List 6 common breast complaints and their risks of malignancy
- Pain- 5%
- Inflammation- <1%
- Nipple discharge- 7% (less than 60 yrs) and 30% (over 60 yrs)
- Lumpiness- 1%
- Palpable Masses- 10% (less than 40 yrs) and 60% (over 50 yrs)
- Gynecomastia- in men, low risk
What are densities on mammographic screening?
- Normal breast adipose tissue replaced with breast lesions.
- Rounded= benign
- Irregular= invasive carcinoma
What are calcifications on mammographic screening?
Form on secretions, necrotic debris, or hyalinized stroma.
- Often associated with benign lesions.
- Malignant= small, irregular, numerous, clustered.
What are characteristics of non-proliferative epithelial breast lesions?
- Not associated with increased risk of breast cancer.
- Cysts, fibrosis and adenosis (increased number of acini per lobule).
- Lumpy on palpation
What are characteristics of proliferative disease without-atypia breast lesions?
- Slightly increased risk of breast cancer.
- Epithelial hyperplasia.
- Sclerosing adenosis.
- Papilloma.
What are characteristics of proliferative disease with-atypia breast lesions?
- Modest increase in risk of breast cancer.
- Atypical ductal hyperplasia.
- Atypical lobular hyperplasia.
What lesions are associated with the lobules and terminal ducts of the breast?
- Cysts
- Sclerosing adenosis
- Small duct papilloma
- Hyperplasia
- Atypical hyperplasia
- Carcinoma
What lesions are associated with the large ducts of the breast?
- Duct ectasia
- Squamous metaplasia of lactiferous ducts.
- Large duct papilloma.
- Paget disease.
What lesions are associated with intralobular stroma of the breast?
- Fibroadenoma
2. Phyllodes tumor
What lesions are associated with interlobular stroma of the breast?
- Fat necrosis
- Lipoma
- Fibromatosis
- Sarcoma
What is gynecomastia?
Breast swelling in boys or men. Increase in stroma and epithelial cells of breast tissue. Stimulated by imbalance of estrogens and androgens.
What are the age and gender risk factors for breast cancer?
- Risk increases after age 30.
- 75% of women with breast cancer are over 50 yrs old.
- Incidence of breast cancer in men is 1% that of women.
What are the family history risk factors for breast cancer?
- Greatest risk with multiple affected first-degree relatives with early-onset breast cancer.
- 5-10% of breast cancers occur in persons with tumor suppressor gene mutations (e.g. BRCA 1). For these people, lifetime risk greater than 90%
What are the race and ethnicity risk factors for breast cancer?
- Highest rate in women of European descent, with higher incidence of ER+ cancers.
- Hispanic and African american women develop cancer at younger age and more likely to be aggressive
What are the reproductive history risk factors for breast cancers?
- Early age of menarche.
- Nulliparity.
- Absence of breastfeeding.
- Older age at first pregnancy.
What are the three categories of breast cancer by hormone receptors?
- Estrogen receptor (ER)- most common
- Progesterone receptor (PR)
- Human epidermal growth factor 2 (HER2 aka ERBB2)
What is the most common location for breast malignancies?
95% of breast malignancies are adenocarcinomas that first arise in the duct/lobular system.
Describe ER positive breast cancers.
- Frequency: 40-55%
- Older age
- Metastasis: bone (70%), visceral (25%), brain (<10%)
- Relapse pattern: late, >10 yrs, survival with metastasis is possible
Describe HER2 negative breast cancers.
- Frequency: 10%
- BRCA 2 mutation carriers.
- Metastasis: bone (80%), visceral (45%), brain (10%)
- Relapse pattern: intermediate.
Describe HER2 positive (ER positive or negative) breast cancers.
- Frequency: 20%
- Young, non-white women, TP53 mutation carriers
- Metastasis: Bone (70%), visceral (45%), brain (30%)
- Relapse pattern: short <10 years, survival with mets is rare
Describe ER negative, HER2 negative breast cancers.
- Frequency: 15%
- young women, BRCA 1 mutation, African american and hispanic women.
- Metastasis: Bone (40%), visceral (35%), brain (25%).
- Relapse pattern: short <5 years, survival with mets is rare
What is Lobular carcinoma in situ (LCIS)?
- Clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion.
- Not associated with calcifications or mammographic densities.
What is ductal carcinoma in situ (DCIS)?
- Malignant clonal proliferation of epithelial cells limited to ducts and lobules by basement membrane.
- Associated with calcifications and mammographic densities.
What is a fibroadenoma?
Benign tumor containing a mixture of proliferating ductal elements (adenoma) embedded in loose fibrous tissue (fibroma).
Most common benign tumor of female breast.
