Breast cancer became more common in Western societies throughout the twentieth century in part because of earlier diagnosis. Increased awareness and increased use of mammographic screening has resulted in the likelihood of the
cancer being diagnosed at a curable stage. A woman’s breasts are often a symbol of femininity, and the possibility of a disfiguring or fatal disease that would threaten her female identity, is problematic. Breast cancer is the most common
form of malignancy experienced by women, and worldwide, the lifetime risk of breast cancer is approximately 1 in 8 women (12,5 %). Men are also at risk of developing breast cancer, but at a significantly lower rate.
The earliest written records of breast cancer are from ancient Egyptian civilizations of 300 to 2500 BC.
The next major advances in breast cancer occurred in surgery at the end of the 19th century, following advances in antisepsis and anaesthesia. In 1894 William Halstead described the radical mastectomy.
The incidence of breast cancer has increased since the introduction of mammography screening and continues to grow with the ageing of the population.
Treatment outcomes have also improved and in most western countries the mortality rate has decreased in recent years, especially in the younger age groups, due to earlier detection and improved treatment.
In the United States, analysis of the SEER Registry (National Cancer Institute’s [NCI] Surveillance, Epidemiology, and End Results [SEER] Program) reveals that the median age for breast cancer diagnosis in women is age 61. However, 5% of
women diagnosed with breast cancer in the US are younger than age 40.
According to the World Health Organization: “Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries (GLOBOCAN 2008.
Incidence rates vary greatly worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe. In most of the developing regions the incidence rates are below 40 per 100,000 (GLOBOCAN 2008).
The lowest incidence rates are found in most African countries but here breast cancer incidence rates are also increasing.
Presentation: Women with breast cancer generally present to their clinicians with a painless lump in their breast; in areas where mammographic screening is common, a mass can be found with mammographic screening.
However, it is important to note that 20% of new cancers are not visible on mammogram.
Management: The current standard is for women to be seen in a multidisciplinary setting that offers a ‘one-stop-shop’ for diagnosis, with specialist breast-cancer surgeons, oncologists, same day cytology, and imaging services.
A careful history prior to examination should be taken.
Benign lumps are more likely in younger women and tend to be painful, enlarging before menstruation.
Malignant lumps tend to be more common in older women and are generally painless. Only 30 % of malignant lumps are painful.
After clinical examination, mammography, aspiration, and core biopsy should be performed.
In younger women, ultrasonography is the radiological investigation of choice.
If malignancy is confirmed, all women should proceed to surgery as soon as possible, within two weeks of diagnosis. Radiation therapy (RT) is often recommended following surgery, and systemic treatment of choice needs to be considered (chemotherapy, endocrine therapy and biologic therapy).
The two main variants of breast cancer are lobular and ductal.
References:
Stephens FO, Aigner KR. Basics of Oncology. Springer-Verlaag, Berlin. ISBN 978-3-540-92924-6. 2009;Chapter 12:151-168.
Almeida CA, Barry SA. Cancer. Basic science and clinical aspects. Breast Cancer. Wiley-Blackwell. Chichester,West Sussex, UK. 2010;Chapter 8:165 -187.
Bower M, Waxman J. Oncology Lecture Notes. Second Edition.2010. Breast Cancer. Wiley-Blackwell. Chichester, West Sussex, UK. 2010;Chapter 5:89 – 95.
Senkus E, Kyriakides S, Ohno S, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2015;26(supplement 5):v8 – v30.
http://www.who.int/cancer/detection/breastcancer/en/index1.html
http://www.uptodate.com/contents/breast-cancer-guide-to-diagnosis-and-treatment-beyond-the-basics
http://www.cancer.gov/types/breast/risk-fact-sheet