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What is breast cancer?

Breast cancer is a malignant tumor that develops from the cells of the breast. It is the most common type of cancer among women in the World. It is most often curable when found early.About 80% of breast cancers start in the ducts.

<s>[INST] What is breast cancer? [/INST] Breast cancer is a malignant tumor that develops from the cells of the breast. It is the most common type of cancer among women in the World. It is most often curable when found early.About 80% of breast cancers start in the ducts. </s>

What are the signs and symptoms of breast cancer?

Early breast cancers may be asymptomatic, and pain and discomfort are typically not present. If a lump is discovered, the following may indicate the possible presence of breast cancer: Change in breast size or shape, Skin dimpling or skin changes, Recent nipple inversion or skin change, or nipple abnormalities, Single-duct discharge, particularly if blood-stained, Axillary lump

<s>[INST] What are the signs and symptoms of breast cancer? [/INST] Early breast cancers may be asymptomatic, and pain and discomfort are typically not present. If a lump is discovered, the following may indicate the possible presence of breast cancer: Change in breast size or shape, Skin dimpling or skin changes, Recent nipple inversion or skin change, or nipple abnormalities, Single-duct discharge, particularly if blood-stained, Axillary lump </s>

What is included in the evaluation of breast cancer?

Evaluation of breast cancer includes the following: Clinical examination Imaging Needle biopsy

<s>[INST] What is included in the evaluation of breast cancer? [/INST] Evaluation of breast cancer includes the following: Clinical examination Imaging Needle biopsy </s>

Which physical findings suggest breast cancer?

The following physical findings should raise concern: Lump or contour change Skin tethering Nipple inversion Dilated veins Ulceration Paget disease Edema or peau d’orange

<s>[INST] Which physical findings suggest breast cancer? [/INST] The following physical findings should raise concern: Lump or contour change Skin tethering Nipple inversion Dilated veins Ulceration Paget disease Edema or peau d’orange </s>

What features of a palpable lump suggest breast cancer?

If a palpable lump is found and possesses any of the following features, breast cancer may be present: Hardness Irregularity Focal nodularity Fixation to skin or muscle

<s>[INST] What features of a palpable lump suggest breast cancer? [/INST] If a palpable lump is found and possesses any of the following features, breast cancer may be present: Hardness Irregularity Focal nodularity Fixation to skin or muscle </s>

How is breast cancer screening performed?

Early detection remains the primary defense in preventing breast cancer. Screening modalities include the following: Breast self-examination Clinical breast examination Mammography Ultrasonography Magnetic resonance imaging

<s>[INST] How is breast cancer screening performed? [/INST] Early detection remains the primary defense in preventing breast cancer. Screening modalities include the following: Breast self-examination Clinical breast examination Mammography Ultrasonography Magnetic resonance imaging </s>

What is the role of biopsy in the workup of breast cancer?

Core biopsy with image guidance is the recommended diagnostic approach for newly diagnosed breast cancers. This is a method for obtaining breast tissue without surgery and can eliminate the need for additional surgeries. Open excisional biopsy is the surgical removal of the entire lump.

<s>[INST] What is the role of biopsy in the workup of breast cancer? [/INST] Core biopsy with image guidance is the recommended diagnostic approach for newly diagnosed breast cancers. This is a method for obtaining breast tissue without surgery and can eliminate the need for additional surgeries. Open excisional biopsy is the surgical removal of the entire lump. </s>

How is breast cancer treated?

Surgery and radiation therapy, along with adjuvant hormone or chemotherapy when indicated, are considered primary treatment. Surgical therapy may consist of lumpectomy or total mastectomy. Radiation therapy may follow surgery in an effort to eradicate residual disease while reducing recurrence rates. There are 2 general approaches for delivering radiation therapy: External-beam radiotherapy (EBRT), Partial-breast irradiation (PBI).

<s>[INST] How is breast cancer treated? [/INST] Surgery and radiation therapy, along with adjuvant hormone or chemotherapy when indicated, are considered primary treatment. Surgical therapy may consist of lumpectomy or total mastectomy. Radiation therapy may follow surgery in an effort to eradicate residual disease while reducing recurrence rates. There are 2 general approaches for delivering radiation therapy: External-beam radiotherapy (EBRT), Partial-breast irradiation (PBI). </s>

What are the chemotherapy regimens used to treat breast cancer?

Hormone therapy and chemotherapy are the 2 main interventions for treating metastatic breast cancer. Common chemotherapeutic regimens include the following: Docetaxel Cyclophosphamide Doxorubicin Carboplatin Methotrexate Trastuzumab

<s>[INST] What are the chemotherapy regimens used to treat breast cancer? [/INST] Hormone therapy and chemotherapy are the 2 main interventions for treating metastatic breast cancer. Common chemotherapeutic regimens include the following: Docetaxel Cyclophosphamide Doxorubicin Carboplatin Methotrexate Trastuzumab </s>

What is the role of drug treatment for breast cancer?

In patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation.

<s>[INST] What is the role of drug treatment for breast cancer? [/INST] In patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation. </s>

What are basic facts about breast cancer?

Many early breast carcinomas are asymptomatic; pain or discomfort is not usually a symptom of breast cancer. Breast cancer is often first detected as an abnormality on a mammogram before it is felt by the patient or healthcare provider.

<s>[INST] What are basic facts about breast cancer? [/INST] Many early breast carcinomas are asymptomatic; pain or discomfort is not usually a symptom of breast cancer. Breast cancer is often first detected as an abnormality on a mammogram before it is felt by the patient or healthcare provider. </s>

What is the anatomy relevant to breast cancer?

The breasts of an adult woman are milk-producing glands on the front of the chest wall. They rest on the pectoralis major and are supported by and attached to the front of the chest wall on either side of the sternum by ligaments. Each breast contains 15-20 lobes arranged in a circular fashion. For more information, visit:

<s>[INST] What is the anatomy relevant to breast cancer? [/INST] The breasts of an adult woman are milk-producing glands on the front of the chest wall. They rest on the pectoralis major and are supported by and attached to the front of the chest wall on either side of the sternum by ligaments. Each breast contains 15-20 lobes arranged in a circular fashion. For more information, visit: </s>

What is the pathophysiology of breast cancer?

