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Key Clinical Updates in Carcinoma of the Female Breast

Guidelines by the American Society of Radiation Oncology and the European Society for Radiotherapy indicate that it is appropriate to discuss partial breast radiation for women over the age of 50 with node-negative, hormone receptor-positive, small (T1) tumors with surgical margins of at least 2 mm.

Adjuvant trastuzumab emtansine was FDA-approved in 2019 for patients with HER2-positive breast cancer with residual disease after standard trastuzumab-containing neoadjuvant therapy.

In 2019, overall survival for hormone receptor-positive, HERS-negative advanced breast cancer was shown to be significantly improved with the addition of ribociclib (MONALEESA-3) or abemaciclib (MONARCH-2) to fulvestrant, thus underscoring the importance of these agents for this disease.

The antibody-drug conjugate trastuzumab deruxtecan (DS8201), in which a HER2-targeted antibody is linked to a novel toxic payload (topoisomerase-I inhibitor), has demonstrated striking activity in heavily pretreated HER2-positive metastatic breast cancer.

A phase III trial ("HER2CLIMB") compared capecitabine plus trastuzumab plus either tucatinib or placebo in patients with pretreated, HER2-positive advanced disease and demonstrated an improved progression-free survival in the overall population, improved progression-free survival in those with CNS metastases and a significantly improved overall survival.

ESSENTIALS OF DIAGNOSIS

  • Risk factors: Age, nulliparity, childbirth after age 30, family history of breast cancer or genetic mutations (BRCA1, BRCA2, or others), and personal history of breast cancer or some types of proliferative conditions.

  • Early findings: Single, nontender, firm to hard mass with ill-defined margins; mammographic abnormalities and no palpable mass.

  • Later findings: Skin or nipple retraction; axillary lymphadenopathy; breast enlargement, erythema, edema, pain; fixation of mass to skin or chest wall.

INCIDENCE & RISK FACTORS

Breast cancer will develop in one of eight American women. Next to skin cancer, breast cancer is the most common cancer in women; it is second only to lung cancer as a cause of death. In 2019, there were approximately 268,600 new cases and 41,760 deaths from breast cancer in the United States. Worldwide, breast cancer is diagnosed in approximately 2.1 million women, and about 626,679 die of breast cancer each year, with the highest rates of diagnosis in Australia/New Zealand, Europe, and North America and lowest rates in Eastern/Middle Africa and South Central Asia. The highest rates of death are in black women in the United States and the lowest rates are in Korean women. These regional differences in incidence are likely due to the variable availability of screening mammography as well as differences in reproductive, nutrition and hormonal factors. In western countries, incidence rates decreased with a reduced use of postmenopausal hormone therapy and mortality declined with increased use of screening and improved treatments. In contrast, incidence and mortality from breast cancer in many African and Asian countries have increased as reproductive factors have changed (such as childbirth after age 30) and as the incidence of obesity has risen.

The most significant risk factor for the development of breast cancer is age. ...

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