Breast Cancer
1 out of 8 women will have cancer which is about 13% of women in the US (most common). 10% have familial predisposition. 50% of familial breast cancer has BRCA1 & BRCA2 genes. Most common is the invasive ductal carcinoma which is usually preceded by DCIS (Ductal carcinoma in situ) on the same side versus LCIS (Lobar carcinoma in situ) on any side.
As for 2023, USPSTF recommends screening mammography every 2 years for ages 50-74 and the American Cancer Society recommends starting at age of 45. Consider starting at age of 40 for women who are high risk. Screening is generally less beneficial for women with a life expectancy of less than 10 years due to the slow-growing nature of many breast cancers.
For individuals with BRCA1 genes, use the following for breast cancer screening:
- Clinical breast exam every 6 months beginning at age 25
- Breast MRI once a year beginning at age 25; Use mammogram, if MRI not available
- Add mammogram once a year beginning at age 30, separated 6 months from MRI
- After risk-reducing mastectomy, only clinical breast exam is recommended.
Always order biopsy for a breast mass even if the imaging is normal. Routine histopathological testing will include ER/PR receptors and HER-2/neu oncogene. Lumpectomy and radiation for small cancer sizes or mastectomy for larger ones and axillary LN dissection if positive sentinel node. Adjuvant therapy helps eradicating micrometastasis and prevent uni/contra-lateral recurrence. Give Tamoxifen for premenopausal and Aromatase inhibitors (Anastrozole...) for postmenopausal. Add Trastuzumab for HER-2 positive.
You can read about this topic using this book: Bland and Copeland's The Breast.
Breast Cancer Surviving Manual is a suggested book for patients to read.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services or your primary care provider. Please refer to your doctor for medical advice.