Disorders of the Breast (Beckman)

Risk factors for breast cancer

- age - personal history of breast CA - hx of atypical hyperplasia (ductal or lobular) on past bx - inherited genetic mutations (BRAC-1 and BRAC-2) - high breast tissue density - first degree relatives with breast or ovarian cancer diagnosed at an early age - early menarche (<12 years) - late cessation of menarche (>55 years) - no term pregnancies - late age at first live birth (>30) - never breastfed - recent and long-term OCP use - post menopausal obesity - personal hx of endometrial or ovarian cancer - alcohol consumption - height (tall) - high socioeconomic status - Ashkenazi Jewish heritage

Sclerosing adenosis of the breast

If there is an increased fibrosis within the expanded lobule with distortion and compression of the epithelium, the lesion is termed sclerosing adenosis.

Ductal Carcinoma in situ

In DCIS, the ducts are filled with atypical epithelial cells. Women with DCIS are at increased risk for developing invasive cancer or a recurrence of the DCIS lesion. For those reasons, DCIS should be evaluated with core-needle bx followed by surgical bx or excision.

Breast cancer risk: reproductive and menstrual history

In general woman who had an early age of menstrual onset (before the age of 12 years) and transition through menopause after the age of 55 years or an increased risk for breast cancer. Delayed childbearing and nulliparity also increase the chance of breast cancer.

Epithelial hyperplasia of the breast

In the normal breast, only myoepithelial cells and a single layer of luminal cells rests on the basement membrane. If therea re more than two cell layers, the abnormality is known as epithelial hyperplasia.

Her2/neu (or c-erb-B2)

Is an oncogene encoding a membrane-bound growth factor receptor. Overexpression confers poor prognosis and is noted in 20 to 30% of invasive ductal cancers

Trastuzumab

Is another drug used to treat breast cancer. It acts on membrane-bound protein produced by Her2/neu. If a patient's cancer is found to over express the Her2/neu protein, it can be given as adjuvant therapy. Trastuzumab is associated with significant side effects, including heart failure, respiratory problems, and life-threatening allergic reactions.

Risk factors for breast cancer: breast changes

It is believed that women with dense breast tissue are at increased risk for breast cancer. In addition, histologic biopsies finding atypical hyperplasia or lobular carcinoma in situ greatly increase the risk of breast cancer

Lobular carcinoma in situ

LCIS is characterized by obliteration of the lumina of the glandular acini by a uniform population of small atypical cells. Management of LCIS and its related condition - atypical lobular hyperplasia - consists of an excisional bx.

BI-RADS Classification 5

Summary Recommendations: Highly suggestive of malignancy Explanation: A lesion with a high probability of cancer - appropriate referral to a breast surgeon is needed.

BI-RADS Classification 4B

Summary Recommendations: Intermediate suspicion for malignancy Explanation: Malignancy is possible

BI-RADS Classification 6

Summary Recommendations: Known biopsy proven malignancy Explanation: Appropriate action should be taken

BI-RADS Classification 4A

Summary Recommendations: Low suspicion of malignancy Explanation: a lesion needing intervention

BI-RADS Classification 4C

Summary Recommendations: Moderate concern Explanation: No classic signs but malignancy is suspected

BI-RADS Classification 3

Summary Recommendations: Probably a benign finding Explanation: A mammogram with a lesion highly likely to benign; follow-up is suggested to establish mammographic stability

BI-RADS Classification 2

Summary Recommendations: benign findings Explanation: negative mammogram but interpreter wishes to describe a finding

BI-RADS Classification 0

Summary recommendations: Need additional imaging evaluation Explanation: A mammogram with a lesion that needs additional imaging, such as spot compression films, magnifications, and additional views

BI-RADS Classification 1

Summary recommendations: Negative Explanation: the breast appears normal

Treatment for stage II breast cancer

Surgery: modified radical mastectomy or breast conservation therapy (includes lumpectomy and breast irradiation)/axillary lymph node dissection Adjuvant therapy: chemotherapy >1 cm +/-tamoxifen Radiation therapy of supraclavicular nodes plus or minus chest wall, if mastectomy performed if >4 positive nodes

Treatment for stage III breast cancer

Surgery: modified radical mastectomy or breast conservation therapy includes (lump ectomy and breast irradiation)/axillary lymph node dissection Adjuvant treatment: chemotherapy +/-neoadjuvant chemotherapy +/-tamoxifen Radiation therapy of the supraclavicular nodes +/- chest wall if mastectomy performed Radiation therapy of the breast (inflammatory breast cancer)

Treatment of stage IV breast cancer

Surgery: surgery for local control Adjuvant treatment: +/- chemotherapy +/- hormonal agents

Treatment of stage 0 breast cancer

Surgery: total mastectomy or breast conservation therapy - includes lump back to me and breast radiation no adjuvant treatment

Treatment for stage I breast cancer

Surgery: total mastectomy or breast conservation therapy - includes lumpectomy and breast irradiation - plus or minus sentinel node biopsy/axillary lymph node dissection. Adjuvant therapy: chemotherapy >1 cm +/- tamoxifen

A 61-year-old woman has been diagnosed with a 2 cm breast tumor. Her stage of breast cancer is?

T4

Tamoxifen

Tamoxifen is used to treat women with estrogen receptor positive breast cancer. It can be used in conjunction with chemotherapy. It is also given as a five-year course of preventative treatment following surgery.

A 33-year-old woman presents for evaluation of a palpable mass in the upper outer quadrant of her left breast. The mass was found on breast self-examination roughly 3 months ago and it's presence is confirmed on clinical breast examination. A diagnostic mammography is reported as normal. The most appropriate next step in the management of this patient is?

Tissue diagnosis

Lympho-vascular supply of the breast

The breast has a rich blood supply and lymphatic system, which support milk production and overall breast health. The ipsilateral lymph node and, occasionally the internal mammary nodes are the most common route of metastasis.

Benign Breast lesions: Proliferative without atypia

ex: Epithelial hyperplasia, sclerosing adenosis, complex sclerosing lesions (radial scar), papillomas Relative risk of developing invasive breast cancer: 1.5-2.0

Benign Breast lesions: Non proliferative

ex: fibrocystic changes, cysts, fibrosis, adenosis, lactational ademonas, fibroadenomas Relative risk of developing invasive breast cancer: 1.0

Benign Breast lesions: Proliferative with atypia

ex: lobular carcinoma in situ, ductal carcinoma in situ Relative risk of developing invasive breast cancer: 8.0-10.0

Core Needle Bx

in a core needle bx, a large needle (14-16G) is used to obtain samples from larger, solid breast masses. 3-6 samples of tissue approximately 2cm long are obtained and are evaluated for abnormal cells in relation to the surrounding breast tissue taken in the sample.

Benign Breast Disease

Includes a large number of conditions that can significantly affect a woman's quality of life.

Nipple Discharge

Nipple discharge is usually benign but may be an early sign of endocrine dysfunction or cancer. The color, consistency, and whether the discharge is b/l or unilateral can yield important clues about cause.

Radial scar

(complex sclerosing lesion) is a nidus of tubules entrapped in a densely hyalinized stroma surrounded by radiating arms of epithelium. The lesion mimics an invasive carcinoma.

Medical therapy

- the only medication approved by the FDA for treating mastalgia is danazol, but it has significant side effects. Other hormonal therapies include bromocriptine and GnRH agonists, but these drugs also have side effects that limit their widespread use. - Selective estrogen receptor modulators (SERMs) such as tamoxifen, also have a role in treating severe mastalgia, though this is an off-label use of the medications. - Tamoxifen should be used only for cases of severe mastalgia that does not respond to other therapies. Raloxifen, also an SERM, has been shown to decrease the incidences of breast cancer in high-risk women. Unlike tamoxifen, it does not stimulate the endometrium. Hot flashes and increased risk of VTE are similar to tamoxifen.

Evaluation of Breast signs and symptoms

- the two most common presenting complaints related to the breast are pain and concern about a mass. - questions about location of complaints, duration of symptoms, how a mass was first discovered, presence or absence of nipple discharge, any changes in size, and association with the menstrual cycle will aid in deciding next steps for diagnosis. - In addition, the clinician should ask about presence of risk factors that would increase likelihood of malignancy

You should counsel the woman with the fibroadenoma the currently a woman living in the United States has a lifetime risk of developing breast cancer of approximately?

1 in 8

BI-RADS category 1 report in a 55 - year - old should be followed up with a mammogram in what period of time?

12 months

A 23-year-old woman is diagnosed with a fibroadenoma of the left breast and she is worried that this will affect her risk of breast cancer later in life. You should tell her that the relative risk of developing invasive breast cancer and woman with a fibroadenoma is

1x greater

Diagnostic mammography

A diagnostic mammogram is done to supplement an abnormal screening mammogram or if a woman has a breast complaint and/or palpable mass. The contralateral breast should also be imaged in case of a clinically apparent mass. If possible, lymph nodes are also imaged to search for unrecognized abnormalities.

You received a mammogram report of category 0 BI-RADS report. You explained to the patient as follows:

A finding is noted that warrants further imaging

Ductal Ectasia

A nonspontaneous, nonbloody, bilateral nipple discharge is usually attributed to fibrocystic changes of the breast; a condition characterized by dilation of the mammary ducts, periductal fibrosis, and inflammaion. It is seen in adolescent women as well as in perimenopausal women.

Medical therapy: breast cancer

Adjuvant - systemic - therapy is used in the treatment of all stages of breast cancer, regardless of lymph node status. Adjuvant therapy includes chemotherapeutic drugs that kill cancer cells and hormonal therapy such as tamoxifen that act as estrogen antagonist.

The historical factor that would most increase her risk of breast cancer would be? A. Late menarche B. Cessation of menses before age 45 years. C. Age greater than 50 years. D. Breast-feeding more than one infant E. Grand multiparity

Age greater than 50 years

Risk factors for breast cancer: age and race

Age is the single largest risk factor for developing breast cancer. The majority of breast cancer cases occur in women over the age of 50 years. When stratified by race, white women are more likely to be diagnosed with breast cancer compared with age matched women of Latin, Asian, and African-American descent

Histologic types of breast cancer

American joint committee on cancer classifies most breast malignancies into one of three histologic categories according to their corresponding cells origin: ductal, lobular, and nipple. About 70 to 80% of breast cancers are invasive ductal carcinomas. These are most common among women in their 50s and have a tendency to spread to regional lymph nodes. Invasive lobular carcinomas comprise 5 to 15% of breast cancers. This type is often multifocal and bilateral. Padget's disease of the nipple presents as a superficial skin lesion similar to eczema

Nonproliferative lesions of the breast: adenosis

An increase in the number of glands associated with lobular growth is known as adenosis. In this case, the architecture of the lobule remains unchanged.

A 46-year-old woman comes to the office for a periodical evaluation. She asks for advice regarding screening mammography. She has had three children, and her first child was born when she was 24 years. She did not breast-feed any of her infants. She had a paternal aunt who died of breast cancer at age 42 years. On physical exam she is 152 cm tall and weighs 55 kg - 121 pounds. based on current screening guidelines and this patient's history, you would recommend that she have screen mammography how often?

Annually

Aromatase inhibitors

Aromatase inhibitor's prevent the production of estrogen in postmenopausal women. AIs are used to extend survival in women with metastatic cancer as primary adjuvant therapy, and in conjunction with tamoxifen to prevent cancer recurrence

BRCA - 2 mutation

BRAC2 is a gene located on the 13q12-13 chromosome. This mutation has a lower incidence of early onset breast cancers (35%) and much lower risk of ovarian cancer compared with BRCA1

BRCA - 1 mutation

BRCA1 is a gene located on the 17q21 chromosome. This mutation is associated with nearly half of the early onset breast cancer is in approximately 90% of hereditary ovarian cancer is.

Risk factors for breast cancer: other factors

Being overweight after menopause has been linked to an increased risk of breast cancer. This is possibly due to an increased peripheral conversion of androstenedione to estrone leading to breast cancer development Women who consume 2 to 4 alcoholic drinks per week have a 30% greater risk of dying from breast cancer than women who never drink.

A 53-year-old patient has a category for finding on BI-RADS category 4 report. What is the most appropriate next step in the management of this patient is?

Biopsy

A 35-year-old G1 with an Intrauterine pregnancy at 31 weeks gestation presents complaining of a firm lump in her left breast. On exam there is a 2X3 centimeter firm nodule surrounded by some erythema in the upper quadrant discovered. There is no skin retraction and the nodule is somewhat mobile. The most appropriate plan of management is?

Biopsy of the mass

Breast cancer

Breast cancer is the second most common malignancy in women, ranking only behind skin cancer. The steady increase in the incidence of breast cancer can be attributed to the increased use of mammography screening, which has enabled the detection of smaller invasive lesions and the earlier diagnosis of in situ lesions

Breast cancer risk: radiation exposure

Breast tissue of young women is highly susceptible to the cancer causing effects of ionizing radiation. When it was received a sufficiently large dose of radiation (example radiation therapy to treat Hodgkin's disease or an enlarged thymus gland) are at a higher risk for radiation-induced breast cancer. Although the threshold is unclear the relationship between dose of radiation and the risk of cancer is directly linear.

A 30-year-old patient with a family history of breast cancer undergoes needle aspiration of the cystic breast mass. The fluid obtained is clear. Your next step in management of this patient would be to?

Check the site later for recurrence of the mass

23 year old patient presents with a 2 to 3 cm firm, painless, freely movable mass in her left breast she reports that the mass does not change during her menstrual cycle and has grown slowly over the past year. The patient found the mass during self breast exam. What is her most likely diagnosis? A. Fibrocystic change Be. Ductile Ectasia C. Mastitis D. Fibroadenoma E. intraductal carcinoma

D. Fibroadenoma

A 45-year-old woman has an abnormal screening mammogram. The next step in management should be?

Diagnostic mammogram

A 40-year-old woman presents with a green, sticky nipple discharge that has been present for a few weeks. The patient most likely has?

Ductal ectasia

Screening Mammography

During a screening mammography, the patient stands or sits in front of an x-ray machine. Two smooth plastic plates are placed around the breast and subsequently compressed to allow for complete visualization of the tissue. A standard 4 image screening mammogram involves two craniocaudal and two mediolateral images. digital mammography may be preferred in women with dense breast tissue, as it offers more ability to enhance the images after they are taken. Lobular carcinoma in situ is more difficult to detect with routine screening mammography

Physical Breast Exam

Evaluation includes both breasts in a systematic fashion, both axillae, and the entire chest wall. The best time to perform a breast examination is in the follicular phase of the menstrual cycle. If the initial exam fails to yield a dominant mass, the options (based on the patient's risk factors) include performing a repeat examination in 3 months or referral to a specialized breast care clinic.

A 28-year-old patient comes to the community health center for the valuation of a tender, for mass in her right breast in the same general location where she was hit by a softball two years ago. Vital signs are normal. She weighs 123 pounds and is 5 foot one tall. Physical examination is normal except for an indurated and poorly defined mass with local skin retraction. Mammography shows fine, stipled calcification. There is no palpable adenopathy to based on the most likely diagnosis, you recommend?

Excisional biopsy

A 20-year-old patient comes to the community health center for the evaluation of the gradual growth of a mass in her left breast. The mass is tender prior to her periods. The patient has had one pregnancy and breast-fed for three months after delivery, ending one year ago. Vital signs are temperature 37°C, pulse 68 per minute, respirations 18 per minute, and blood pressure 118/64 mmHg. She weighs 56 kg (123 lb) And is 155 cm tall. Physical exam is normal except for a mobile, firm and appropriately 1 cm nodule in the upper outer quadrant of the left breast. She has no expressible nipple discharge and no adenopathy. Based on this patient's history and physical findings, the most likely diagnosis is?

Fibroadenoma

Nonproliferative lesions of the breast: Fibrocystic Changes

Fibrocystic changes of the breast are a spectrum of features that can be observed in the normal breast. Lobules of the breast may form cysts of varying sizes; cyst walls are lined by flattened atrophic epithelium or may be modified through apocrine metaplasia. Ruptured cysts leave scarring and inflammation that may lead to fibrotic changes.

Fine Needle aspiration bx

Fine needle aspiration is useful in determining if a palpable mass/lump is a simple cyst. The procedure is performed in the office with or without the aid of local anesthesia. The suspected mass is stabilized between two fingers of one hand and aspirated using a 22- 24 G needle. Clear aspirated fluid does not need to undergo pathologic evaluation, and the patient may return for a CBE within 4-6 months if the mass disappears. If it reappears, the patient is managed with diagnostic mammography and U/S. Bloody aspirated fluid should be evaluated cytologically, and the patient should undergo diagnostic mammography and U/S.

Breast cancer screening guidelines

For the general population, breast cancer surveillance involves a combination of clinical breast exam and radiographic imaging. In 2009 the US preventative Service task force found insufficient evidence for teaching breast self exam. The American College of obstetricians and gynecologists supports the practice of breast self exam only in high-risk patients and for teaching breast self awareness in low-risk patients. - The value of mammography increases with age - The USPS TF found sufficient evidence to demonstrate that mammogram screening every one to three years significantly reduces mortality for breast cancer. The college currently recommends that mammography be performed annually at the age of 40 years where as the USPSTF recommends that the decision to start regular biennial screening mammography before age 50 should be an individual one and take patient context into account, including the patient values regarding specific benefits and harms. These screening standards not apply to women with inherited genetic mutations placing them at increased risk for developing breast cancer. In this population, breast cancer occurs at younger age and is missed by screening mammography nearly 50% of the time. Recommendations for BRCA carriers include monthly BSEs beginning at the age of 18 to 20 years, annual CBEs and screening mammograms beginning after age 25 years - or 5 to 10 years before the age of diagnosis in the affected relative. MRI is recommended as a supplement to mammography not a replacement.

Mastalgia

Mastalgia, or breast pain, can be divided into 3 categories: cyclic, noncyclic and extrammamary (nonbreast) pain. - Cyclic mastalgia begins with the luteal phase of the menstrual cycle and resolves after the onset of menses. - Noncyclic mastalgia is not associated with the menstrual cycle and includes etiologies such as cysts, tumors, mastitis, and a hx of breast surgery. Non cyclic pain is also associated with some hormonal medications, antidepressants (seraltine and amitriptyline); and anti-HTN drugs. - Extrammamory pain can be caused by a number of conditions including chest wall trauma, rib fractures, shingles, and fibromyalgia. R/o serius causes of chest pain.

A 34-year-old patient complains of cyclic breast tenderness and diffuse nodularity on monthly breast self-examination. Your examination finds multiple firm, mobile masses, predominately in the upper outer quadrant of each breast. You aspirate one of these masses and obtain clear, straw - colored fluid. What is the best initial management of this condition?

Mechanical support of the breast

Fiberoptic ductoscopy

Nipple discharge that is bloody and unilateral may be caused by an invasive ductal carcinoma, intraductal papilloma, or an intraductal carcinoma. Patients of this type usually require ductography and ductal excision. A new technique that employs fiberoptic technology, fiberoptic ductoscopy, allows the direct visualization of the breast ducts as well as sampling of the ductal cells.

A 29-year-old female Medicaid patient comes to the office for breast cancer screening because she recently had a 28-year-old friend diagnosed with cancer. She has never had any breast problems and has not had a mammogram. She's not aware of any family members with breast cancer. Gynecologic history finds that she began her period at Age 15 years but had the first of her five children at age 17 years. She breast-fed two of her children. Her periods are regular and she has had a sterilization procedure. She weighs 183 lbs and is 150cm tall. Physical exam is normal. The factor that most adversely affects this patient's risk for breast cancer is?

Obesity

Breast cancer follow-up

Once the initial treatment has been completed, the obstetrician - gynecologist often takes on the role of screening and surveillance. For the first two years, follow-up appointments occur every 3 to 6 months and then annually after that. Mammography physical examination should continue indefinitely. Most cases of breast cancer recurrence is within five years of primary therapy.

Papillomas of the breast

Papillomas are intraductal growths composed of abundant stroma and lined by both luminal and myoepithelial cells. Solitary intraductal papillomas are found in the major lactiferous ducts of women, typically between 30-50 years of age, and cause a serous or serosanguineous drainage.

A 25-year-old G1 P0010 woman with an LMP 3 weeks ago presents to your office with a "lump" noted in her right breast, 10 days ago. On examination, there is a 1 cm, cystic, mobile, tender mass in the Areola of the right breast at 12 o'clock position. There's no accompanying lymphadenopathy. Management at this point should be?

Repeat examination at the end of the next menstrual cycle

Nonproliferative lesions of the breast: Simple fibroademonas

Simple fibroadenomas are common tumors found in women in their late teens and early twenties. These masses are solid, round, rubbery, and mobile on examination. The tumors do have structural and glandular components in the mass, although they do not have a malignant potential, they can enlarge during pregnancy and cause discomfort.

Breast masses: warning signs

Some characteristics of breast masses that suggest malignancy include >2cm in size, immobility, poorly defined margins, firmness, skin dimpling or color changes, retraction or changes in the nipple (e.g. scaling), bloody nipple discharge, and ipsilateral lymphadenopathy. It is estimated that it takes an average of 5 years for a tumor to reach a palpable size.

Breast cancer staging

The AJCC stages breast malignancies according to the TNM system that describes characteristics of the primary tumor, involvement of regional lymph nodes, and distant metastases. Surgical stage helps determine the appropriate types of therapy. In addition to stage, receptor status is another important indicator of breast cancer prognosis. Expression of estrogen or progesterone receptors positively affects prognosis.

Anatomy of the adult female breast

The adult female breast is a modified sebaceous gland, located within the superficial fascia of the chest wall.

Histologic anatomy of the female breast

The breast is composed primarily of lobules or glands, milk ducts, connective tissue, and fat. The relative amounts of these tissue types vary considerably with age. In younger women, the breast consists predominantly of glandular tissue. With age, the glands involute and are replaced by fat, a process accelerated by menopause.

Organization of breast tissue

The breast is organized into 12-20 lobules, with a disproportionate amount of the glandular or lobular tissue in the upper, outer quadrants of each breast. This disproportionate distribution of glandular tissue accounts for why breast cancer most commonly arises in the upper quadrant These lobules consist of clusters of secretory cells arranged in an alveolar patter and surrounded by myoepithelial cells. These glands drain into a series of collecting milk ducts that course through the breast, ultimately coalescing into approximately 5-10 collecting ducts that lead to and drain at the nipple. Typically, cancer begins at these terminal duct-lobular units of the breast and follows the path of those ducts.

Breast development

The breast tissue is very sensitive to hormonal changes, especially in the glandular cells. Estrogen is primarily responsible for the growth of adipose tissue and laciferous ducts. Conversely, progesterone stimulation leads to lobular growth and alveolar budding.

Breast cancer risk assessment tool: the Gail model

The gal model allows clinicians to estimate a woman's risk for developing invasive breast cancer over the next five years and in her lifetime. It is based on a mathematical model of breast cancer risk calculation. Seven risk factors are used in calculations: a history of LCIS or DCIS, age, age at onset of menstruation, age at the time of first live birth, number of first-degree relatives with breast cancer, personal history of breast biopsy, and race/ethnicity. The usefulness of the Gail model is limited in patients with second-degree relatives with breast cancer, and falsely increased in patients with multiple breast biopsies. Family history of breast cancer is the strongest predictor of risk among the factors used in the model. Current prophylactic options include chemoprevention with SERMs including tamoxifen and raloxifene and prophylactic mastectomy.

Surgical therapy of breast cancer

The surgical treatment is lumpectomy - breast conservation or mastectomy. Mastectomy is removal of all breast tissue and the nipple stellar complex with preservation of the pectoralis muscles. A modified radical mastectomy also includes removal of the axillary lymph nodes. Radiation therapy is used in conjunction with mastectomy for later stages of breast cancer and to accompany lumpectomy and partial mastectomy for early stages of breast cancer. Radiation is an essential component of lumpectomy. The combination of lump ectomy and radiation yields outcomes that are equal to those of radical mastectomy. Breast reconstruction should be an option for all women who desire it

MRI Evaluation of the breast

The use of MRI for screening the general population is limited by the cost of the examiation, lack of standard examination technique, and inability to detect microcalcifications. MRI is being used as an adjunt for early detection of breast cancer in women at very high risk, and it may also be used as part of post-cancer breast diagnosis for further evaluation of breast involvement.

Proliferative lesions without atypia

These lesions are commonly found on mammography and do not usually cause a palpable mass. They represent proliferation of cells of the ductal or lobular epithelium. The cells themselves are normal, that is, nonmalignant.

Ultrasonography Evaluation of the breast

U/S is useful in evaluating the breasts of young women and others with dense tissue, allowing better differentiation between a solid and cystic mass, and in guiding tissue core needle biopsies. In women younger than 40 years (especially adolescents) U/S is the most common initial modality to evaluate a breast mass

A 21-year-old patient complains of the breast mass present for a few days. The initial evaluation modality should be?

Ultrasound

Proliferative lesions with atypia

When malignant cells replace the normal epithlium lining the ducts or lobules, the lesion is known as carcinoma in situ. The basement membrane remains intact, and, therefore, the cells cannot metastasize. Following treatment of both LCIS and DIS, preventative therapy with SERMs such as tamoxifen has been shown to reduce the risk of invasive breast cancer in these patients.

Risk factors for breast cancer: family history and genetics

Women who have 1st° relative (parent, sibling, and offspring) with breast cancer have a higher risk than the general population. If a woman younger than 40 years is diagnosed with breast cancer, evaluating for genetic mutations that predispose individuals to cancer is reasonable.

Mammography

mammography is an x-ray technique used to study the breast. Mammography is able to detect lesions approximately 2 years before they become palpable.