The current understanding of breast cancer etiopathogenesis is that invasive cancers arise through a series of molecular alterations at the cell level. These alterations result in breast epithelial cells with immortal features and uncontrolled growth.

<s>[INST] What is the pathophysiology of breast cancer? [/INST] The current understanding of breast cancer etiopathogenesis is that invasive cancers arise through a series of molecular alterations at the cell level. These alterations result in breast epithelial cells with immortal features and uncontrolled growth. </s>

How is breast cancer categorized?

various types of breast cancers: Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatics.

<s>[INST] How is breast cancer categorized? [/INST] various types of breast cancers: Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatics. </s>

What are the types of breast cancer?

The normal breast consists of three main components: the lobules (milk-producing glands), the ducts (thin tubes that connect the lobules to the nipple) and the stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels)

<s>[INST] What are the types of breast cancer? [/INST] The normal breast consists of three main components: the lobules (milk-producing glands), the ducts (thin tubes that connect the lobules to the nipple) and the stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels) </s>

What causes breast cancer?

Breast cancer develops as a result of genetic mutations or damage to DNA. These can be associated withTrusted Source exposure to estrogen, inherited genetic defects, or inherited genes that can cause cancer, such as the BRCA1 and BRCA2 genes.

<s>[INST] What causes breast cancer? [/INST] Breast cancer develops as a result of genetic mutations or damage to DNA. These can be associated withTrusted Source exposure to estrogen, inherited genetic defects, or inherited genes that can cause cancer, such as the BRCA1 and BRCA2 genes. </s>

What is the role of age in the etiology of breast cancer?

Increasing age and female sex are established risk factors for breast cancer. Sporadic breast cancer is relatively uncommon among women younger than 40 years but increases significantly thereafter. The effect of age on risk is illustrated in the SEER (Surveillance, Epidemiology and End Results) data, where the incidence of invasive breast cancer for women younger than 50 years is 44.0 per 100,000 as compared with 345 per 100,000 for women aged 50 years or older.

<s>[INST] What is the role of age in the etiology of breast cancer? [/INST] Increasing age and female sex are established risk factors for breast cancer. Sporadic breast cancer is relatively uncommon among women younger than 40 years but increases significantly thereafter. The effect of age on risk is illustrated in the SEER (Surveillance, Epidemiology and End Results) data, where the incidence of invasive breast cancer for women younger than 50 years is 44.0 per 100,000 as compared with 345 per 100,000 for women aged 50 years or older. </s>

What is the role of family history in the etiology of breast cancer?

A positive family history of breast cancer is the most widely recognized risk factor for breast cancer. The lifetime risk is up to 4 times higher if a mother and sister are affected, and it is about 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age (≤50 years

<s>[INST] What is the role of family history in the etiology of breast cancer? [/INST] A positive family history of breast cancer is the most widely recognized risk factor for breast cancer. The lifetime risk is up to 4 times higher if a mother and sister are affected, and it is about 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age (≤50 years </s>

Which family history factors increase the risk for breast cancer?

The family history characteristics that suggest increased risk of cancer are summarized as follows: Two or more relatives with breast or ovarian cancer Breast cancer occurring in an affected relative younger than 50 years Relatives with both breast cancer and ovarian cancer

<s>[INST] Which family history factors increase the risk for breast cancer? [/INST] The family history characteristics that suggest increased risk of cancer are summarized as follows: Two or more relatives with breast or ovarian cancer Breast cancer occurring in an affected relative younger than 50 years Relatives with both breast cancer and ovarian cancer </s>

How is family history–based risk for breast cancer assessed?

a number of family history–based risk assessment tools have been developed for clinical use, including the following: BRCAPRO Couch Myriad I and II Ontario Family History Assessment Tool (FHAT) Manchester

<s>[INST] How is family history–based risk for breast cancer assessed? [/INST] a number of family history–based risk assessment tools have been developed for clinical use, including the following: BRCAPRO Couch Myriad I and II Ontario Family History Assessment Tool (FHAT) Manchester </s>

What is the role of reproductive factors in the etiology of breast cancer?

Reproductive factors and steroid hormones Late age at first pregnancy, nulliparity, early onset of menses, and late age of menopause have all been consistently associated with an increased risk of breast cancer. Prolonged exposure to elevated levels of sex hormones has long been postulated as a risk factor for developing breast cancer, explaining the association between breast cancer and reproductive behaviors.

<s>[INST] What is the role of reproductive factors in the etiology of breast cancer? [/INST] Reproductive factors and steroid hormones Late age at first pregnancy, nulliparity, early onset of menses, and late age of menopause have all been consistently associated with an increased risk of breast cancer. Prolonged exposure to elevated levels of sex hormones has long been postulated as a risk factor for developing breast cancer, explaining the association between breast cancer and reproductive behaviors. </s>

What is the role of estradiol in the etiology of breast cancer?

Clinical trials of secondary prevention in women with breast cancer have demonstrated the protective effect of selective estrogen receptor modulators (SERMs) and aromatase inhibitors on recurrence and the development of contralateral breast cancers. Use of SERMs in women at increased risk for breast cancer has prevented invasive ER-positive cancers. These data support estradiol and its receptor as a primary target for risk reduction but do not establish that circulating hormone levels predict increase risk.

<s>[INST] What is the role of estradiol in the etiology of breast cancer? [/INST] Clinical trials of secondary prevention in women with breast cancer have demonstrated the protective effect of selective estrogen receptor modulators (SERMs) and aromatase inhibitors on recurrence and the development of contralateral breast cancers. Use of SERMs in women at increased risk for breast cancer has prevented invasive ER-positive cancers. These data support estradiol and its receptor as a primary target for risk reduction but do not establish that circulating hormone levels predict increase risk. </s>

What is the role of oral contraceptives (OCs) in the etiology of breast cancer?

One of the most widely studied factors in breast cancer etiology is the use of exogenous hormones in the form of oral contraceptives (OCs) and hormone replacement therapy (HRT). The overall evidence suggests an approximately 25% greater risk of breast cancer among current users of OCs. The risk appears to decrease with age and time since OC discontinuance. For OC users, risk returns to that of the average population risk about 10 years after cessation.

