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Essentials of Diagnosis
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Risk factors
Age
Nulliparity
Childbirth after age 30
Family history of breast cancer or genetic mutations (BRCA1, BRCA2 or others)
Personal history of breast cancer or some types of proliferative conditions
Early findings
No palpable mass, or
Single, nontender, firm to hard mass with ill-defined margins
Mammographic abnormalities
Later findings
Breast mass, enlargement, redness, edema, pain
Skin or nipple retraction
Fixation of mass to skin or chest wall
Axillary lymphadenopathy
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General Considerations
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A woman's risk of breast cancer rises rapidly until her early 60s, peaks in her 70s, and then declines
A significant family history of breast or ovarian cancer may also indicate a high risk of developing breast cancer
Germline mutations in the BRCA family of tumor suppressor genes or other breast cancer susceptibility genes account for approximately 5–10% of breast cancer diagnoses and tend to cluster in certain ethnic groups, including women of Ashkenazi Jewish descent
Women with a mutation in the BRCA1 gene, located on chromosome 17, have an estimated 85% chance of developing breast cancer in their lifetime
Other genes associated with an increased risk of breast and other cancers include
BRCA2 (associated with a gene on chromosome 13)
Ataxia-telangiectasia mutation (ATM), BARD1, CHEK2, PALB2, RAD51D
Mutation of the tumor suppressor gene p53
Primary care clinicians should assess a woman's personal and family history for breast, ovarian, tubal or peritoneal cancer using a familial risk assessment tool
Those with a positive result should receive genetic counseling in order to decide whether genetic testing is indicated
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Second most common cancer in women
Second most common cause of cancer death in women
268,000 new cases and 41,760 deaths from breast cancer in US women in 2019
Worldwide, breast cancer is diagnosed in approximately 2.1 million women, and about 626,679 die of breast cancer each year
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Presenting complaint is a lump (usually painless) in 70%
Less frequently
Breast pain
Nipple discharge
Erosion, retraction, enlargement, or itching of the nipple
Redness, generalized hardness, enlargement, or shrinking of the breast
Axillary mass or swelling of the arm (rare)
With metastatic disease, back or bone pain, jaundice, or weight loss
Physical examination is done with patient sitting, arms at sides and then overhead, and supine with arm abducted
Findings include
Nontender, firm or hard mass with poorly delineated margins
Skin or nipple retraction or dimpling
Breast asymmetry
Erosions of nipple epithelium
Watery, serous or bloody discharge
Metastatic disease suggested by
Advanced stage (stage III ...