Breast Disease Chapter 19

Breast Disease

• Chapter 19 in a medical textbook covers breast disease, including symptoms, benign breast disease, breast cancer screening, risk factors, diagnosis, and care.
• Breast cancer screening is a national program in the UK, started in 1988, aiming to detect early-stage cancers to improve survival rates (84% 5-year survival for stage I, 18% for stage IV).
• Screening is primarily for women aged 50–70 (47–73 in some areas), although older women can request it 3-yearly. Screening detects ~85% of cancers in women over 50, and ~70–80% of screening-detected cancers have a good prognosis.
• High-risk women (family history) may benefit from early or more frequent screening with mammograms or MRI.
• Screening involves 2-view mammograms at designated centers, with normal results leading to 3-year recall and abnormal ones to immediate further investigation.
• Interval cancers are those detected between screenings due to missed detection at the time of screening or new events after screening.

Risk Factors for Breast Cancer

• Breast cancer is the most common cancer in the UK and affects both men and women. Breast cancer screening is discussed on page 670.
• Risk factors include geography (more common in developed countries), age (increases with age), socioeconomic factors (higher in more affluent classes), obesity, high-fat diet, alcohol consumption, physical inactivity, early menarche, late menopause, pregnancy history (fewer pregnancies and nulliparity increases risk), breastfeeding, combined hormonal contraception, and prior breast conditions.
• Family history is a strong risk factor; a faulty gene (BRCA1/2 or TP53) or a history of breast cancer in first- or second-degree relatives increases risk. Referral pathways for women with a family history are depicted in Figure 19.3.

Breast Cancer: Diagnosis and Care

• Prevention strategies include lifestyle modifications (reduced alcohol, increased exercise, avoiding exogenous hormones), chemoprophylaxis (tamoxifen), and prophylactic surgery.
• Common presentation includes breast lumps, breast pain, nipple changes, nipple discharge, and skin changes.
• Management involves urgent assessment by a breast surgeon, mammography, ultrasound, and biopsy if necessary.
• Treatment options include surgery (lumpectomy, mastectomy), hormone therapy, radiotherapy, and chemotherapy, depending on the stage and type of cancer.
• Diagnosis is categorized in stages (in situ, stage I-IV) based on tumor size, lymph node involvement, and metastasis. Stage categorization is outlined in Table 19.4.
• Adjuvant endocrine therapies (tamoxifen, aromatase inhibitors, trastuzumab) are important for managing breast cancer's progression, based on responses to oestrogen and progesterone receptors.
• Prognosis depends on factors such as age, stage, tumor grade, estrogen receptor status, and patient access to proper care.