<s>[INST] What is the role of oral contraceptives (OCs) in the etiology of breast cancer? [/INST] One of the most widely studied factors in breast cancer etiology is the use of exogenous hormones in the form of oral contraceptives (OCs) and hormone replacement therapy (HRT). The overall evidence suggests an approximately 25% greater risk of breast cancer among current users of OCs. The risk appears to decrease with age and time since OC discontinuance. For OC users, risk returns to that of the average population risk about 10 years after cessation. </s>

What is the role of hormone replacement therapy (HRT) in the etiology of breast cancer?

Data obtained from case-control and prospective cohort settings support an increased risk of breast cancer incidence and mortality with the use of postmenopausal HRT. Increased risk of breast cancer has been positively associated with length of exposure, with the greatest risk being observed for hormonally responsive lobular, mixed ductal-lobular, and tubular cancers. Risk is greater among women taking combination HRT than among those taking estrogen-only formulations.

<s>[INST] What is the role of hormone replacement therapy (HRT) in the etiology of breast cancer? [/INST] Data obtained from case-control and prospective cohort settings support an increased risk of breast cancer incidence and mortality with the use of postmenopausal HRT. Increased risk of breast cancer has been positively associated with length of exposure, with the greatest risk being observed for hormonally responsive lobular, mixed ductal-lobular, and tubular cancers. Risk is greater among women taking combination HRT than among those taking estrogen-only formulations. </s>

What are guidelines for HRT in women at high risk of breast cancer?

There are currently no formal guidelines for the use of HRT in women at high risk for breast cancer (ie, women with a family history of breast cancer, a personal history of breast cancer, or benign breast disease).

<s>[INST] What are guidelines for HRT in women at high risk of breast cancer? [/INST] There are currently no formal guidelines for the use of HRT in women at high risk for breast cancer (ie, women with a family history of breast cancer, a personal history of breast cancer, or benign breast disease). </s>

How should menopausal symptoms be treated in women at high risk of breast cancer?

Many new treatments for menopausal symptoms have been suggested (eg, clonidine, venlafaxine, gabapentin, and combination venlafaxine plus gabapentin). To date, no randomized clinical trials among women at increased risk of breast cancer or women with a history of breast cancer have assessed the overall efficacy or risks associated with these treatments. Use of these agents is controversial and should target the severity of menopausal symptoms.

<s>[INST] How should menopausal symptoms be treated in women at high risk of breast cancer? [/INST] Many new treatments for menopausal symptoms have been suggested (eg, clonidine, venlafaxine, gabapentin, and combination venlafaxine plus gabapentin). To date, no randomized clinical trials among women at increased risk of breast cancer or women with a history of breast cancer have assessed the overall efficacy or risks associated with these treatments. Use of these agents is controversial and should target the severity of menopausal symptoms. </s>

Which history findings increase the risk for a second primary breast cancer occurrence?

A history of breast cancer is associated with a 3- to 4-fold increased risk of a second primary cancer in the contralateral breast. The presence of any premalignant ductal carcinoma in situ (DCIS) or LCIS confers an 8- to 10-fold increase in the risk of developing breast cancer in women who harbor untreated preinvasive lesions.

<s>[INST] Which history findings increase the risk for a second primary breast cancer occurrence? [/INST] A history of breast cancer is associated with a 3- to 4-fold increased risk of a second primary cancer in the contralateral breast. The presence of any premalignant ductal carcinoma in situ (DCIS) or LCIS confers an 8- to 10-fold increase in the risk of developing breast cancer in women who harbor untreated preinvasive lesions. </s>

What is the role of lifestyle factors in the etiology of breast cancer?

As with cancers of the colon and prostate, diets that are rich in grains, fruits, and vegetables; low in saturated fats; low in energy (calories); and low in alcohol—the more common pattern in less industrialized countries—are thought to be protective against breast cancer.

<s>[INST] What is the role of lifestyle factors in the etiology of breast cancer? [/INST] As with cancers of the colon and prostate, diets that are rich in grains, fruits, and vegetables; low in saturated fats; low in energy (calories); and low in alcohol—the more common pattern in less industrialized countries—are thought to be protective against breast cancer. </s>

What is the role of obesity in the etiology of breast cancer?

Increased risk of postmenopausal breast cancer has been consistently associated with the following: Adult weight gain of 20-25 kg above body weight at age 18. Western dietary pattern (high energy content in the form of animal fats and refined carbohydrates) Sedentary lifestyle Regular, moderate consumption of alcohol (3-5 alcoholic beverages per week)

<s>[INST] What is the role of obesity in the etiology of breast cancer? [/INST] Increased risk of postmenopausal breast cancer has been consistently associated with the following: Adult weight gain of 20-25 kg above body weight at age 18. Western dietary pattern (high energy content in the form of animal fats and refined carbohydrates) Sedentary lifestyle Regular, moderate consumption of alcohol (3-5 alcoholic beverages per week) </s>

Which Western lifestyle factors increase the risk for breast cancer?

The Western lifestyle (ie, chronic excess energy intake from meat, fat, and carbohydrates and lack of exercise) strongly correlates with development of the following: Obesity, particularly abdominal obesity Chronic hyperinsulinemia

<s>[INST] Which Western lifestyle factors increase the risk for breast cancer? [/INST] The Western lifestyle (ie, chronic excess energy intake from meat, fat, and carbohydrates and lack of exercise) strongly correlates with development of the following: Obesity, particularly abdominal obesity Chronic hyperinsulinemia </s>

Which environmental factors increase the risk for breast cancer?

A number of environmental exposures have been investigated in relation to breast cancer risk in humans, including the following : Tobacco smoke (both active and passive exposure) Dietary (eg, charred and processed meats) Alcohol consumption Environmental carcinogens (eg, exposure to pesticides, radiation, and environmental and dietary estrogens)

<s>[INST] Which environmental factors increase the risk for breast cancer? [/INST] A number of environmental exposures have been investigated in relation to breast cancer risk in humans, including the following : Tobacco smoke (both active and passive exposure) Dietary (eg, charred and processed meats) Alcohol consumption Environmental carcinogens (eg, exposure to pesticides, radiation, and environmental and dietary estrogens) </s>

What is the global prevalence of breast cancer?

