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Chapter 6: Breast Cancer

Rachel C. Jankowitz; Nancy E. Davidson

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    AMA Citation
    Jankowitz RC, Davidson NE. Jankowitz R.C., Davidson N.E. Jankowitz, Rachel C., and Nancy E. Davidson.Breast Cancer. In: Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al.eds. Hematology-Oncology Therapy, 2e New York, NY: McGraw-Hill; . http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126321284. Accessed January 25, 2020.
    MLA Citation
    Jankowitz RC, Davidson NE. Jankowitz R.C., Davidson N.E. Jankowitz, Rachel C., and Nancy E. Davidson.. "Breast Cancer." Hematology-Oncology Therapy, 2e Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al. New York, NY: McGraw-Hill, , http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126321284.

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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 235,030 (male: 2,360; female: 232,670. Estimated new cases for 2014 in the United States) Stage at Presentation
Stage I: 49%
123.8 per 100,000 females per year Stage II: 39%
Deaths: Estimated 40,430 in 2014 (male: 430; female: 40,000) Stage III: 7%
Median age: 61 years Stage IV: 5%
Male to female ratio: 1:160

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Pathology

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Pathology
Invasive Carcinoma
1. Ductal: 49–75%
2. Lobular: 5–16%
3. Medullary: 3–9%
4. Mucinous: 1–2%
5. Tubular: 1–3%
Ductal Carcinoma In Situ
1. Comedo
2. Cribriform
3. Micropapillary
4. Papillary
5. Solid

 

Harris JR et al. Disease of the Breast, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2010

Work-up

In situ:

  1. History and physical

  2. Bilateral diagnostic mammogram

  3. Pathology review with ER status

  4. Genetic counseling if patient is high risk for hereditary breast cancer

Stages I & II:

  1. History and physical

  2. CBC with platelets

  3. LFTs and alkaline phosphatase

  4. Diagnostic bilateral mammogram

  5. Pathology review with ER/PR/HER-2 status

  6. Genetic counseling if the patient is at high risk for hereditary breast cancer

Stage III:

  1. History and physical

  2. CBC with platelets

  3. LFTs and alkaline phosphatase

  4. Diagnostic bilateral mammogram

  5. Pathology review with ER/PR/HER-2 status

  6. Consider bone scan, abdominal ± pelvis CT or US or MRI, and chest imaging

  7. Genetic counseling if the patient is at high risk for hereditary breast cancer

Stage IV:

  1. History and physical

  2. CBC with platelets

  3. LFTs and alkaline phosphatase

  4. Diagnostic bilateral mammogram

  5. Pathology review with ER/PR/HER-2 status

  6. Chest imaging

  7. Bone scan, X-rays of symptomatic bones and long or weight-bearing bones and bones abnormal on bone scan

  8. Consider abdominal ± pelvis CT or MRI

  9. Biopsy at first recurrence with pathology review

  10. Genetic counseling if the patient is at high risk for hereditary breast cancer

Staging

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Staging
Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
Tis (DCIS) Ductal carcinoma in situ
Tis (LCIS) Lobular carcinoma in situ
Tis (Paget) Paget disease of the nipple is NOT associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Paget's disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should still be noted
T1 Tumor ≤20 mm in greatest dimension
T1mi Tumor ≤1 mm in greatest dimension
T1a Tumor >1 mm but ≤5 mm in greatest dimension
T1b Tumor >5 mm but ≤10 mm in greatest dimension
T1c Tumor >10 mm but ≤20 mm in greatest dimension
T2 Tumor >20 mm but ≤50 mm in greatest dimension
T3 Tumor >50 mm in greatest ...

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