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Comprehensive Overview of Breast Cancer: Risk Factors, Diagnosis, and Treatment

Breast cancer is a significant health concern, being the second leading cause of cancer deaths among women. In the U.S., one in eight women will be diagnosed, although early diagnosis has improved mortality rates. Factors influencing risk include age, family history, diet, reproductive history, and hormonal factors. Early detection through mammography and clinical exams is crucial, with various biopsy techniques available for diagnosis. This overview highlights pathology, natural history, and prognosis for different breast cancer types, aiding in better understanding and awareness.

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Comprehensive Overview of Breast Cancer: Risk Factors, Diagnosis, and Treatment

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  1. Ch 35 BREAST CANCER 부산백병원 산부인과 R1 서 영 진

  2. 1/3 of all cancers in women • 2nd only to lung cancer as the leading cause of cancer deaths in women • Incidence: increased significantly one in every eight women in U.S.A • But, mortality rate actually declined -increased success in earlier diagnosis & treatment

  3. PREDISPOSING FACTOR • 25세 미만: less than 1% 30세 이후: a sharp increase 45세-50세: short plateau 이후: increases steadily with age

  4. PREDISPOSING FACTOR • Family hystory -only 20%: family hystory -mother & sister : breast cancer after menopause -> risk is not increased bilateral premenopausally -> at least 40%~50% unilateral premenopausally -> 30% -inherited oncogenes: BRCA 1 (chromosome 17q 21) BRCA 2 (chromosome 13q 12-13)

  5. PREDISPOSING FACTOR • Diet, obesity, and alcohol - high-fat diet, obesity, alcohol :risk factor - but, not clear

  6. PREDISPOSING FACTOR • Reproductive and hormonal factors - the risk of breast ca increases with the length of a women’s reproductive phase - menarche is lower early menopause artificial menopause (oophorectomy) -> the risk is decreased -> but, no clear association with irregularity & duration of menses

  7. -lactation does not affect the breast cancer ->but, risk is high : never pregnant > multiparous -primigravida: older > younger (high incidence) -although short-term estrogen treatment for menopausal symptoms prebably does not increase the risk of breast ca, prolonged use or higher dosages of estrogen may increase the risk -> low dose or combination with progestin -> but, benbefits in preventing osteoporosis and heart problem

  8. HISTORY OF CANCER • Endometrial carcinoma, ovarian carcinoma, or colon cancer has also been associated with an increased risk of breast cancer

  9. DIAGNOSIS • most commonly in the upper outer quadrant (there is more beast tissue) • mammography and physical examination, the standard screening modalities, are complementary -10% to 50 % of cancers detectred mammographically are not palpable, physocal exam detects 10% to 20% of cancers not seen on mammography • All women unfergo screening mammography starting at age 40, along with clinical or self breast examination

  10. DIAGNOSIS • USG, MRI, CT, PET, sestamibiscans, serum blood marker: be used only when indicated • palpation: easy- older, more fatty • Malignancy: thickening area amid normal nodulaity skin dimpling nipple retraction skin erosion • clinically malignancy: 30~40% benign on histology clinically benign: 20~25% malignant by biopsy

  11. Biopsy techniques • Fine-needle aspiration cytology (FNA) - 20- or 22- gauge needle - a high level of diagnostic accuracy :10-15% false negative rare false positive -negative FNA cytology results do not exclude malignancy and usually are followes by excisional biopsy or careful observation

  12. Open biopsy -FNA cytology has not been performed the results are negative or eqivocal 1. the location of the mass confirmed 2. local anesthesia: skin, suncutaneous around mass 3. incision: directly over the mass (ellise-cosmetically) paraareolar(near the nipple-areolar complex) 4. mass: gently grasped with Allis forcep or stay suture 5. the mass should be excised completely

  13. 6. adequate hemostasis breast parenchyma : not reapproximated deeply subcutaneous fat: with fine absorbable suture skin: subcuticular suture and adhesive strips usually a drain is not necessary

  14. Mammographic localization biopsy - biopsy of nonpalpable lesion - mammographer : localization & a biologic dye surgeon: review & excised • Stereotactic core biopsy - localize abnormalities and perform needle biopsy without surgery

  15. PATHOLOGY AND NATURAL HISTORY • Breast ca : in the intermediate-sized ducts or terminal ducts and lobules -the diagnosis of lobular and intraductal carcinoma is based on histological appearance than site of origin • infiltrating ductal carcinoma: 60-70% -mammographically, stellate density -macroscopically, gritty and chalky • Medullary carcinoma -a dence lymphocytic infiltration -sloe growing, less aggressive malignancy

  16. Mucinous (colloid) carcinoma : 5% of breast ca -glossly, mucinous, gelatinous • Papillary carcinoma -noninvasive ductal carcinoma • Tubualr carcinoma: 1% of breast ca -better prognosis than infiltrating ductal carcinoma rarely metastasize to axillary LN

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