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PATIENT STORY

A 55-year-old woman presents for routine screening mammogram. The patient does not have any complaints but has a family history of breast cancer in a sister at the age of 40 years. Her mammogram demonstrates an irregular mass with possible local spread (Figures 95-1 and 95-2). She is referred to a breast surgeon, and the biopsy confirms the diagnosis of breast cancer.

FIGURE 95-1

A mammogram that demonstrates an irregular mass with possible local spread. (Reproduced with permission from John Braud, MD.)

FIGURE 95-2

A close-up view of the lesion shown in Figure 95-1. (Reproduced with permission from John Braud, MD.)

INTRODUCTION

Breast cancer is a major health concern for all women. It is the most common female cancer in the United States, and the second most common cause of cancer death in women after lung cancer.1

EPIDEMIOLOGY

  • In 2012, approximately 250,000 women in the United States were diagnosed with breast cancer.2 Breast cancer incidence in the United States has doubled over the past 60 years. Since the early 1980s, most of the increase has been in early stage and in situ cancers because of mammogram screening and better chemotherapy (Figures 95-1, 95-2, 95-3, 95-4).

  • Approximately 232,620 new cases of invasive breast cancer were expected to be diagnosed in the United States in 2011, and 39,970 were expected to die from the disease.1

  • Globally, breast cancer is the most common cancer, and the leading cause of cancer death in females. Breast cancer incidence rates are highest in North America, Australia–New Zealand, and Europe, and lowest in Asia and sub-Saharan Africa.2,3

  • Locally advanced breast cancer (LABC) has been decreasing in frequency over the past several decades, at least partially as a result of earlier diagnosis because of better screening (Figures 95-5, 95-6, 95-7, 95-8). It represents 30% to 50% of newly diagnosed breast cancers in medically underserved populations.4

  • Primary inflammatory breast cancer (IBC) is relatively rare, accounting for 0.5% to 2% of invasive breast cancers.5 However, it accounts for a greater proportion of cases presenting with more advanced disease. IBC is a clinical diagnosis. At presentation, almost all women with primary IBC have lymph node involvement and approximately one third have distant metastases.6

FIGURE 95-3

A screening mammogram of a 55-year-old woman who is without breast complaints. The mammogram demonstrates a significant mass with spiculations. (Reproduced with permission from John Braud, MD.)

FIGURE 95-4

Close-up view of the mass shown in Figure 95-3...

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