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Breast malignant, males, children
Breast cancer
General

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 20 October 2016, last major update March 2012

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PubMed Search: Breast cancer [title]

Table of Contents
Epidemiology | Clinical features | Laboratory | Case reports | Treatment | Microscopic (histologic) description | Additional references
Cite this page: Breast cancer - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantcarcinomageneral.html. Accessed July 14th, 2017.
Epidemiology
  • Most common invasive malignancy in US women after skin cancer
  • Estimated 227K new cases of invasive carcinoma in US women in 2012, 2K in men (American Cancer Society)
  • Estimated 63K new cases of in situ carcinoma in US women in 2012
  • Occurs in 1 of 8 to 9 women in US (1 of 232 at age 30 - 39 years, 1 of 29 at age 70 - 79)
  • Similar incidence in other Western countries, but much lower incidence in Japan (Cancer Research UK)
  • Sharp decrease in incidence in US women 50 - 69 years old may reflect reduced use of hormone replacement therapy (Breast Cancer Res 2007;9:R28)
Clinical features
  • 50% occur in upper outer quadrant, 17% central (subareolar), 5 - 15% other quadrants, 13% involve more than one quadrant (3% diffuse)
  • Tumors in outer quadrant are more likely to have axillary nodes than those in inner quadrant
  • Common symptoms are breast lumps and nipple abnormalities, sometimes discomfort
  • Tumors presenting between mammographic screenings (interval tumors) are more aggressive

Synchronous
  • Second tumor discovered within 2 months of initial primary tumor
  • Molecular studies can determine if synchronous tumors are two primaries or one primary with metastases (Mod Pathol 2008;21:1200)

Clinical examination
  • For breast, palpation is less sensitive / specific than mammography; mammographic abnormality is often presenting sign
  • For axillary nodes, 40% of clinically negative nodes have tumor and 15% of clinically positive nodes lack tumor
Laboratory
Mammography
  • Can detect tumors as small as 1 - 2 mm via microcalcifications
  • Microcalcifications are present in 50% of carcinomas vs. 20% of benign breast disease
  • Suspicious mammographic features are opacity with irregular, spiculated margins, variable calcifications
  • Also clusters of fine calcifications and asymmetry
  • Only 20% of “suspicious” microcalcifications are actually malignant
  • Up to 30% of tumors are not detectable by mammography due to poor resolution from surrounding fibrous breast (generally younger women)

MRI
  • Detects increased tumor vascularity and increased tumor uptake of contrast agents
  • Usually no gross findings so must examine entire specimen (Hum Pathol 2007;38:1754)

Ultrasound
  • Can distinguish solid versus cystic lesions (latter are generally benign)

Needle biopsy
  • Radiologist marks microcalcifications with needle, surgeon removes area around needle, specimen is Xrayed to verify specimen includes microcalcifications of interest
  • Pathologist should verify presence of microcalcifications
  • Note: calcium oxalate crystals are easily missed by pathologists – must look for birefringence under polarized light
Case reports
Treatment
  • Five year relative survival overall has improved from 63% in early 1960s to 89% in 2009 (US National Cancer Institute)
  • Five year survival rate is 98% for localized breast cancer, dropping to 27% if distant metastases
  • Death rate is 27 per 100,000 women (40,000 deaths per year in US), slowly falling since 1990 in North America, Western Europe and Australia
  • #2 cause of US cancer deaths in women after lung cancer
  • Main treatment is surgical excision (usually lumpectomy or modified radical mastectomy, sampling lumpectomy cavity margins may reduce need for re-excision, Am J Surg Pathol 2005;29:1625)
  • Radiation therapy if positive margins or to control locally recurrent disease (44% recur without radiation if close / non involved margins for DCIS versus 94% recurrence if margins are extensively positive, Mod Pathol 2004;17:81)
  • Anti estrogen drugs (tamoxifen and others to reduce risk of recurrence in same or opposite breast, particularly for ER+ tumors)
  • Combination chemotherapy (for metastatic disease, to reduce the risk of contralateral breast carcinoma)
  • Preoperative (neoadjuvant) chemotherapy shrinks large tumors to allow surgery or more conservative surgery
Microscopic (histologic) description
  • Invasive if stromal invasion present
  • Most tumors are adenocarcinomas arising from terminal duct lobular unit
  • In situ carcinoma is present to variable extent (“extensive” if > 25% of tumor volume seen inside and outside of invasive tumor field)
Additional references
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