The final decades of the 20th century saw worldwide increases in the incidence of breast cancer, with the highest rates reported in Westernized countries. Reasons for this trend are largely attributed to introduction of screening mammography. Changes in reproductive patterns—particularly fewer children and later age at first birth—may also have played a role, as may changes in lifestyle factors, including the following: Western dietary patterns Decreased physical activity Rising obesity rates

<s>[INST] What is the global prevalence of breast cancer? [/INST] The final decades of the 20th century saw worldwide increases in the incidence of breast cancer, with the highest rates reported in Westernized countries. Reasons for this trend are largely attributed to introduction of screening mammography. Changes in reproductive patterns—particularly fewer children and later age at first birth—may also have played a role, as may changes in lifestyle factors, including the following: Western dietary patterns Decreased physical activity Rising obesity rates </s>

Which age groups have the highest prevalence of breast cancer?

The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age; 95% of new cases occur in women aged 40 years or older. The median age of women at the time of breast cancer diagnosis is 62 years.

<s>[INST] Which age groups have the highest prevalence of breast cancer? [/INST] The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age; 95% of new cases occur in women aged 40 years or older. The median age of women at the time of breast cancer diagnosis is 62 years. </s>

What are the racial predilections of breast cancer?

According to the Cancer Society (CS), breast cancer rates per 100,000 among women from various racial and ethnic groups are as follows : Non-Hispanic White: 128.7 Non-Hispanic Black: 125.5 American Indian/Alaskan Native: 100.7 Hispanic/Latina: 91.9 Asian/Pacific Islander: 90.7

<s>[INST] What are the racial predilections of breast cancer? [/INST] According to the Cancer Society (CS), breast cancer rates per 100,000 among women from various racial and ethnic groups are as follows : Non-Hispanic White: 128.7 Non-Hispanic Black: 125.5 American Indian/Alaskan Native: 100.7 Hispanic/Latina: 91.9 Asian/Pacific Islander: 90.7 </s>

How do the mortality rates for breast cancer vary among racial and ethnic groups?

Among world women from 2006 through 2015, breast cancer death rates declined annually by 2.6% in American Indians/Alaskan Natives, 1.8% in non-Hispanic whites, NHWs, 1.5% in non-Hispanic blacks, 1.4% in Hispanics, and 0.9% in Asians/Pacific islanders. Breast cancer death rates in black women began to exceed those in white women in the early 1980s, and the disparity remains large; in 2015, breast cancer death rates were 39% higher in black women than white women

<s>[INST] How do the mortality rates for breast cancer vary among racial and ethnic groups? [/INST] Among world women from 2006 through 2015, breast cancer death rates declined annually by 2.6% in American Indians/Alaskan Natives, 1.8% in non-Hispanic whites, NHWs, 1.5% in non-Hispanic blacks, 1.4% in Hispanics, and 0.9% in Asians/Pacific islanders. Breast cancer death rates in black women began to exceed those in white women in the early 1980s, and the disparity remains large; in 2015, breast cancer death rates were 39% higher in black women than white women </s>

What is the prognosis of breast cancer?

The decrease in breast cancer death rates is thought to represent progress in both earlier detection and improved treatment modalities.The 2021 estimates are 44,130 expected breast cancer deaths (43,600 in women, 530 in men).

<s>[INST] What is the prognosis of breast cancer? [/INST] The decrease in breast cancer death rates is thought to represent progress in both earlier detection and improved treatment modalities.The 2021 estimates are 44,130 expected breast cancer deaths (43,600 in women, 530 in men). </s>

What are the prognostic and predictive factors for breast cancer?

Numerous prognostic and predictive factors for breast cancer have been identified by the College of American Pathologists (CAP) to guide the clinical management of women with breast cancer. Breast cancer prognostic factors include the following: Axillary lymph node status Tumor size Lymphatic/vascular invasion Patient age Histologic grade

<s>[INST] What are the prognostic and predictive factors for breast cancer? [/INST] Numerous prognostic and predictive factors for breast cancer have been identified by the College of American Pathologists (CAP) to guide the clinical management of women with breast cancer. Breast cancer prognostic factors include the following: Axillary lymph node status Tumor size Lymphatic/vascular invasion Patient age Histologic grade </s>

What are the survival rates for breast cancer?

Patients with node-negative disease have an overall 10-year survival rate of 70% and a 5-year recurrence rate of 19%. In patients with lymph nodes that are positive for cancer, the recurrence rates at 5 years are as follows: One to three positive nodes – 30-40% Four to nine positive nodes – 44-70% ≥10 positive nodes – 72-82%

<s>[INST] What are the survival rates for breast cancer? [/INST] Patients with node-negative disease have an overall 10-year survival rate of 70% and a 5-year recurrence rate of 19%. In patients with lymph nodes that are positive for cancer, the recurrence rates at 5 years are as follows: One to three positive nodes – 30-40% Four to nine positive nodes – 44-70% ≥10 positive nodes – 72-82% </s>

What is the prognosis of breast cancer following HER2-targeted therapies?

In the past, HER2 overexpression was associated with a more aggressive tumor phenotype and a worse prognosis (higher recurrence rate and increased mortality), independent of other clinical features (eg, age, stage, and tumor grade), especially in patients who did not receive adjuvant chemotherapy. Prognosis has improved with the routine use of HER2-targeted therapies, which consist of the following: Trastuzumab – Monoclonal antibody Pertuzumab – Monoclonal antibody Lapatinib – A small-molecule oral tyrosine kinase inhibitor

<s>[INST] What is the prognosis of breast cancer following HER2-targeted therapies? [/INST] In the past, HER2 overexpression was associated with a more aggressive tumor phenotype and a worse prognosis (higher recurrence rate and increased mortality), independent of other clinical features (eg, age, stage, and tumor grade), especially in patients who did not receive adjuvant chemotherapy. Prognosis has improved with the routine use of HER2-targeted therapies, which consist of the following: Trastuzumab – Monoclonal antibody Pertuzumab – Monoclonal antibody Lapatinib – A small-molecule oral tyrosine kinase inhibitor </s>

What is the prognosis of DCIS breast cancer?

DCIS is divided into comedo (ie, cribriform, micropapillary, and solid) and noncomedo subtypes, a division that provides additional prognostic information on the likelihood of progression or local recurrence. Generally, the prognosis is worse for comedo DCIS than for noncomedo DCIS (see Histology).

