Breast Cancer

2019 ◽  
Author(s):  
Stephen B Edge ◽  
Lindi VanderWalde ◽  
Alyssa D. Throckmorton
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
The United States ◽  
Breast Cancer Treatment ◽  
Western World ◽  
Cancer Management

Breast cancer is the most common malignancy in women in the Western world. Its prevalence and public health impact are increasing in developing countries, and breast cancer leads to the death of hundreds of thousands of women worldwide annually. In the United States, surgeons are involved in the treatment of most women with breast cancer and surgical care must be coordinated with other components of comprehensive breast cancer treatment. This review covers breast evaluation and management of findings suspicious for cancer, management of clinical or screening-detected findings, management of breast cancer, noninvasive cancer (carcinoma in situ), invasive breast cancer, special circumstances, and follow-up after breast cancer treatment.  This review contains 9 figures, 41 tables, and 106 references. Key words: Breast cancer, ductal carcinoma in situ, lobular carcinoma in situ, chemotherapy, hormone receptor-positive, HER2/neu, breast-conserving therapy, reconstruction, mastectomy, adjuvant therapy, radiation therapy

Pleomorphic lobular carcinoma in situ: A distinct entity of controversial significance.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 177-177
Author(s):  
Marina De Brot ◽  
Shirin Muhsen ◽  
Victor P. Andrade ◽  
Starr Koslow Mautner ◽  
Melissa Murray ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Previous History ◽  
Prior History ◽  
Lobular Carcinoma In Situ ◽  
Pleomorphic Lobular Carcinoma ◽  
History Of

177 Background: Pleomorphic lobular carcinoma in situ (PLCIS) is an increasingly diagnosed variant of lobular carcinoma in situ. Histologically, it resembles ductal carcinoma in situ (DCIS), leading to controversy over proper management. Yet, the natural history of PLCIS is unknown. Here we describe our experience with PLCIS. Methods: Review of pathology reports (1995–2012) identified 233 cases of LCIS variants. Patients with synchronous ipsilateral DCIS or invasive cancer (IC) were excluded leaving 25 cases for review. Consensus review by 3 pathologists further excluded 7; leaving 18 cases, 12 of which were classified as PLCIS and 6 as LCIS with pleomorphic features (LCIS-PF). (Table) PLCIS was defined by cellular dyshesion, nuclear pleomorphism with a 2-3 fold size variation, conspicuous nucleoli, mitoses and abundant cytoplasm; lesions not meeting all parameters were classified as LCIS-PF. Loss of e-cadherin was confirmed; clinical data were obtained from medical records. Results: Mean patient age at diagnosis of PLCIS/LCIS-PF was 57 yrs (42-67 yrs). All cases presented with imaging abnormalities. A previous history of breast cancer was present in 7/18 (39%) pts (3/7, ipsilateral; 4/7, contralateral). Following PLCIS/LCIS-PF diagnosis, 6/18 (33%) pts underwent mastectomy and 12/18 had excision alone, with (n=3) or without chemoprevention (n=9). Margin status was negative in 4/12 pts; close in 3/12 pts and positive in 5/12 pts undergoing excision. At a median follow-up of 27 mos (2-148 mos), 2/12 pts treated with excision developed ipsilateral breast cancer (1 DCIS; 1 IC). Both had close margins at initial excision; median time to cancer, 54 mos. Conclusions: Pure PLCIS is an uncommon lesion. Synchronous malignancy or prior history of breast cancer are often present in patients with PLCIS, contributing to the difficulty in determining the actual risk conferred by this lesion and appropriate management. Efforts to systematically characterize LCIS variants and prospective documentation of outcomes are needed to clarify the significance of these lesions. [Table: see text]

Occult Nipple Involvement in Breast Cancer: Clinicopathologic Findings in 316 Consecutive Mastectomy Specimens

2009 ◽  
Vol 27 (30) ◽  
pp. 4948-4954 ◽  
Author(s):  
Elena F. Brachtel ◽  
Jennifer E. Rusby ◽  
James S. Michaelson ◽  
L. Leon Chen ◽  
Alona Muzikansky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Univariate Analysis ◽  
Oncological Safety ◽  
En Face ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Purpose Although breast-conserving surgery is a standard approach for patients with breast cancer, mastectomy often becomes necessary. Surgical options now include nipple-sparing mastectomy but its oncological safety is still controversial. This study evaluates frequency and patterns of occult nipple involvement in a large contemporary cohort of patients with the retroareolar margin as possible indicator of nipple involvement. Patients and Methods Three hundred sixteen consecutive mastectomy specimens (232 therapeutic, 84 prophylactic) with grossly unremarkable nipples were evaluated by coronal sections through the entire nipple and subareolar tissue. Extent and location of nipple involvement by carcinoma was assessed with the tissue deep to the skin as potential retroareolar en-face resection margin. Results Seventy-one percent of nipples from therapeutic mastectomies showed no pathologic abnormality, 21% had ductal carcinoma in situ (DCIS), invasive carcinoma (IC), or lymphovascular invasion (LVI), and 8% lobular neoplasia (lobular carcinoma in situ). Human epidermal growth factor receptor 2 amplification, tumor size, and tumor-nipple distance were associated with nipple involvement by multivariate analysis (P = .0047, .0126, and .0176); histologic grade of both DCIS (P = .002) and IC (P = .03), LVI (P = .03), and lymph node involvement (P = .02) by univariate analysis. Nipple involvement by IC or DCIS was identified in the retroareolar margin with a sensitivity of 0.8 and a negative predictive value of 0.96. None of the 84 prophylactic mastectomies showed nipple involvement by IC or DCIS. Conclusion Nipple-sparing mastectomy may be suitable for selected cases of breast carcinoma with low probability of nipple involvement by carcinoma and prophylactic procedures. A retroareolar en-face margin may be used to test for occult involvement in patients undergoing nipple-sparing mastectomy.

