Breast Cancer

Aka: Breast Cancer

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II. Epidemiology

  1. Incidence: New Cases of Breast Cancer (2020)
    1. Women: 276,480 cases/year (15% of all new cancers)
    2. Men: 2,620 cases/year
  2. Mortality from Breast Cancer (2020)
    1. Women: 42,170 (7% of all cancer deaths)
    2. Men: 520
  3. References
    1. NIH Cancer Stat Facts: Female Breast Cancer
      1. https://seer.cancer.gov/statfacts/html/breast.html

III. Risk Factors

  1. See Breast Cancer Risk Factors

IV. Pathophysiology

  1. Breast Cancer is slow growing: 100 day doubling time
  2. Breast Cancer is not detectable for 8-10 years
    1. Year 8: Mammogram identifies 100 billion cell mass
    2. Year 10: Mass palpable on Clinical Breast Exam

V. Exam

  1. See Breast Exam
  2. See Breast Mass
  3. Breast Cancer metastases (may occur years after primary treatment)
    1. Bones
    2. Lungs
    3. Brain
    4. Liver
    5. Skin (extremity and torso Plaques and erythematous Nodules)

VI. Diagnosis

  1. See Breast Cancer Diagnosis
  2. See Breast Cancer Staging

VII. Management

  1. See Breast Cancer Management
  2. See Breast Cancer Monitoring

VIII. Management: Risk (medical-legal concerns)

  1. Document all Breast complaints
    1. Breast Masses are self diagnosed in 60% of cases
  2. Lawsuit pearls
    1. Premenopausal patients account for 63-68% of suits
    2. Common Allegations
      1. Physical Findings failed to impress
      2. Failure to follow-up with patient
      3. Negative Mammogram report
      4. Mammogram misread
  3. Document any Family History
  4. Compare previous Mammography
  5. Document recommendations for follow-up
  6. Follow documented schedule
  7. Remember to follow up with other consultants
  8. Biopsy palpable mass with negative Mammogram
  9. Pregnancy should not delay diagnostic studies
  10. Most specialties have been named in Malpractice suits
    1. Radiology (24%)
    2. Obstetrics and Gynecology (23%)
    3. Family Practice and General Practice (17%)
    4. Surgery (14%)
    5. Internal Medicine (9%)
    6. Pathology (2%)

IX. Prevention

  1. See Breast Cancer Screening
  2. See Breast Cancer Gene Marker (e.g. BRCA)

X. Prognosis: Breast Cancer 5 year survival

  1. In Situ (stage 0): 100%
  2. Early invasive (stage I, IIa, IIb)
    1. Local spread: 98%
    2. Regional spread: 83.6%
  3. Locally advanced (stage IIIa-c): 57%
  4. Metastatic (stage IV): 23.4%

XI. Resources

  1. See Breast Cancer Resources

XII. References

  1. (1995) Physician Insur Assoc Amer, Breast Cancer Study
  2. Khan (2020) Am Fam Physician 103(1): 33-41 [PubMed]
  3. Maughan (2010) Am Fam Physician 81(11):1339-46 [PubMed]

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