Breast Cancer

Risk Factors
§ Age >50
§ Family History
§ LCIS or atypical hyperplasia
§ Dense breast tissue
§ BRCA mutation



Types
Invasive
Ductal
Lobular
Mucinous
Tubular
Non-invasive
DCIS (does not metastasize)


Diagnosis
§ Mammogram is a SCREENING TOOL
§ FNA
§ Excisional Bx
§ Core Bx
§ Sterotactic BX
Who to MRI?
§ Known BRCA mutation
§ First degree relative with BRCA mutation
§ 20% risk based on validated model (BRACA-Pro)
§ Other familial syndrome
§ Cowden, Li-Fraummeni, HNPCC
§ Hx of chest wall RT btwn 10-30yr of age
§ e.g. Hodgkins disease




Treatment
§ Surgical Treatment
§ Mastectomy
§ Breast conversation
§ Lumpectomy with XRT





Hormonal Treatment
§ ER, PR, Her 2 nu status
§ Adjunct therapy to minimize risk of recurrence
§ Tamoxifen
§ Aromatase inhibitor (Irimidex)
§ Herceptin
Survival -/+ adjuvant tx
§ T1a: 95% 96%
§ T1b: 90% 93%
§ T1c: 80% 86.5%
§ T2aN0: 70% 80%
§ T2bN1: 60% 73%
§ T3aN0: 70% 80%
§ T3bN1: 40% 60%
§ TXNXM1: <5% at 5 years

Tamoxifen
§ 5 yrs duration (newer data to support 10)
§ Decreases recurrence risk by 37-54%
§ Increases overall survival by 11-34%
§ Monitor for development of endometrial cancer