HemeOnc

Breast Cancer

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Breast Cancer

  • Epidemiology
  1. Incidence: New Cases of Breast Cancer (1997)
    1. Women: 180,200 cases/year
      1. Age <40 years: 7% (12,600 women annually)
      2. Age <50 years: 25% (45,700 women annually)
    2. Men: 1400 cases/year
  2. Mortality from Breast Cancer (1997): 43,900
  3. References
    1. (1997) ACS, Cancer Statistics 1997
  • Risk Factors
  • 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
  • Exam
  • 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%)
  • Resources
  1. See Breast Cancer Resources
  • 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%
  • References
  1. (1995) Physician Insur Assoc Amer, Breast Cancer Study
  2. Maughan (2010) Am Fam Physician 81(11):1339-46 [PubMed]