scholarly journals A Clinical Case Study of Synchronous Breast Cancer

2021 ◽  
Vol 28 (3) ◽  
pp. 329-332
Author(s):  
Mihai MEHEDINTU-IONESCU ◽  
◽  
Stefan-Andrei COMAN ◽  
Horia-Alexandru TOADER ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Clinical Case ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Clinical Case Study ◽  
The Right ◽  
Synchronous Breast Cancer

The following article represents a clinical case study of a synchronous breast cancer in a 47 year old woman with no prior significant comorbidities.Up to 10% of all breast cancers can be synchronous (usually found with the help of breast MRI). The occurrence of bilaterally is considerable with invasive lobular carcinoma. The patient observed after self-palpating her breast a nodule in the infero-external quadrant of the right breast. During almost 4 months the patient underwent punch biopsy of the right breast, lumpectomy and finally double mastectomy with immediate reconstruction using Mentor implants and AMD. The histopathological result showed ductal carcinoma in situ in the right breast and lobular carcinoma in situ in both breasts. Postoperatively the patient is free of cancer, but under clinical and imagistic surveillance.

Ductal Carcinoma In Situ: Challenges, Opportunities, and Uncharted Waters

2012 ◽  
pp. 40-44 ◽  
Author(s):  
Abigail W. Hoffman ◽  
Catherine Ibarra-Drendall ◽  
Virginia Espina ◽  
Lance Liotta ◽  
Victoria Seewaldt
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Targeted Prevention ◽  
Breast Cancers ◽  
Increased Risk

Overview: Ductal carcinoma in situ (DCIS) is a heterogeneous group of diseases that differ in biology and clinical behavior. Until 1980, DCIS represented less than 1% of all breast cancer cases. With the increased utilization of mammography, DCIS now accounts for 15% to 25% of newly diagnosed breast cancer cases in the United States. Although our ability to detect DCIS has radically improved, our understanding of the pathophysiology and factors involved in its progression to invasive carcinoma is still poorly defined. In many patients, DCIS will never progress to invasive breast cancer and these women are overtreated. In contrast, some DCIS cases are clinically aggressive and the women may be undertreated. We are able to define some of the predictors of aggressive DCIS compared with DCIS of low malignant potential. However, our ability to risk-stratify DCIS is still in its infancy. Clinical risk factors that predict aggressive disease and increased risk of local recurrence include young age at diagnosis, large lesion size, high nuclear grade, comedo necrosis, and involved margins. Treatment factors such as wider surgical margins and radiation therapy reduce the risk of local recurrence. DCIS represents a key intermediate in the stepwise progression to malignancy, but not all aggressive breast cancers appear to have a DCIS intermediate, notably within triple-negative breast cancer. Ongoing studies of the genetic and epigenetic alterations in precancerous breast lesions (atypia and DCIS) as well as the breast microenvironment are important for developing effective early detection and individualized targeted prevention.

scholarly journals Lobular Carcinoma in Situ: A 29-Year Longitudinal Experience Evaluating Clinicopathologic Features and Breast Cancer Risk

2015 ◽  
Vol 33 (33) ◽  
pp. 3945-3952 ◽  
Author(s):  
Tari A. King ◽  
Melissa Pilewskie ◽  
Shirin Muhsen ◽  
Sujata Patil ◽  
Starr K. Mautner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Incidence ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Breast Cancer Incidence ◽  
Lobular Carcinoma In Situ