<s>[INST] What is the prognosis of DCIS breast cancer? [/INST] DCIS is divided into comedo (ie, cribriform, micropapillary, and solid) and noncomedo subtypes, a division that provides additional prognostic information on the likelihood of progression or local recurrence. Generally, the prognosis is worse for comedo DCIS than for noncomedo DCIS (see Histology). </s>

What is the prognosis of LCIS breast cancer?

Approximately 10-20% of women with LCIS develop invasive breast cancer within 15 years after their LCIS diagnosis. Thus, LCIS is considered a biomarker of increased breast cancer risk.

<s>[INST] What is the prognosis of LCIS breast cancer? [/INST] Approximately 10-20% of women with LCIS develop invasive breast cancer within 15 years after their LCIS diagnosis. Thus, LCIS is considered a biomarker of increased breast cancer risk. </s>

What is the prognosis of infiltrating ductal carcinoma breast cancer?

Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatic vessels. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be more multifocal. Nevertheless, its prognosis is comparable to that of ductal carcinoma.

<s>[INST] What is the prognosis of infiltrating ductal carcinoma breast cancer? [/INST] Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor and has a tendency to metastasize via lymphatic vessels. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be more multifocal. Nevertheless, its prognosis is comparable to that of ductal carcinoma. </s>

What is the prognosis of medullary carcinoma breast cancer?

Typical or classic medullary carcinomas are often associated with a good prognosis despite the unfavorable prognostic features associated with this type of breast cancer, including ER negativity, high tumor grade, and high proliferative rates. However, an analysis of 609 medullary breast cancer specimens from various stage I and II National Surgical Adjuvant Breast and Bowel Project (NSABP) protocols indicates that overall survival and prognosis are not as good as previously reported. Atypical medullary carcinomas also carry a poorer prognosis.

<s>[INST] What is the prognosis of medullary carcinoma breast cancer? [/INST] Typical or classic medullary carcinomas are often associated with a good prognosis despite the unfavorable prognostic features associated with this type of breast cancer, including ER negativity, high tumor grade, and high proliferative rates. However, an analysis of 609 medullary breast cancer specimens from various stage I and II National Surgical Adjuvant Breast and Bowel Project (NSABP) protocols indicates that overall survival and prognosis are not as good as previously reported. Atypical medullary carcinomas also carry a poorer prognosis. </s>

What is the prognosis of mucinous carcinoma breast cancer?

Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy.

<s>[INST] What is the prognosis of mucinous carcinoma breast cancer? [/INST] Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy. </s>

What is the prognosis of cystic papillary carcinoma breast cancer?

Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy.

<s>[INST] What is the prognosis of cystic papillary carcinoma breast cancer? [/INST] Overall, patients with mucinous carcinoma have an excellent prognosis, with better than 80% 10-year survival. Similarly, tubular carcinoma has a low incidence of lymph node involvement and a very high overall survival rate. Because of the favorable prognosis, these patients are often treated with only breast-conserving surgery and local radiation therapy. </s>

What is the prognosis of metaplastic breast cancer?

For metaplastic breast cancer, the majority of published case series have demonstrated a worse prognosis than with infiltrating ductal carcinoma, even when adjusted for stage, with a 3-year overall survival rate of 48-71% and 3-year disease-free survival rate of 15-60%. In most case series, large tumor size and advanced stage have emerged as predictors of poor overall survival and prognosis. Nodal status does not appear to impact survival in metaplastic breast cancer.

<s>[INST] What is the prognosis of metaplastic breast cancer? [/INST] For metaplastic breast cancer, the majority of published case series have demonstrated a worse prognosis than with infiltrating ductal carcinoma, even when adjusted for stage, with a 3-year overall survival rate of 48-71% and 3-year disease-free survival rate of 15-60%. In most case series, large tumor size and advanced stage have emerged as predictors of poor overall survival and prognosis. Nodal status does not appear to impact survival in metaplastic breast cancer. </s>

What is the prognosis of mammary Paget disease?

Paget disease of the breast is associated with an underlying breast cancer in 75% of cases. Breast-conserving surgery can achieve satisfactory results, but at the risk of local recurrence. Poor prognostic factors include a palpable breast tumor, lymph node involvement, histologic type, and an age of less than 60 years. Paget disease with a palpable mass usually has an invasive component and a lower 5-year survival rate (20-60%). Those that do not have an underlying palpable mass have a higher 5-year survival rate (75-100%).

<s>[INST] What is the prognosis of mammary Paget disease? [/INST] Paget disease of the breast is associated with an underlying breast cancer in 75% of cases. Breast-conserving surgery can achieve satisfactory results, but at the risk of local recurrence. Poor prognostic factors include a palpable breast tumor, lymph node involvement, histologic type, and an age of less than 60 years. Paget disease with a palpable mass usually has an invasive component and a lower 5-year survival rate (20-60%). Those that do not have an underlying palpable mass have a higher 5-year survival rate (75-100%). </s>

What is the association between breast cancer and cardiovascular disease (CVD)?

Cardiovascular disease (CVD) risk is increased in women with breast cancer. The increase is due in part to the cardiotoxic effects of some breast cancer treatments (eg, chemotherapy, radiotherapy, targeted therapy such as trastuzumab). In addition, breast cancer and CVD, share several risk factors, including smoking, obesity, and the typical Western diet.

<s>[INST] What is the association between breast cancer and cardiovascular disease (CVD)? [/INST] Cardiovascular disease (CVD) risk is increased in women with breast cancer. The increase is due in part to the cardiotoxic effects of some breast cancer treatments (eg, chemotherapy, radiotherapy, targeted therapy such as trastuzumab). In addition, breast cancer and CVD, share several risk factors, including smoking, obesity, and the typical Western diet. </s>

Which clinical history findings are characteristic of breast cancer?

Many early breast carcinomas are asymptomatic, particularly if they were discovered during a breast-screening program. Larger tumors may present as a painless mass. Pain or discomfort is not usually a symptom of breast cancer; only 5% of patients with a malignant mass present with breast pain. Often, the purpose of the history is not diagnosis but risk assessment. A family history of breast cancer in a first-degree relative is the most widely recognized breast cancer risk factor.

<s>[INST] Which clinical history findings are characteristic of breast cancer? [/INST] Many early breast carcinomas are asymptomatic, particularly if they were discovered during a breast-screening program. Larger tumors may present as a painless mass. Pain or discomfort is not usually a symptom of breast cancer; only 5% of patients with a malignant mass present with breast pain. Often, the purpose of the history is not diagnosis but risk assessment. A family history of breast cancer in a first-degree relative is the most widely recognized breast cancer risk factor. </s>

What are the USPSTF guidelines on risk assessment for BRCA-related breast cancer?

The current USPSTF recommendations are as follows: Women who have family members with breast, ovarian, tubal, or peritoneal cancer should be screened to identify a family history that may be associated with an increased risk for mutations in the breast cancer susceptibility genes BRCA1 or BRCA2 Women who have positive screening results should receive genetic counseling and then BRCA testing if warranted Women without a family history associated with an increased risk for mutations should not receive routine genetic counseling or BRCA testing

<s>[INST] What are the USPSTF guidelines on risk assessment for BRCA-related breast cancer? [/INST] The current USPSTF recommendations are as follows: Women who have family members with breast, ovarian, tubal, or peritoneal cancer should be screened to identify a family history that may be associated with an increased risk for mutations in the breast cancer susceptibility genes BRCA1 or BRCA2 Women who have positive screening results should receive genetic counseling and then BRCA testing if warranted Women without a family history associated with an increased risk for mutations should not receive routine genetic counseling or BRCA testing </s>

What are the signs and symptoms of breast cancer?

If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following: Change in breast size or shape Skin dimpling or skin changes (eg, thickening, swelling, or redness) Recent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge) Nipple discharge, particularly if bloodstained Axillary lump

<s>[INST] What are the signs and symptoms of breast cancer? [/INST] If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following: Change in breast size or shape Skin dimpling or skin changes (eg, thickening, swelling, or redness) Recent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge) Nipple discharge, particularly if bloodstained Axillary lump </s>

Which breast exam findings suggest breast cancer?

The clinician should be alert to symptoms of metastatic spread, such as the following: Bone pain Symptoms of hypercalcemia Breathing difficulties Abdominal distention Jaundice Localizing neurologic signs Altered cognitive function Headache

<s>[INST] Which breast exam findings suggest breast cancer? [/INST] The clinician should be alert to symptoms of metastatic spread, such as the following: Bone pain Symptoms of hypercalcemia Breathing difficulties Abdominal distention Jaundice Localizing neurologic signs Altered cognitive function Headache </s>

How are palpable lumps characterized in breast cancer?

The nature of palpable lumps is often difficult to determine clinically, but the following features should raise concern: Hardness Irregularity Focal nodularity Asymmetry with the other breast Fixation to skin or muscle (assess fixation to muscle by moving the lump in the line of the pectoral muscle fibers with the patient bracing her arms against her hips)

<s>[INST] How are palpable lumps characterized in breast cancer? [/INST] The nature of palpable lumps is often difficult to determine clinically, but the following features should raise concern: Hardness Irregularity Focal nodularity Asymmetry with the other breast Fixation to skin or muscle (assess fixation to muscle by moving the lump in the line of the pectoral muscle fibers with the patient bracing her arms against her hips) </s>

What are the signs and symptoms of metastatic breast cancer?

If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following: Change in breast size or shape Skin dimpling or skin changes (eg, thickening, swelling, or redness) Recent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge) Nipple discharge, particularly if bloodstained Axillary lump

<s>[INST] What are the signs and symptoms of metastatic breast cancer? [/INST] If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer may include the following: Change in breast size or shape Skin dimpling or skin changes (eg, thickening, swelling, or redness) Recent nipple inversion or skin change or other nipple abnormalities (eg, ulceration, retraction, or spontaneous bloody discharge) Nipple discharge, particularly if bloodstained Axillary lump </s>

Which conditions should be included in the differential diagnosis of breast cancer?

The differential diagnosis includes the following: Circumscribed breast lesions – Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia) Skin thickening – Inflammatory carcinoma and mastitis Stellate lesions – Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma Dilated ducts with or without nipple discharge – Papilloma, ductal carcinoma, duct ectasia, and fibrocystic disease

<s>[INST] Which conditions should be included in the differential diagnosis of breast cancer? [/INST] The differential diagnosis includes the following: Circumscribed breast lesions – Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia) Skin thickening – Inflammatory carcinoma and mastitis Stellate lesions – Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma Dilated ducts with or without nipple discharge – Papilloma, ductal carcinoma, duct ectasia, and fibrocystic disease </s>

What are the differential diagnoses for Breast Cancer?

The differential diagnosis includes the following: Circumscribed breast lesions – Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia) Skin thickening – Inflammatory carcinoma and mastitis Stellate lesions – Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma Dilated ducts with or without nipple discharge – Papilloma, ductal carcinoma, duct ectasia, and fibrocystic disease

<s>[INST] What are the differential diagnoses for Breast Cancer? [/INST] The differential diagnosis includes the following: Circumscribed breast lesions – Benign breast disease (eg, fibroadenomas and cysts), breast cancer, breast lymphoma, and metastasis to the breast from other primary sites (eg, neuroendocrine or extramedullary acute myeloid leukemia) Skin thickening – Inflammatory carcinoma and mastitis Stellate lesions – Breast cancer, traumatic fat necrosis, a radial scar, and a hyalinized fibroadenoma Dilated ducts with or without nipple discharge – Papilloma, ductal carcinoma, duct ectasia, and fibrocystic disease </s>

What is the triple assessment algorithm for breast cancer diagnosis?

Breast cancer evaluation should be an ordered inquiry that begins with symptoms and a general clinical history. This is followed by a sequence that has become formalized as triple assessment, which includes the following components: Clinical examination Imaging (usually mammography, ultrasonography, or both) Needle biopsy

<s>[INST] What is the triple assessment algorithm for breast cancer diagnosis? [/INST] Breast cancer evaluation should be an ordered inquiry that begins with symptoms and a general clinical history. This is followed by a sequence that has become formalized as triple assessment, which includes the following components: Clinical examination Imaging (usually mammography, ultrasonography, or both) Needle biopsy </s>

What is the efficacy of breast cancer screening in the early detection of breast cancer?

