LB, Barnett CM, Esteva FJ. Breast Cancer. In: DiPiro, JT, Talbert
RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic
Approach. 8th edition. http://accesspharmacy.com/content.aspx?aid=8007809.
Accessed July 30, 2012
- Malignancy originating from breast tissue
- Not completely understood
- Current evidence supports concept of carcinogenesis as genetically
regulated, multistage process.
- Carcinogenesis includes initiation, promotion, conversion,
- Growth of normal and cancerous cells genetically controlled
by balance or imbalance of oncogene, proto-oncogene, and tumor suppressor
gene protein products.
- Multiple genetic mutations
required to convert normal cells to cancerous cells.
- Breast cancer cells often spread undetected by contiguity,
lymph channels, and through blood early in course of disease, resulting
in metastatic disease after local therapy.
common metastatic sites:
- Lymph nodes
- Most common type of cancer
- Female gender and increasing age 2 variables most strongly
associated with occurrence of breast cancer.
age at diagnosis: between 60 and 65 years of age.
- Male gender is poor prognostic factor.
- Screening programs to detect cancers in asymptomatic
women at risk:
- Breast self-examination
- Routine screening mammography
- Pharmacologic risk reduction of breast cancer
estrogen receptor modulators (SERMs)
- Tamoxifen and
raloxifene reduce rates of invasive breast cancer in women at high
- Rates of endometrial cancer and deep vein thromboses higher
- Overall quality of life is similar between two agents.
- Aromatase inhibitors
- Early menarche
- Late age at first birth
- Hormone replacement therapy
- Personal and family history
- Mutations of tumor suppresser genes [BRCA1 and BRCA2]
- Environmental (e.g., radiation exposure)
- See National Cancer Institute risk calculator for
interactive risk assessment of multiple factors.
- Patients may not have any symptoms; detected in asymptomatic
patients through routine screening mammography
- Painless, palpable lump most common.
- Less common:
- Nipple discharge, retraction, or dimpling
- Skin edema, redness, or warmth
- Palpable local-regional lymph nodes
- Systemic metastases symptoms depend on site:
- Difficulty breathing
- Abdominal pain or enlargement
- Mental status changes
Means of Confirmation
- Breast biopsy: Core-needle biopsy offers more definitive
- Tumor markers
- Cancer antigen (CA 27,29)
- Carcino-embryonic antigen (CEA)
- Alkaline phosphatase or liver function tests may be elevated
in metastatic disease.
- Mammography, with or without ultrasound, breast MRI, or
- Chest x-ray, chest CT, bone scan, abdominal CT or ultrasound,
or MRI for systemic staging
- Pathologic review
- Determination of tumor estrogen/progesterone receptor
(ER/PR) status and HER2 status
- Surgery to assure complete removal of abnormal tissue
- Stage (anatomical extent of disease) based
- Extent and size of primary tumor (T1–4)
- Presence and ...