Breast cancer is the second most common form of cancer in women and the most common cause of death due to cancer in women. Approximately 1 in 8 women in the United States will develop breast cancer. About 178,000 new cases of breast cancer are found every year and approximately 41,000 deaths per year are attributed to breast cancer.

Breast cancer is more common in caucasian women and the average age of diagnosis is 60-years-old . A person’s risk of contracting breast cancer is significantly higher if there is a family history of breast cancer with the risk increasing up to four times higher if the mother or sister have been diagnosed with the disease.

The most common, early sign of breast cancer is a single, non-tender, hard breast lump with poorly defined edges. Other signs of breast cancer include breast pain, nipple discharge, breast enlargement, nipple retraction, breast redness, and enlarged lymph node in the armpit.

Breast cancer screening is a combination of breast physical examination, mammogram, ultrasound and MRI imaging of the breast.

Breast physical examination is a combination of monthly self-breast exams and yearly physician examinations. Up to 74% of breast cancer incidences are detected by an abnormal physical examination of the breast.

The mammogram is a very important screening tool and up to 50% of early breast cancers can only be found on a mammogram. The American Cancer Society, the American College of Radiology, and the American Medical Association recommend mammograms yearly beginning at age 40.

Screening breast ultrasound can detect cancers missed by mammogram and has been shown to increase breast cancer detection by 42% over mammogram alone.

Screening MRI imaging of the breast is the most useful in woman at high risk for breast cancer as it may detect cancer otherwise not found by mammogram or ultrasound. However, MRI of the breast is not a good screening tool for average-risk women in that it may be too sensitive and inappropriately detect non-cancerous lesions.

Blood tests for gene mutations of BRCA-1, and BRCA- 2 are available as genetic screening in women with a family history of breast cancer. Blood tests for recurrent breast cancer include the tumor markers CA 15-3 or CA 27-29 and Carcinoembryonic antigen (CEA).

The ability to successfully treat breast cancer depends on the intensity of the cancer at the time of diagnosis, the cancer cell type and whether the cancer cells have estrogen or progesterone receptors.

Women at high risk of developing breast cancer may consider, with their physician, prophylactic treatment with Tamoxifen or Raloxifen.

Albain KS. Adjuvant chemotherapy for lymph node-negative, estrogen receptor-negative breast cancer: a tale of three trials. J Natl Cancer Inst. 2004;96:1801. [PMID: 15601631]
Giordano SH et al. Breast cancer treatment guidelines in older women. J Clin Oncol. 2005;23:783. [PMID: 15681522]
Gordon PB: Ultrasound for breast cancer screening and staging. Radiol Clin North Am 40:431, 2002 [PMID: 12117185]

November 4, 2008