Chapter 105. Breast Cancer

• Breast cancer is usually diagnosed in the early stages when it is a highly curable malignancy.
• Local 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.
• Adjuvant 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.
• The choice of the most appropriate chemotherapy, endocrine therapy, and anti-HER2 regimen is complex and rapidly changing as results from ongoing randomized clinical trials are reported.
• Neoadjuvant chemotherapy and biotherapy are appropriate for selected patients with early breast cancer and most patients with locally advanced breast cancer and inflammatory breast cancer followed by local therapy and further adjuvant systemic therapy as indicated.
• Whereas the goal of adjuvant and neoadjuvant chemotherapy is curative, the goal of chemotherapy in the metastatic setting is palliative.
• Initial therapy of metastatic breast cancer in most women with hormone receptor–positive tumors should include endocrine therapy.
• About 60% of women with metastatic breast cancer will respond to chemotherapy regimens; anthracycline- and taxane-containing regimens are the most active.
• Anti-HER2 therapies and other biologic or targeted agents (e.g., everolimus) in combination with chemotherapy or endocrine therapy have significantly improved outcomes for selected patients with metastatic breast cancer.
• Although controversial, regular screening mammography in women younger than 50 years of age is beneficial, and many national and international studies demonstrate a reduction in the breast cancer mortality rate from annual or biennial screening mammography in women ages 50 to 74 years.

On completion of the chapter, the reader will be able to:

1. List factors associated with an increased risk of breast cancer in the United States.

2. Assess patients for signs and symptoms related to breast cancer in early and late stages of the disease.

3. Explain the diagnostic plan for newly diagnosed and recurrent breast cancer in all stages of the disease.

4. Discuss the staging system for breast cancer, including clinical and pathologic staging criteria for both the breast and lymph nodes.

5. Critique available prognostic variables for clinical utility.

6. Compare and contrast available surgical techniques for the local treatment of early and advanced stages of breast cancer.

7. Determine which patient populations may benefit from adjuvant systemic therapy for breast cancer.

8. Debate the risks and benefits of chemotherapy regimens used in the adjuvant treatment of breast cancer.

9. Critique the available evidence regarding the use of endocrine therapy in the adjuvant treatment of breast cancer.

10. Explain the clinical characteristics and basic treatment approach for inflammatory breast cancer.

11. Determine the treatment goals for early-stage, locally advanced, and metastatic breast cancer.

12. Determine appropriate indications for endocrine therapy, chemotherapy, and biologic therapy for patients with metastatic breast cancer.

13. Critique available endocrine therapy options for metastatic ...