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KEY CONCEPTS

KEY CONCEPTS

  • imageBreast cancer is usually diagnosed in the early stages when it is highly curable.

  • imageAlthough controversial, regular screening mammography in women younger than 50 years of age is beneficial, and many studies demonstrate that annual or biennial screening mammography in women ages 50 to 74 years reduces the breast cancer mortality rate.

  • imageLocal therapy of early-stage breast cancer consists of modified radical mastectomy or lumpectomy plus external-beam radiation therapy. The surgical approach to the ipsilateral axilla may consist of a lymph node mapping procedure with sentinel lymph node biopsy or a full level I/II axillary lymph node dissection.

  • imageAdjuvant endocrine therapy reduces the rates of relapse and death in patients with hormone receptor–positive early breast cancer. Adjuvant chemotherapy reduces the rates of relapse and death in all patients with early-stage breast cancer.

  • imageThe choice of the most appropriate chemotherapy, endocrine therapy, and anti-HER2 therapy regimen is complex and rapidly changes as results from ongoing randomized clinical trials are reported.

  • imageNeoadjuvant chemotherapy and biotherapy are appropriate for selected patients with early breast cancer and most patients with locally advanced and inflammatory breast cancer followed by local therapy and further adjuvant systemic therapy as indicated.

  • imageThe goal of adjuvant and neoadjuvant chemotherapy is cure while the goal of chemotherapy in the metastatic setting is palliation.

  • imageAnti-HER2 therapies and other biologic or targeted agents (eg, everolimus, cyclin-dependent kinase [CDK] inhibitors) in combination with chemotherapy or endocrine therapy have significantly improved outcomes for patients with metastatic breast cancer (MBC).

  • imageInitial therapy of MBC in most women with hormone receptor–positive tumors should include endocrine therapy.

  • imageAbout 60% of women with MBC will respond to chemotherapy regimens; anthracycline- and taxane-containing regimens are the most active.

PATIENT CARE PROCESS

Patient Care Process for Breast Cancer

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Collect

  • Patient characteristics (eg, age, sex)

  • Physical exam

  • Patient medical history (personal and family history for breast and ovarian cancers, start of menstruation, time of menopause, surgical history [eg, hysterectomy, oophorectomy])

  • Social history (eg, tobacco/ethanol use) and dietary habits

  • Current medications including OTC use, herbal products, birth control, and dietary supplements

  • Objective data

    • Height, weight

    • Labs including complete blood count with differential, serum creatinine (SCr), total bilirubin, AST, ALT, Alkaline phosphatase

    • For other details, see section “Clinical Presentation

Assess

  • History of diabetes, hypertension, overall cardiac health and history, complete with current medications

  • Ability/willingness to pay for treatment options, insurance coverage

  • Emotional status (eg, presence of anxiety, depression)

  • For other details, see section “Clinical Presentation

Plan*

  • Drug therapy regimen including specific chemotherapy, endocrine therapy or targeted therapy and include dose, route, frequency, and duration (see Fig. 145-3, Tables 145-7 through 145-10 and Table 145-12 in sections “Systemic Adjuvant Therapy” and “Metastatic Breast Cancer (Stage IV)”)

  • Monitoring parameters including efficacy (eg, staging studies such as CT chest/abdomen/pelvis, bone scan, CT/MRI brain in the cases of metastatic disease; ultrasound in the cases of neoadjuvant therapy), ...

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