 11, 1999
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  4. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
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  26. Journal Watch 24(20):153, 2004
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  27. Journal Watch 24(21):164, 2004 Warner E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, Cutrara MR, DeBoer G, Yaffe MJ, Messner SJ, Meschino WS, Piron CA, Narod SA. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA. 2004 Sep 15;292(11):1317-25. PMID: [22]
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  29. Journal Watch 25(8):67, 2005 Olsen AH, Njor SH, Vejborg I, Schwartz W, Dalgaard P, Jensen MB, Tange UB, Blichert-Toft M, Rank F, Mouridsen H, Lynge E. Breast cancer mortality in Copenhagen after introduction of mammography screening: cohort study. BMJ. 2005 Jan 29;330(7485):220. Epub 2005 Jan 13. <PubMed> PMID: [25] <Internet> [26]
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  39. Wolff AC, Hammond ME, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, Dowsett M, Fitzgibbons PL, Hanna WM, Langer A, McShane LM, Paik S, Pegram MD, Perez EA, Press MF, Rhodes A, Sturgeon C, Taube SE, Tubbs R, Vance GH, van de Vijver M, Wheeler TM, Hayes DF; American Society of Clinical Oncology; College of American Pathologists. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007 Jan 1;25(1):118-45. Epub 2006 Dec 11. <PubMed> PMID: [39] <Internet> [40]
  40. The Role of Gemcitabine in the Management of Metastatic Breast Cancer: A Clinical Practice Guideline Dent S et al, Program in Evidence-based Care (PEBC) [41]
  41. The Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trialists' Group Effect and anastrozole and tomoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008, 9:45 PMID: [42]
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    - Mamounas EP et al Benefit from exemestane as extended adjuvant therapy after 5 years of adjuvant tamoxifen: Intention-to-treat analysis of the National Surgical Adjuvant Breast and Bowel Project B-33 Trial. J Clin Oncol 2008 Apr 20; 26:1965. PMID: [44]
    - Goss PE et al. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. J Clin Oncol 2008 Apr 20; 26:1948. PMID: [45]
  43. Zahl PH et al The Natural History of Invasive Breast Cancers Detected by Screening Mammography Arch Intern Med. 2008;168(21):2311-2316. PMID: [46]
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  44. Miller K et al. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 2007 Dec 27; 357:2666. PMID: &dopt=Abstract
    - FDA advisory committee does not recommend approval for Avastin for breast cancer. [48]
    - FDA MedWatch Avastin (bevacizumab): Process for Removal of Breast Cancer Indication Begun [49]
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  45. Simmons C et al. Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases? Ann Oncol 2009 Mar 18; [e-pub ahead of print] <PubMed> PMID: [51] <Internet> [52]
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  47. Morrow M et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA 2009 Oct 14; 302:1551. PMID: [55]
  48. Gartner R et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009 Nov 11; 302:1985. PMID: [56]
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  49. Holmes MD et al. Aspirin intake and survival after breast cancer. J Clin Oncol 2010 Feb 16; <PubMed> PMID: [58] <Internet> [59]
  50. Punglia RS et al Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: Retrospective cohort analysis. BMJ 2010 Mar 2; 340:c845 [60] PMID: [61]
  51. Botteri E et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol 2010 Apr; 21:723. PMID: [62]
  52. Burstein HJ et al. American Society of Clinical Oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 2010 Jul 12 PMID: [63]
  53. Muss HB, D'Alessandro HA, Brachtel EF. Case 15-2010 - an 85-year-old woman with mammographically detected early breast cancer. N Engl J Med 2010; 362:1921-1928; May 20, 2010. PMID: [64]
  54. Giuliano AE et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized clinical trial. JAMA 2011 Feb 9; 305:569-575 <PubMed> PMID: [65] <Internet> [66]
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  55. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011 Nov 12; 378:1707 PMID: [69]
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  59. Kesson EM et al. Effects of multidisciplinary team working on breast cancer survival: Retrospective, comparative, interventional cohort study of 13,722 women. BMJ 2012 Apr 26; 344:e2718. PMID: [79]
  60. Breast Cancer (PDQ): Treatment [80]
    - Breast Cancer and Pregnancy (PDQ) [81]
    - Male Breast Cancer (PDQ): Treatment [82]
    - Breast Cancer: NIH Institute and Center Resources [83]
    - Cellular Classification of Breast Cancer [84]
  61. National Guideline Clearinghouse
    - General:
    - Breast cancer. (Intracorp) ngc-guideline: [85]
    - Breast cancer in limited-resource countries: diagnosis and pathology. (Breast Health Global Initiative) ngc-guideline: [86]
    - Breast cancer in limited-resource countries: early detection and access to care. (Breast Health Global Initiative) ngc-guideline: [87]
    - Breast cancer in limited-resource countries: treatment and allocation of resources. (Breast Health Global Initiative) ngc-guideline: [88]
    - Hereditary breast and ovarian cancer syndrome. American College of Obstetricians and Gynecologists ngc-guideline: [89]
    - Breast cancer. In: Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities. New Zealand Guidelines Group ngc-guideline: [90]
    - Screening:
    - Breast cancer screening (American College of Obstetricians and Gynecologist) ngc-guideline: [91]
    - Risk assessment and genetic counseling for hereditary breast and ovarian cancer: recommendations of the National Society of Genetic Counselors. National Society of Genetic Counselors ngc-guideline: [92]
    - Risk reduction
    - American Society of Clinical Oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction ngc-guideline: [93]
    - Breast Health Global Initiative
    - Guideline implementation for breast healthcare in low- and middle-income countries: breast healthcare program resource allocation. ngc-guideline: [94]