Whereas early detection has been advocated as a primary defense against the development of life-threatening breast cancer, questions have been raised in the past few years regarding the age at which to initiate, the modality to use, the interval between screenings, whether to screen older women, and even the impact on breast cancer−related deaths. It is widely believed that breast tumors that are smaller or nonpalpable and that present with a favorable tumor marker profile are more treatable when detected early.

<s>[INST] What is the efficacy of breast cancer screening in the early detection of breast cancer? [/INST] Whereas early detection has been advocated as a primary defense against the development of life-threatening breast cancer, questions have been raised in the past few years regarding the age at which to initiate, the modality to use, the interval between screenings, whether to screen older women, and even the impact on breast cancer−related deaths. It is widely believed that breast tumors that are smaller or nonpalpable and that present with a favorable tumor marker profile are more treatable when detected early. </s>

Which modalities are used to screen for breast cancer?

A number of screening modalities exist for breast cancer, including clinical breast examination, mammography, ultrasonography, and MRI.

<s>[INST] Which modalities are used to screen for breast cancer? [/INST] A number of screening modalities exist for breast cancer, including clinical breast examination, mammography, ultrasonography, and MRI. </s>

What is the role of mammography in the workup of breast cancer?

A survival benefit of early detection with mammography screening has been demonstrated. A review that used seven statistical models determined that the use of screening mammography reduced the rate of death from breast cancer by 28–65% (median, 46%). A meta-analysis found that screening mammography reduces breast cancer mortality by about 20–35% in women 50–69 years old and slightly less in women 40–49 years old at 14 years of follow-up.

<s>[INST] What is the role of mammography in the workup of breast cancer? [/INST] A survival benefit of early detection with mammography screening has been demonstrated. A review that used seven statistical models determined that the use of screening mammography reduced the rate of death from breast cancer by 28–65% (median, 46%). A meta-analysis found that screening mammography reduces breast cancer mortality by about 20–35% in women 50–69 years old and slightly less in women 40–49 years old at 14 years of follow-up. </s>

Which factors affect a women's decision to undergo a breast cancer screening mammogram?

Although mammography guidelines have been in place for more than 30 years, 20-30% of women still do not undergo screening as indicated. The 2 most significant factors governing a woman’s decision to undergo mammography are physician recommendation and access to health insurance. Nonwhite women and those of lower socioeconomic status remain less likely to obtain mammography services and more likely to present with life-threatening, advanced stage disease.

<s>[INST] Which factors affect a women's decision to undergo a breast cancer screening mammogram? [/INST] Although mammography guidelines have been in place for more than 30 years, 20-30% of women still do not undergo screening as indicated. The 2 most significant factors governing a woman’s decision to undergo mammography are physician recommendation and access to health insurance. Nonwhite women and those of lower socioeconomic status remain less likely to obtain mammography services and more likely to present with life-threatening, advanced stage disease. </s>

What are the ACS guidelines for breast cancer screening?

The 2015 ACS recommendations for women at average risk of breast cancer are as follows: Women should have the opportunity to begin annual screening at 40-44 years of age (qualified recommendation) Women should begin regular screening mammography at age 45 years (strong recommendation) Women aged 45-54 years should be screened annually (qualified recommendation) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation) Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation) Clinical breast examination is not recommended for breast cancer screening in average-risk women at any age

<s>[INST] What are the ACS guidelines for breast cancer screening? [/INST] The 2015 ACS recommendations for women at average risk of breast cancer are as follows: Women should have the opportunity to begin annual screening at 40-44 years of age (qualified recommendation) Women should begin regular screening mammography at age 45 years (strong recommendation) Women aged 45-54 years should be screened annually (qualified recommendation) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation) Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation) Clinical breast examination is not recommended for breast cancer screening in average-risk women at any age </s>

What are the USPSTF guidelines for breast cancer screening?

Instead of routine screening for women 40-49 years old, the USPSTF recommends that clinicians provide screening to selected patients in this age range, depending on individual circumstances and patient preferences. The USPSTF further concluded that for most individuals without signs or symptoms, there is likely to be only a small benefit from screening. Finally, the USPSTF recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination in women aged 40 years or older or the benefits and harms of screening mammography in women aged 75 years or older.

<s>[INST] What are the USPSTF guidelines for breast cancer screening? [/INST] Instead of routine screening for women 40-49 years old, the USPSTF recommends that clinicians provide screening to selected patients in this age range, depending on individual circumstances and patient preferences. The USPSTF further concluded that for most individuals without signs or symptoms, there is likely to be only a small benefit from screening. Finally, the USPSTF recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the benefits and harms of clinical breast examination in women aged 40 years or older or the benefits and harms of screening mammography in women aged 75 years or older. </s>

What are the ACP guidelines for breast cancer screening?

2019 review by the American College of Physicians (ACP) provides the following guidance statements regarding screening of asymptomatic women at average risk and in good health: Women 40-49 years of age: Discuss benefits and harms of screening mammography (potential harms outweigh the benefits in most cases). Women 50-74 years of age: Offer biennial mammography. Discontinue screening in women ≥75 years of age and in those with a life expectancy of ≤10 years. Do not use clinical breast examination to screen for breast cancer in women of any age.

<s>[INST] What are the ACP guidelines for breast cancer screening? [/INST] 2019 review by the American College of Physicians (ACP) provides the following guidance statements regarding screening of asymptomatic women at average risk and in good health: Women 40-49 years of age: Discuss benefits and harms of screening mammography (potential harms outweigh the benefits in most cases). Women 50-74 years of age: Offer biennial mammography. Discontinue screening in women ≥75 years of age and in those with a life expectancy of ≤10 years. Do not use clinical breast examination to screen for breast cancer in women of any age. </s>

What are the ACR guidelines for breast cancer screening?

In contrast to the ACP recommendation against the use of tomosynthesis (3D mammography) in breast cancer screening, the American College of Radiology (ACR) states that, “breast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing.” The ACR notes that further studies will be needed to determine which subgroups of women are likely to benefit most from tomosynthesis screening.

