Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Epidemiology Table Graphic Jump Location | Download (.pdf) | Print 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 Table Graphic Jump Location | Download (.pdf) | Print 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: History and physical Bilateral diagnostic mammogram Pathology review with ER status Genetic counseling if patient is high risk for hereditary breast cancer Stages I & II: History and physical CBC with platelets LFTs and alkaline phosphatase Diagnostic bilateral mammogram Pathology review with ER/PR/HER-2 status Genetic counseling if the patient is at high risk for hereditary breast cancer Stage III: History and physical CBC with platelets LFTs and alkaline phosphatase Diagnostic bilateral mammogram Pathology review with ER/PR/HER-2 status Consider bone scan, abdominal ± pelvis CT or US or MRI, and chest imaging Genetic counseling if the patient is at high risk for hereditary breast cancer Stage IV: History and physical CBC with platelets LFTs and alkaline phosphatase Diagnostic bilateral mammogram Pathology review with ER/PR/HER-2 status Chest imaging Bone scan, X-rays of symptomatic bones and long or weight-bearing bones and bones abnormal on bone scan Consider abdominal ± pelvis CT or MRI Biopsy at first recurrence with pathology review Genetic counseling if the patient is at high risk for hereditary breast cancer ++ Staging Table Graphic Jump Location | Download (.pdf) | Print 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 dimension T4 Tumor of any ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth