Breast Cancer

1 in 8 women will develop breast cancer in their lifetime

 

Risk Factors

  • Female (99% of breast cancers)
  • Oestrogen Exposure (years of menstruation, few/no children/no breastfeeding)
  • Alcohol
  • Obesity
  • Family history (first-degree relatives)

 

Genetics

  • BRCA genes are tumour suppressor genes
  • Faulty BRCA1 gene
    • Chromosome 17
    • Around 60% (to 80%) will develop breast cancer
    • Around 40% will develop ovarian cancer
    • Also increased risk of bowel and prostate cancer
  • Faulty BRCA2 gene
    • Chromosome 13
    • Around 40% will develop breast cancer
    • Around 15% will develop ovarian cancer
  • Many other rarer genetic abnormalities are associated with breast cancer (e.g. TP53 and PTEN genes)

 

Breast cancer metastasis (2 Ls 2 Bs)

  • Lungs
  • Liver
  • Bones
  • Brain

 

Ductal Carcinoma In Situ (DCIS)

  • Pre-cancerous or cancerous epithelial cells of the breast ducts
  • Localised to a single area
  • Often picked up by mammogram screening
  • Potential to spread locally over years
  • Potential to become an invasive breast cancer (around 30%)
  • Good prognosis if full excised with adjuvant treatment

 

Lobular Carcinoma In Situ (LCIS)

  • Also referred to as “lobular neoplasia”
  • A pre-cancerous condition occurring typically in pre-menopausal women
  • Asymptomatic and undetectable on mammogram
  • Usually diagnosed incidentally on breast biopsy
  • Represents an increased risk of invasive breast cancer in the future (around 30%)
  • Usually managed with close monitoring (e.g. 6 monthly examination and yearly mammograms)

 

Invasive Breast Cancer (NST)

  • NST = No Specific Type
  • Also known as Invasive Ductal Carcinomas
  • Originate in cells from the breast ducts
  • 80% of invasive breast cancers fall into this category
  • Show up on mammograms

 

Invasive Lobular Carcinomas (ILC)

  • Around 10% of invasive breast cancers
  • Originate in cells from the breast lobules
  • Not always visible on mammograms

 

Inflammatory Breast Cancer

  • 1-3% of breast cancers
  • Presents similarly to a breast abscess or mastitis
  • Swollen, warm, tender breast with pitting skin (peau d’orange)
  • Does not respond to antibiotics
  • Worse prognosis than other breast cancers

 

Paget’s Disease of the Nipple

  • Looks like eczema of the nipple/areolar
  • Erythematous, scaly rash
  • Indicates breast cancer involving the nipple
  • May represent DCIS or invasive breast cancer
  • Requires biopsy, staging and treatment as with any other invasive breast cancer

 

Rarer Types of Breast Cancer

  • Medullary Breast Cancer
  • Mucinous Breast Cancer
  • Tubular Breast Cancer
  • Multiple others
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