Breast Cancer (Techniques Final)

Breast Structure

Composed of glandular tissue, subcutaneous fat, and supportive tissue

Tail of Spence

The upper outer quadrant of breast tissue that extends into the low axilla

Lymphatic Drainage

Axillary nodes (principal pathway)

Internal mammary nodes

Supraclavicular nodes

Lymphatic involvement plays a major role in prognosis

True

Main site of drainage is from ________ breast

Ipsilateral

Axillary lymph node spread typically follows an orderly progression. Can skip metastasis occur?

Yes

Which tumors have higher risk of internal mammary lymph node involvement?

Inner quadrant tumors

Lifetime risk for breast cancer in women

1 in 8

What group faces higher mortality despite lower incidence?

Black women

Mortality rate is ___ higher in black women than in white women?

40%

Nonmodifiable risk factors for breast cancer

Age

Gender

Race

Family history (BRCA1/2)

Early menarche

Late menopause

High breast density

Prior radiation exposure

Two most significant risk factors

Gender and Age

How much higher is incidence in women than men?

100 times

Median age at diagnosis

62

Incidence higher in which race?

White women

Modifiable risk factors

Obesity

Alcohol/tobacco use

Hormone therapy

Sedentary lifestyle

Reproductive risk factors

Nulliparity or having first child after 30

Lack of breastfeeding

Factors associated with decreased risk of breast cancer

Breastfeeding for at least 1 year

Regular exercise

Healthy weight

Early pregnancy

Estrogen after hysterectomy

Selective estrogen receptor modulators

Aromatase inhibitors

Risk-reducing surgery (mastectomy, oophorectomy)

Screening Guidelines (ACS)

Age 30 — Annual breast MRI + mammogram for high-risk individuals

Age 40 — Optional annual mammogram

Age 45 — Annual mammogram recommended

Age 55+ — Biennial screening, depending on health status and life expectancy

Diagnostic Tools:

Mammogram

US

MRI

Bx

Role of mammogram in diagnosis

Standard for early detection but may have false positives/negatives

Role of US in diagnosis

Helps differentiate cysts vs. solid masses, useful in dense breasts

Role of MRI in diagnosis

Higher sensitivity (but less specific), especially useful for high-risk patients

Role of bx in diagnosis

Definitive diagnosis

Fine needle, core needle, or excisional

Physical presentations

Change in breast or nipple appearance

Change in size/shape of breast

Dimpling

Swelling

Recent asymmetry

Inverted nipple or retraction

Nipple discharge

Skin changes

Signs of advanced disease

Pain

Enlarged lymph nodes

Palpable mass with or without fixation to chest wall

Thickening of skin

Peau d’orange

Signs of Inflammatory Breast Cancer (IBC)

Rapid onset

Redness

Swelling

No distinct lump

Noninvasive (pre-cancerous) types

Ductal Carcinoma In Situ (DCIS)

Lobular Carcinoma In Situ (LCIS)

Invasive Breast Cancer types

Invasive Ductal Carcinoma (IDC)

Invasive Lobular Carcinoma (ILC)

Triple-Negative Breast Cancer

Inflammatory Breast Cancer (IBC)

Most common noninvasive type

DCIS

Most common invasive type

IDC

Type that can most commonly affect men

IDC

Second most common invasive type

ILC

Triple-Negative breast cancer

Aggressive

Lacks the three most common hormone receptors

More common in younger and Black women

Inflammatory Breast Cancer

Aggressive

Often presents with diffuse redness and swelling

Diagnosed as Stage 3 (if confined to breast) or Stage 4 (if spread beyond breast)

Always classified as T4d

Staging system

TNM

Common sites of mets

Bone, lung, liver, brain

Treatment

Surgery

RT

Chemotherapy

Hormonal therapy

Breast-Conserving Surgery (Lumpectomy)

For early-stage disease

Requires post-op radiation

Radical (Halsted) Mastectomy

Removes breast, overlying skin, pectoral muscles, and axillary lymph nodes

Modified Radical Mastectomy

Removes breast, underlying fascia, and Levels I & II lymph nodes

Improves local control but not long-term survival

Total Mastectomy

Removes entire breast but spares lymph nodes

Nipple-Sparing Mastectomy

Initially for prophylactic mastectomy, now common for early-stage cancer

Has higher recurrence rates

Sentinel node biopsy

Identifies node-negative cases to avoid more extensive surgery

________ staging is pertinent to breast disease management

Axillary

Tangents dose

45—50.4 Gy

Sclav dose

46.8—50.4 Gy

Tumor bed boost dose

60 Gy

Radiation technique post-lumpectomy

Standard whole-breast RT ± boost to tumor bed

Radiation technique post-mastectomy

Indicated for locally advanced disease

Chemotherapy indicators

Used for aggressive tumors, lymph node involvement, or large tumors

Can be neoadjuvant to shrink tumor size prior to surgery

Hormonal therapy used for breast cancer

Tamoxifen

5-Year survival rate for invasive breast cancer

92%

Racial disparities for breast cancer prognosis

Black women have lower survival rates due to later-stage diagnosis and highest risk of developing triple negative breast cancer

Why do women under age 35 have worse survival rates?

Presenting with later stage and estrogen negative disease

Women under age 35 have better prognosis than women 35+

False