gynecology and obstetrics
Breast Cancer
Key Points
Breast cancer is the second leading cause of cancer death in women; cumulative risk of developing breast cancer by age 95 is 12%. Factors that greatly increase risk include breast cancer in close relatives (particularly if aBRCAgene mutation is present), atypical ductal or lobular hyperplasia, lobular carcinoma in situ, and significant exposure to chest radiation therapy before age 30. Factors suggesting a poorer prognosis include younger age, absence ofestrogenandprogesteronereceptors, and presence of HER2 protein orBRCAgene mutations. For most women, treatment requires surgical removal, lymph node sampling, systemic therapy (endocrine therapy or chemotherapy), and radiation therapy. Treat with endocrine therapy (eg,tamoxifen, aromatase inhibitor) if tumors have hormone receptors. Consider treating metastatic disease to relieve symptoms (eg, with chemotherapy, endocrine therapy, or, for bone metastases, radiation therapy or bisphosphonates), even though survival is unlikely to be prolonged. 