<aside> 💡 TRIPLE ASSESSMENT

• clinical: Hx and Ex
• Imaging: mammograph (tomosynthesis), USS, MRI
• Biopsy: FNA - cytology, core -histology, Open -histology </aside>

Most breast cancers are adenocarcinomas

They may arise from ductal tissue (80%) or lobular tissue (20%)They may be in situ (have not penetrated basement membrane) or invasive

• No Special Type (ductal) - grows out as mass, changes shape of breast, spiculated lesion, common

• Lobular - single filing into tissues, doesnt change imaging, can be multifocal

• most common is SPORADIC (90%)

  • 50yo
  • <50yo is familial)

• Types

Demographics

• Peak incidence post-menopausal women

Risk Factors

• Age >55
• Female (100x risk of males)
• PMHx Breast cancer
• Family history of breast cancer and genetic risk factors
  • First degree relatives with breast cancer (2-3 fold increased risk)
  • BRCA1 and BRCA2 mutations present in 5-10% of breast cancer
    • BRCA1 = more common, young age, higher risk of cancer, high-grade, triple negative, associated with ovarian, prostate and pancreas cancer.
    • BRCA2 = less common, lower risk of cancer, low-grade, ER +ve, male breast cancer.
• Increased lifetime oestrogen exposure:
  • Menarche before age 12
  • First live birth after 30 years old
  • Nulliparity (never having completed a pregnancy beyond 20 weeks)
  • Menopause after age 55
  • HRT
• Lifestyle factors
  • Smoking
  • Alcohol consumption
  • Obesity