CASE: BREAST CANCER

Alegre. Almora. Alonzo. Amaro. Amolenda. Anacta. Andal. Ang. Ang. Ang.

General Information

• 45-y/o F • Chief Complaint: Left breast mass.

History

Other relevant data should be taken from the history; Family history;menstrual history; pregnancy; lactation.

• Menarche; menstrual cycles• Sexual History• Previous pregnancies• Family history of breast

cancer

Consult

Personal risk factors: • Gender

– Females have a 100-fold increase in risk as compared to males. • Age – breast cancer risk increases with age

– 96% of breast cancers occur in women age 40 and older (ACS, 2003-2004).

• Race – Caucasian women have a greater risk of breast cancer than

other racial groups. • Prolonged exposure to endogenous estrogen and

progestins • Exposure to exogenous combined estrogen and progestin

therapy in hormone replacement therapy for postmenopausal women

Breast Cancer Diagnostic Algorithms for Primary Care Providers

(Third Edition, June 2005)

• Alcohol use – greater than 27 drinks per week. (Gronbaek,

2004.)• Obesity

– obese women with BMI >30 had estrogen concentrations between 60% and 219% higher then thin women

• Radiation exposure to the upper torso – e.g. treatment of Hodgkin’s lymphoma.

Breast Cancer Diagnostic Algorithms for Primary Care Providers

(Third Edition, June 2005)

Risk Factors

• Increase number of menstrual cycles (increased estrogen exposure) – Early menarche, nulliparity late menopause

• Pregnant or Lactating Women– During pregnancy, breast grows secondary to

estrogen, progesterone, HPL, prolactin (low levels)– After pregnancy, progesterone drops, increasing

effects of prolactin

Family History

• One or more first- or second-degree relatives with breast cancer at an early age (less than 40-50 years of age).

• Breast cancer and a second primary cancer in a close relative, especially ovarian cancer. – Other cancers w/ a genetic risk include:

• thyroid, colorectal, prostate, endometrial, pancreatic, adrenocortical carcinoma, melanoma, childhood sarcoma, leukemia/lymphoma, and brain tumors.

• Male breast cancer in a close relative.• Two or more relatives with breast cancer at any age.

Breast Cancer Diagnostic Algorithms for Primary Care Providers

(Third Edition, June 2005)

Physical Exam• L breast

– 2 X 2 cm. hard, non-tender, & movable mass with irregular margins underneath the nipple.

• Axilla is negative for any masses.

• The R breast and the rest of the PE are normal.

Personal Risk Factors

• 45y/o F– 35% benign– 25% cyst– 9% fibroadenoma– 31% other benign lesion

Breast Mass

Benign • round or oval shape• circumscribed margins • width-to– AP dimension

ratio greater than 1.4

Malignant• irregular shape• microlobulated or

spiculated • width-to–AP dimension

ratio of 1.4 or less

Rhabar, et al. Benign versus Malignant Solid Breast Masses: US Differentiation. December 1999 Radiology, 213, 889-894.

Working diagnosis

• Malignant breast lesion – (2 X 2 cm. hard, non-tender, & movable mass with

irregular margins underneath the nipple)

• Clinical stage– T1N0M0

• T1: Tumor 2.0 cm or less in greatest dimension • N0: No regional LN metastasis• M0: No distant metastasis