Early Breast Cancer
There were about 186,000 new cases of breast cancer in the year 2000, it is the second leading cause of cancer death in women only superseded by lung cancer. There is an increased incidence probably because of the increased use of screening mammography, one in 10 women who live to the age of 80 will get breast cancer, not 1 in 10 women in this room, but 1 in 10 women that are able to live to the age of 80. We need to remember that 1% of all breast cancers do occur in men. Risk factors are well known. If you are over the age of 50, you have an increased risk of breast cancer just based on your age alone. If you have a personal history of breast cancer or a history of ovarian, uterine or colon cancer, you have an increased risk of breast cancer. Family history is classically the most important nonpersonal risk factor, the most important risk factor in a family is if it’s a maternal relative first degree premenopausal and breast cancer was bilateral. Adolescent exposure to radiation is becoming an increasingly common risk as children who were radiated in their teens, especially for Hodgkin’s disease or in older women for thyroid problem. It’s unclear whether exogenous estrogens or fertility drugs increase the risk of breast cancer unrelated to the other risk factors and this is still being debated in the literature.
The most common histology of breast cancer is an infiltrating ductal carcinoma which is approximately 90% of all breast cancers. The most common site is the upper outer quadrant and that’s only because there is more breast tissue in the upper outer quadrant than other parts of the breast. The most common metastases is to the axilla and about 1 to 2% of breast cancers are bilateral or occur in both breasts at the time of diagnosis. So when a woman presents with a palpable mass in one breast, we must remember not to forget the other side. Clinical presentations are by far and away now, an abnormal screening mammogram. A woman goes for her screening mammogram and something is found. The second most common presentation is a palpable mass, classically it’s new and classically it’s painless. About 1 to 2% of women who present with breast cancer have some associated pain or sensation so that should not be of note. But most breast cancers do not cause pain. Bloody nipple discharge is a rare presentation for breast cancer, the most common cause for bloody nipple discharge is an intraductal papilloma. Skin changes are a sign of advanced disease and occasionally a patient will present with axillary adenopathy alone and the breast cancer remains occult.