A.

DEFINITION
Breast cancer is a malignant tumor that starts in the cells of the breast. Like other cancers, there
are several factors that can raise the risk of getting breast cancer. Damage to the DNA and
genetic mutations can lead to breast cancer have been experimentally linked to estrogen
exposure. Some individuals inherit defects in the DNA and genes like the BRCA1, BRCA2 and
P53 among others. Those with a family history of ovarian or breast cancer thus are at an
increased risk of breast cancer.

The immune system normally seeks out cancer cells and cells with damaged DNA and destroys
them. Breast cancer may be a result of failure of such an effective immune defense and
surveillance.

These are several signaling systems of growth factors and other mediators that interact
between stromal cells and epithelial cells. Disrupting these may lead to breast cancer as well.

B. RISK FACTORS
 Age: The strongest risk factor for breast cancer is age. Most breast cancers occur in
women > 50.
 Family history: Having a 1st-degree relative (mother, sister, daughter) with breast cancer
doubles or triples risk of developing the cancer, but breast cancer in more distant
relatives increases risk only slightly.
 Breast cancer gene mutation: About 5 to 10% of women with breast cancer carry a
mutation in one of the two known breast cancer genes, BRCA1 or BRCA2. If relatives of
such a woman also carry the mutation, they have a 50 to 85% lifetime risk of developing
breast cancer.
 Personal history: Having had in situ or invasive breast cancer increases risk. Risk of
developing cancer in the contralateral breast after mastectomy is about 0.5 to 1%/year of
follow-up.
 Gynecologic history: Early menarche, late menopause, or late first pregnancy increases
risk. Women who have a first pregnancy after age 30 are at higher risk than those who
are nulliparous.
 Breast changes: History of a lesion that required a biopsy increases risk slightly. Benign
lesions that may slightly increase risk of developing invasive breast cancer include
complex fibroadenoma, moderate or florid hyperplasia (without atypia), sclerosing
adenosis, and papilloma.
 Use of oral contraceptives: Oral contraceptive use increases risk very slightly (by about
5 more cases per 100,000 women). Risk increases primarily during the years of
contraceptive use and tapers off during the 10 years after stopping.
 Hormone therapy: Postmenopausal hormone (estrogen plus a progestin) therapy
appears to increase risk modestly after only 3 years of use. After 5 years of use, the
increased risk is about 7 or 8 more cases per 10,000 women for each year of use (about
a 24% increase in relative risk).
 Radiation therapy: Exposure to radiation therapy before age 30 increases risk.
 Diet: Diet may contribute to development or growth of breast cancers. Obese
postmenopausal women are at increased risk, but there is no evidence that dietary
modification reduces risk.
 Lifestyle factors: Smoking and alcohol may contribute to a higher risk of breast cancer.

C. DIAGNOSTICS STUDIES AND ITS POSSIBLE RESULTS

 DIAGNOSTIC MAMMOGRAM – A diagnostic mammogram is an x-ray of the breast. It
can help determine symptoms that are indicative of the presence of cancer. In addition
to finding tumors that are too small to feel, mammograms may also spot ductal
carcinoma in situ (DCIS)
 ULTRASOUND – A breast ultrasound is a scan that uses penetrating sound waves
causing echoes, which a computer uses to paint a picture of what’s happening inside the
breast tissue. It may provide evidence about whether a lump is solid mass, a cyst filled
with fluid, or a combination of the two.
 MRI - During a breast MRI, a magnet connected to a computer transmits magnetic
energy and radio waves (not radiation) through the breast tissue. It scans the tissue,
making detailed pictures of areas within the breast. These images help the medical team
distinguish between normal and diseased tissue.
 BIOPSY - A breast biopsy is a test that removes tissue or sometimes fluid from the
suspicious area. The removed cells are examined under a microscope and further tested
to check for the presence of breast cancer. A biopsy is the only diagnostic procedure
that can definitely determine if the suspicious area is cancerous.

D. MEDICAL-SURGICAL MANAGEMENT
 Breast-conserving surgery (also called a lumpectomy, quadrantectomy, partial
mastectomy, or segmental mastectomy) is a surgery in which only the part of the breast
containing the cancer is removed. The goal is to remove the cancer as well as some
surrounding normal tissue. How much breast is removed depends on where and how big
the tumor is, as well as other factors.
 Axillary lymph node dissection is the removal of some or all fat-enmeshed axillary lymph
nodes for determination of extent of disease spread; the single most important
determinant for prognosis and for need for adjuvant treatment.
 Mastectomy is a surgery in which the entire breast is removed, including all of the breast
tissue and sometimes other nearby tissues. There are several different types of
mastectomies. Some women may also get a double mastectomy, in which both breasts
are removed.

E. PHARMACOLOGIC MANAGEMENT

 Tamoxifen (Nolvadex), Toremifene (Fareston) - Blocks estrogen receptors

 Fulvestrant (Faslodex) - Destroys estrogen receptors
 Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin), Aminoglutethimide
(Cytadren) - prevents production of estrogend by inhibiting aromatase.
F. DIAGRAM (Identify specific signs and symptoms)