Introduction Most common cancer and second most common cause of death in adult women 12% lifetime risk BRCA1 and BRCA2 mutations are associated with multiple / early onset breast and ovarian cancer. Incidence: most common in the elderly 50% of all breast cancer occur in woman over the age of 65 20% among woman under 50 2% in woman less than 30 75% have no risk factors Risk factors include: increasing age breast cancer in first degree relatives or mother with breast cancer A low fiber, high fat diet obesity history of contralateral breast cancer a history of endometrial cancer which is also a estrogen induced cancer h/o radiation increases # menstrual cycles or exposure to estrogen nulliparity early menarche (<11 yo.) late menopause (>50 yo.) late first pregnancy (>30 yo) Physical/anatomic risk factors include: (CHAFED LIPS) C: cancer in breast H: hyperplasia A: atypical hyperplasia F: female E: elderly D: DCIS L: LCIS I: inherited genes P: papilloma S: sclerosing adenitis Prevention smoking cessation alcohol cessation exercise breastfeeding Presentation Presents with: asymptomatic breast lump nipple discharge especially bloody, unilateral Most often presents in upper/outer quadrant Physical Exam shows: firm immobile, painless lump some skin changes (redness, ulcerations, edema, nodularity) skin retraction indicates involvement of Cooper's ligament axillary lymohadenopathy in more advanced cases breast skin edema with dimpling (peau d' orange) is a finding with a poor prognosis represents obstruction of the lymphatics cancer Evaluation Combination of the physical exam, mammography, and fine-needle aspiration is highly accurate ultrasound is sometimes used to see if the mass is cystic Labs include serum calcium level alkaline phosphatase check for estrogen and progesterone receptors TMN Staging Staging is done with the TNM system and imaging (CT/bone scan) > 5cm Stage IIB Stage IIIA Stage IIIA Stage IV 2-5 cm Stage IIA Stage IIB Stage IIIA Stage IV < 2cm Stage I Stage IIA Stage IIIA Stage IV No nodes Mobile axilalry nodes Fixed axillary nodes Distant mets (including ipsilateral supraclavicular nodes) Types of Breast Cancer Carcinoma in situ LCIS LCIS DCIS DCIS DCIS Paget's Breast Disease Invasive carcinoma DCIS Invasive Lobular Carcinoma DCIS Invasive Ductal Carcinoma DCIS Inflammatory Carcinoma DCIS Cystosarcoma Phyllodes Mammogram Screening Highly effective screening tool except in young women dense breast tissue in young woman interferes with specificity and sensitivity most effective in postmenopausal patients because of less glandular breast All women aged 50-74 should have mammograms every 1-2 years controversial whether screening mammography should begin as early as age 40 Women with with first degree relatives with cancer should begin screening ten years before family member developed cancer Women with breast implants should undergo the same screening schedule as women without implants