Breast cancer (summary)

This is a basic article for medical students and other non-radiologists

Breast cancer is the commonest malignancy in female patients.

Reference article

This is a summary article; read more in our article on breast cancer.

Summary

• epidemiology
  • 1 in 4 cancer deaths in women worldwide ¹
  • In Australia, second only to lung cancer in cancer-related mortality and most commonly diagnosed cancer in women ¹
  • 1 in 8 Australian women receive diagnosis by age 85 ¹
• presentation
  • breast lump
  • change in breast shape or skin
  • axillary lymph node enlargement or breathlessness (metastases)
• pathophysiology
  • risk factors
    • modifiable: smoking, hormonal birth control
    • genetic: 5-10% of cases (BRCA1 and BRCA2 90%, p53, PTEN, STK11)
  • classification
    • histology (ductal, lobular)
    • grade (low, intermediate, high)
    • stage (TNM)
    • receptor status (ER, PR)
    • DNA assays
• investigation
  • mammogram (older) and ultrasound (younger)
  • breast MRI for challenging cases
  • US/mammogram guided biopsy
• treatment
  • surgery (breast-conserving surgery vs mastectomy)
  • chemotherapy
  • radiation therapy (e.g. EBRT, IORT, brachytherapy)
  • hormonal therapy ^2-7

Role of imaging

• population screening using mammography
  • 45-50 years to 70-75 years (depending on country)
• making a diagnosis in symptomatic patients
• staging the disease
• assessing response to treatment

Radiographic features

Mammography

Mammography is used for breast screening and is more useful in older patients. It is less useful in younger patients who tend to have denser breast tissue.

Ultrasound

Useful in the context of a symptomatic patient. Can be used to make a diagnosis and also to guide biopsy.