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Diagnostic evaluation of women with suspected breast cancer

Laura J Esserman, MD, MBA
Bonnie N Joe, MD, PhD
Section Editors
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Daniel F Hayes, MD
Deputy Editor
Wenliang Chen, MD, PhD


Approximately 230,480 American women are diagnosed with breast cancer annually, and 39,520 women die from this disease [1]. Global cancer statistics show that breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23 percent of total cancer cases and 14 percent of cancer deaths [2]. Breast cancer is now also the leading cause of cancer death among females in economically developing countries.

Despite increasing incidence rates, annual mortality rates from breast cancer have decreased over the last decade (1.9 percent per year from 2008 to 2012) [3]. The decline has been more pronounced in Caucasian than in African-American women. (See "Factors that modify breast cancer risk in women".)

A significant portion of the decline in mortality is attributable to the impact of screening mammography, which permits diagnosis at an earlier stage of disease [4-7]. Preinvasive breast cancer (ductal carcinoma in situ [DCIS]) now accounts for 25 to 30 percent of all newly diagnosed, mammographically detected breast cancers. (See "Screening for breast cancer: Strategies and recommendations" and "Breast ductal carcinoma in situ: Epidemiology, clinical manifestations, and diagnosis", section on 'Mammographic screening'.)

The majority of breast cancers are diagnosed as a result of an abnormal mammogram, but not all mammographic findings represent cancer. Women who have an abnormal screening mammogram often need further diagnostic evaluation with additional mammographic views such as spot-compression magnification views or spot tomosynthesis views and/or targeted ultrasonography to determine the need for tissue sampling or biopsy. Additionally, not all cancers are detectable on mammography. A clinically suspicious mass should also be biopsied, regardless of imaging findings, as approximately 15 percent of such lesions can be mammographically occult [8]. The goal of the initial biopsy is to obtain sufficient diagnostic material using the least invasive approach and to avoid surgical excision of benign lesions. (See "Breast biopsy".)

This review will discuss the diagnostic evaluation and management of a woman with suspected breast cancer due to either abnormal imaging or physical findings. Initial staging workup of patients with newly diagnosed breast cancer, the general approach to evaluation of breast masses in women, and breast biopsy techniques are discussed separately. (See "Clinical features, diagnosis, and staging of newly diagnosed breast cancer" and "Clinical manifestations and diagnosis of a palpable breast mass" and "Breast biopsy".)


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