Clinical features, diagnosis, and staging of newly diagnosed breast cancer
- Laura J Esserman, MD, MBA
Laura J Esserman, MD, MBA
- Professor of Surgery and Radiology
- University of California, San Francisco
- Director, UCSF Carol Franc Buck Breast Care Center
- Bonnie N Joe, MD, PhD
Bonnie N Joe, MD, PhD
- Professor of Radiology and Biomedical Imaging
- UCSF Breast Imaging
Globally, breast cancer is the most frequently diagnosed malignancy, accounting for over a million cases each year . It is also the leading cause of cancer death in women worldwide. In the United States, breast cancer is the most common female cancer, the second most common cause of cancer death in women .
Once a diagnosis of breast cancer is established, it is important to accurately define the initial extent of disease since this information will affect treatment recommendations. This topic will review the clinical manifestations, differential diagnosis, and staging following a diagnosis of breast cancer.
The factors that modify breast cancer risk, diagnostic evaluation of women with suspected breast cancer, the treatment approach to in situ and invasive breast cancer, and the use of prognostic and predictive factors when making adjuvant treatment decisions are reviewed as separate topics.
Breast cancer is the most commonly diagnosed cancer worldwide, including low and middle income countries [1,3,4]. The incidence rates are highest in North America, Australia/New Zealand, and in western and northern Europe, and lowest in Asia and sub-Saharan Africa . These international differences are likely related to societal changes as a result of industrialization (eg, changes in fat intake, body weight, age at menarche, and/or lactation, and reproductive patterns such as fewer pregnancies and later age at first birth). Studies of migration patterns to the US are consistent with the importance of cultural and/or environmental changes . In general, incidence rates of breast cancer are greater in second-generation migrants and increase further in third- and fourth- generation migrants.
In the United States, breast cancer accounts for over 250,000 cases each year and is responsible for over 40,000 deaths . The incidence rates decreased from 1999 to 2007 by 1.8 percent per year . It is likely that two factors have contributed to this: the discontinuation of hormone replacement therapy (HRT) and the saturation/leveling of screening mammography rates [7-11]. Of these factors, the discontinuation of HRT has probably had a greater effect [9,12,13]. This was demonstrated in a report from the Women’s Health Initiative where a rapid decline in breast cancer incidence was noted in trial participants following discontinuation of HRT . Discontinuation of HRT was not accompanied by changes in mammographic utilization, suggesting that the latter did not play a role in the decline in incidence rates. (See "Menopausal hormone therapy: Benefits and risks", section on 'Breast cancer'.)
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- CLINICAL FEATURES
- Signs and symptoms
- - Breast mass
- - Locally advanced disease
- - Metastatic disease
- Imaging findings
- - Infiltrating ductal carcinoma
- - Infiltrating lobular carcinoma
- - Mixed ductal/lobular carcinoma
- Molecular subtypes
- - Luminal subtypes
- - HER2-enriched
- - Basal subtypes
- DIFFERENTIAL DIAGNOSIS
- POST-DIAGNOSIS EVALUATION
- Breast cancer receptor testing
- - ER and PR
- - HER2
- - Frequency of subtypes
- Role of imaging
- Assessing the extent of disease
- Significance of intramammary lymph nodes
- Primary tumor
- Lymph nodes
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS