Breast carcinoma

Breast carcinoma
Updated: 02/14/2020
© Jun Wang, MD, PhD

General feature
  • Most common cancer in women, regardless of race or ethnicity
  • Second most common cause of death from cancer in women
  • Mortality reducing due to early detection by mammogram
Etiology
  • Genetic
  • Hormonal: most commonly associated risk factor
Higher risk group
  • Age: risk increases with age until age 80
  • Personal history of breast cancer
  • Inherited genetic mutations for breast cancer
  • History of atypical hyperplasia
  • Mammographically dense breasts
Intermediate risk group
  • High endogenous estrogen or testosterone levels, etc
Carcinogenesis
  • Estrogen dependent: most common, ER+
  • Her2 associated: most common in Li-Fraumeni syndrome
  • ER, Her2 independent
Molecular abnormalities
  • Hereditary Breast and Ovary Cancer syndrome: BRCA1 and BRCA2


Molecular subtypes
  • Luminal A: ER+, PR+, her2-
  • Luminal B: ER+, PR+, her2+
  • Her2+: ER-, PR-, her2+
  • Basal like: ER-, PR-, her2-, CK5/6+
  • Unclassified
Most common clinical features
  • Mass
  • Abnormal mammogram findings
Categories per morphology
Ancillary test
  • Estrogen receptor
  • Progesterone receptor
  • Her2
  • Proliferative index by ki67
Categories per ancillary test results
  • ER positive Her2 negative, low proliferation
Older woman, men, mammogram detected
Well to moderately differentiated
Good prognosis
  • ER positive Her2 negative, high proliferation
BRCA mutation carriers
Poorly differentiated
Intermediate prognosis
  • Her2 positive
ER may be positive or negative
Young women, non white
p53 mutation
Early relapse
Rare survival with metastasis
  • ER negative Her2 negative
Not the same as basal like, even similar
Medullary, adenoid cystic, secretory, metaplastic
Young women, non white
BRCA1 mutation carriers
Rare survival with metastasis
Management
  • Ductal carcinoma in situ, pleomorphic lobular carcinoma in situ: Surgery, hormonal, radiation
  • Classic lobular carcinoma in situ: Watchful waiting, probably hormonal therapy
  • Invasive carcinoma: surgery, chemotherapy, radiation therapy, hormonal therapy


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