Purpose The increased breast cancer risk conferred by a diagnosis of lobular carcinoma in situ (LCIS) is poorly understood. Here, we review our 29-year longitudinal experience with LCIS to evaluate factors associated with breast cancer risk. Patients and Methods Patients participating in surveillance after an LCIS diagnosis are observed in a prospectively maintained database. Comparisons were made among women choosing surveillance, with or without chemoprevention, and those undergoing bilateral prophylactic mastectomies between 1980 and 2009. Results One thousand sixty patients with LCIS without concurrent breast cancer were identified. Median age at LCIS diagnosis was 50 years (range, 27 to 83 years). Fifty-six patients (5%) underwent bilateral prophylactic mastectomy; 1,004 chose surveillance with (n = 173) or without (n = 831) chemoprevention. At a median follow-up of 81 months (range, 6 to 368 months), 150 patients developed 168 breast cancers (63% ipsilateral, 25% contralateral, 12% bilateral), with no dominant histology (ductal carcinoma in situ, 35%; infiltrating ductal carcinoma, 29%; infiltrating lobular carcinoma, 27%; other, 9%). Breast cancer incidence was significantly reduced in women taking chemoprevention (10-year cumulative risk: 7% with chemoprevention; 21% with no chemoprevention; P < .001). In multivariable analysis, chemoprevention was the only clinical factor associated with breast cancer risk (hazard ratio, 0.27; 95% CI, 0.15 to 0.50). In a subgroup nested case-control analysis, volume of disease, which was defined as the ratio of slides with LCIS to total number of slides reviewed, was also associated with breast cancer development (P = .008). Conclusion We observed a 2% annual incidence of breast cancer among women with LCIS. Common clinical factors used for risk prediction, including age and family history, were not associated with breast cancer risk. The lower breast cancer incidence in women opting for chemoprevention highlights the potential for risk reduction in this population.

Ductal Carcinoma In Situ, and the Influence of the Mode of Detection, Population Characteristics, and Other Risk Factors

2012 ◽  
pp. 45-48 ◽  
Author(s):  
Beth A. Virnig ◽  
Shi-Yi Wang ◽  
Todd M. Tuttle
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
The United States ◽  
Population Characteristics ◽  
Breast Irradiation

Overview: Approximately 25% of breast cancers in the United States are diagnosed as ductal carcinoma in situ (DCIS). Rates of DCIS have risen from 5.8 per 100,000 women in the 1970s to 32.5 per 100,000 in 2004. This pattern is generally attributed to increased use of screening mammography. DCIS is a major risk factor for invasive breast cancer, and considerable controversy remains about whether DCIS should be considered a direct precursor of invasive breast cancer. There is, however, a general consensus that DCIS represents an intermediate step between normal breast tissue and invasive breast cancer. Although the majority of major risk factors are similar for DCIS and invasive breast cancer, prognostic factors including estrogen and progesterone receptor status and HER2 positivity are less well studied but look to have similar value in both cases. The use of postdiagnostic MRI, sentinel lymph node biopsy, surgery, radiation, and endocrine therapy are all evolving as evidence from randomized and observational studies continues to accumulate. Treatment of DCIS requires a balance between risk of overtreatment and undertreatment. Ongoing studies are focusing on whether partial-breast irradiation is as effective as whole-breast irradiation and whether treatment with endocrine therapies can reduce the likelihood of either invasive breast cancer or DCIS recurrence. In general, treatment decisions should take into account the likelihood that an apparent case of DCIS could harbor foci of invasive disease.

Increasing Rates of Contralateral Prophylactic Mastectomy Among Patients With Ductal Carcinoma In Situ

2009 ◽  
Vol 27 (9) ◽  
pp. 1362-1367 ◽  
Author(s):  
Todd M. Tuttle ◽  
Stephanie Jarosek ◽  
Elizabeth B. Habermann ◽  
Amanda Arrington ◽  
Anasooya Abraham ◽  
...  
Keyword(s):  
United States ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Prophylactic Mastectomy ◽  
Lobular Carcinoma ◽  
Contralateral Prophylactic Mastectomy ◽  
Breast Conserving Surgery ◽  
The United States

Purpose Some women with unilateral ductal carcinoma in situ (DCIS) undergo contralateral prophylactic mastectomy (CPM) to prevent cancer in the opposite breast. The use and trends of CPM for DCIS in the United States have not previously been reported. Methods We used the Surveillance, Epidemiology, and End Results database to analyze the initial treatment (within 6 months) of patients with unilateral DCIS diagnosed from 1998 through 2005. We determined the CPM rate as a proportion of all surgically treated patients and as a proportion of all patients who underwent mastectomy. We compared demographic and tumor variables in women with unilateral DCIS who underwent surgical treatment. Results We identified 51,030 patients with DCIS; 2,072 patients chose CPM. The CPM rate was 4.1% for all surgically treated patients and 13.5% for patients undergoing mastectomy. Among all surgically treated patients (including breast-conserving surgery), the CPM rate increased by 148% from 1998 (2.1%) to 2005 (5.2%). Among patients who underwent mastectomy to treat DCIS (excluding patients undergoing breast-conserving surgery), the CPM rate increased by 188% from 1998 (6.4%) to 2005 (18.4%). Young patient age, white race, recent year of diagnosis, and the presence of lobular carcinoma in situ were significantly associated with higher CPM rates among all surgically treated patients and all patients undergoing mastectomy. Large tumor size and higher grade were significantly associated with increased CPM rates among all surgically treated patients but lower CPM rates among patients undergoing mastectomy. Conclusion The use of CPM for DCIS in the United States markedly increased from 1998 through 2005.

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