    - Guideline implementation for breast healthcare in low- and middle-income countries: diagnosis resource allocation. ngc-guideline: [95]
    - Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. ngc-guideline: [96]
    - Guideline implementation for breast healthcare in low- and middle-income countries: treatment resource allocation. ngc-guideline: [97]
    - Markers:
    - American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. ngc-guideline: [98]
    - American Society of Clinical Oncology 2007 update recommendations for the use of tumor markers in breast cancer. ngc-guideline: [99]
    - Recommendations from the EGAPP Working Group: can tumor gene expression profiling improve outcomes in patients with breast cancer? Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group ngc-guideline: [100]
    - American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. ngc-guideline: [101]
    - Staging:
    - Stage 1 breast carcinoma (American College of Radiology) ngc-guideline: [102]
    - Staging. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [103]
    - Imaging:
    - Diagnostic imaging in breast cancer. (Program in Evidence-based Care) ngc-guideline: [104]
    - Pregnancy
    - Pregnancy and breast cancer. Royal College of Obstetricians and Gynaecologists ngc-guideline: [105]
    - Management:
    - The role of aromatase inhibitors in adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: a clinical practice. (Program in Evidence-based Care) ngc-guideline: [106]
    - The role of trastuzumab (Herceptin[R]) in the treatment of women with HER2/neu-overexpressing metastatic breast cancer. (Program in Evidence-based Care) ngc-guideline: [107]
    - The role of trastuzumab in adjuvant and neoadjuvant therapy in women with HER2/neu-overexpressing breast cancer: a clinical practice guideline. (Program in Evidence-based Care) ngc-guideline: [108]
    - Adjuvant taxane therapy for women with early-stage, invasive breast cancer. (Program in Evidence-based Care) ngc-guideline: [109]
    - Guidance on the use of vinorelbine for the treatment of advanced breast cancer. (National Institute for Health and Clinical Excellence) ngc-guideline: [110]
    - The role of gemcitabine in the management of metastatic breast cancer: a clinical practice guideline. (Program in Evidence-based Care) ngc-guideline: [111]
    - Local regional recurrence (LR) and salvage surgery-- breast cancer (American College of Radiology) ngc-guideline: [112]
    - American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. ngc-guideline: [113]
    - The role of HER2/neu in systemic and radiation therapy for women with breast cancer: a clinical practice guideline. Program in Evidence-based Care ngc-guideline: [114]
    - Trastuzumab for the adjuvant treatment of early-stage HER2- positive breast cancer. (National Institute for Health and Clinical Excellence) ngc-guideline: [115]
    - Docetaxel for the adjuvant treatment of early node-positive breast cancer. National Institute for Health and Clinical Excellence ngc-guideline: [116]
    - Paclitaxel for the adjuvant treatment of early node-positive breast cancer. National Institute for Health and Clinical Excellence ngc-guideline: [117]
    - Gemcitabine for the treatment of metastatic breast cancer. National Institute for Health and Clinical Excellence ngc-guideline: [118]
    - Fulvestrant for systemic therapy of locally advanced or metastatic breast cancer in postmenopausal women: guideline recommendations. Program in Evidence-based Care ngc-guideline: [119]
    - Advanced breast cancer. Diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [120]
    - Early and locally advanced breast cancer. Diagnosis and treatment. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [121] American College of Radiology
    - ACR Appropriateness Criteria - locally advanced breast cancer. American College of Radiology ngc-guideline: [122]
    - ACR Appropriateness Criteria - stage I breast carcinoma American College of Radiology ngc-guideline: [123]
    - ACR Appropriateness Criteria - conservative surgery and radiation-stage I and II breast carcinoma. American College of Radiology ngc-guideline: [124]
    - ACR Appropriateness Criteria - postmastectomy radiotherapy. American College of Radiology ngc-guideline: [125]
    - The continued use of trastuzumab beyond disease progression in patients with metastatic breast cancer. Program in Evidence-based Care ngc-guideline: [126]
    - The use of bevacizumab in metastatic breast cancer. Program in Evidence-based Care ngc-guideline: [127]
    - Ductal carcinoma in situ. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [128]
    - General principles of care. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [129]
    - Radiotherapy. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [130]
    - Special issues. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [131]
    - Surgery for early invasive breast cancer. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [132]
    - Systemic therapy: chemotherapy regimens. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [133]
    - Systemic therapy: endocrine therapies. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [134]
    - The prophylactic use of filgrastim in patients with breast cancer. Program in Evidence-based Care ngc-guideline: [135]
    - Zoledronic acid as adjuvant therapy in combination with adjuvant endocrine therapy for premenopausal women with early-stage hormone receptor positive breast cancer. Program in Evidence-based Care ngc-guideline: [136]
    - American Society of Clinical Oncology clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer. ngc-guideline: [137]
    - Management of gynecologic issues in women with breast cancer. American College of Obstetricians and Gynecologists ngc-guideline: [138]
    - Follow-up:
    - Progesterone-only and non-hormonal contraception in the breast cancer survivor: joint review and committee opinion of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada. ngc-guideline: [139]
    - Follow-up. In: Management of early breast cancer. New Zealand Guidelines Group ngc-guideline: [140]

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