<s>[INST] What are the ACR guidelines for breast cancer screening? [/INST] In contrast to the ACP recommendation against the use of tomosynthesis (3D mammography) in breast cancer screening, the American College of Radiology (ACR) states that, “breast tomosynthesis has shown to be an advance over digital mammography, with higher cancer detection rates and fewer patient recalls for additional testing.” The ACR notes that further studies will be needed to determine which subgroups of women are likely to benefit most from tomosynthesis screening. </s>

What is the efficacy of 3D mammography for breast cancer screening?

In the Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study—a prospective population-based screening study in 9672 women that compared integrated 3D mammography with 2D mammography—3D mammography detected more cases of breast cancer than 2D mammography but increased the percentage of false-positive recalls in sequential screen-reading. Thus, the benefit of significantly increased breast cancer detection with tomosynthesis screening must be weighed against the possible risk of overdiagnosis.

<s>[INST] What is the efficacy of 3D mammography for breast cancer screening? [/INST] In the Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study—a prospective population-based screening study in 9672 women that compared integrated 3D mammography with 2D mammography—3D mammography detected more cases of breast cancer than 2D mammography but increased the percentage of false-positive recalls in sequential screen-reading. Thus, the benefit of significantly increased breast cancer detection with tomosynthesis screening must be weighed against the possible risk of overdiagnosis. </s>

How does breast density affect the risk for breast cancer?

High interval cancer rates were observed for women with a 5-year BCSC risk of 1.67% or greater and extremely dense breasts or a 5-year risk of 2.50% or greater and heterogeneously dense breasts. However, study participants who met those criteria accounted for only 24% of all women with dense breasts. The highest rate of advanced-stage breast cancer, >0.4 case per 1000 examinations, was seen in women with 5-year BCSC risk of 2.50% or greater and heterogeneously or extremely dense breasts. Such patients comprised 21% of all women with dense breasts.

<s>[INST] How does breast density affect the risk for breast cancer? [/INST] High interval cancer rates were observed for women with a 5-year BCSC risk of 1.67% or greater and extremely dense breasts or a 5-year risk of 2.50% or greater and heterogeneously dense breasts. However, study participants who met those criteria accounted for only 24% of all women with dense breasts. The highest rate of advanced-stage breast cancer, >0.4 case per 1000 examinations, was seen in women with 5-year BCSC risk of 2.50% or greater and heterogeneously or extremely dense breasts. Such patients comprised 21% of all women with dense breasts. </s>

What is the role of diagnostic mammography in the evaluation of breast cancer?

Mammography is used both for screening to detect a cancer and for diagnostic workup of patients after a tumor is detected. Screening mammography is performed in asymptomatic women, whereas diagnostic mammography is performed in symptomatic women (ie, when a breast lump or nipple discharge is present or when an abnormality is found during screening mammography).

<s>[INST] What is the role of diagnostic mammography in the evaluation of breast cancer? [/INST] Mammography is used both for screening to detect a cancer and for diagnostic workup of patients after a tumor is detected. Screening mammography is performed in asymptomatic women, whereas diagnostic mammography is performed in symptomatic women (ie, when a breast lump or nipple discharge is present or when an abnormality is found during screening mammography). </s>

What is the role of ultrasonography in the workup of breast cancer?

Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. It is generally employed to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. As a screening tool, ultrasonography is limited by a number of factors, most notably its failure to detect microcalcifications and its poor specificity (34%).

<s>[INST] What is the role of ultrasonography in the workup of breast cancer? [/INST] Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. It is generally employed to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. As a screening tool, ultrasonography is limited by a number of factors, most notably its failure to detect microcalcifications and its poor specificity (34%). </s>

What is the role of MRI in the workup of breast cancer?

In an effort to overcome the limitations of mammography and ultrasonography, MRI has been explored as a modality for detecting breast cancer in women at high risk and in younger women. A combination of T1, T2, and 3-D contrast-enhanced MRI techniques has been found to possess high sensitivity (approximating 86-100% in combination with mammography and clinical breast examination) to malignant changes in the breast.

<s>[INST] What is the role of MRI in the workup of breast cancer? [/INST] In an effort to overcome the limitations of mammography and ultrasonography, MRI has been explored as a modality for detecting breast cancer in women at high risk and in younger women. A combination of T1, T2, and 3-D contrast-enhanced MRI techniques has been found to possess high sensitivity (approximating 86-100% in combination with mammography and clinical breast examination) to malignant changes in the breast. </s>

When is MRI indicated for the diagnosis of breast cancer?

The principal indications for MRI of the breast are screening for breast cancer in women at increased risk, staging of known cancer, and evaluation of response to neoadjuvant chemotherapy. Breast MRI is based on T1-weighted contrast-enhanced imaging, but multiparametric assessment, including T2-weighted, ultrafast, and diffusion-weighted imaging, may be used to improve the characterization of lesions

<s>[INST] When is MRI indicated for the diagnosis of breast cancer? [/INST] The principal indications for MRI of the breast are screening for breast cancer in women at increased risk, staging of known cancer, and evaluation of response to neoadjuvant chemotherapy. Breast MRI is based on T1-weighted contrast-enhanced imaging, but multiparametric assessment, including T2-weighted, ultrafast, and diffusion-weighted imaging, may be used to improve the characterization of lesions </s>

Which radiotracers are used in scintimammography for the diagnosis of breast cancer?

Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status. When PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.

<s>[INST] Which radiotracers are used in scintimammography for the diagnosis of breast cancer? [/INST] Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status. When PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences. </s>

What are contraindications for scintimammography in the workup of breast cancer?

Scintimammography is not indicated as a screening procedure for the detection of breast cancer. However, it may play a role in various specific clinical indications, as in cases of nondiagnostic or difficult mammography and in the evaluation of high-risk patients, tumor response to chemotherapy, and metastatic involvement of axillary lymph nodes.

<s>[INST] What are contraindications for scintimammography in the workup of breast cancer? [/INST] Scintimammography is not indicated as a screening procedure for the detection of breast cancer. However, it may play a role in various specific clinical indications, as in cases of nondiagnostic or difficult mammography and in the evaluation of high-risk patients, tumor response to chemotherapy, and metastatic involvement of axillary lymph nodes. </s>

What is the role of PET scanning in the workup of breast cancer?

Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status. When PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences.

<s>[INST] What is the role of PET scanning in the workup of breast cancer? [/INST] Using a wide range of labeled metabolites (eg, fluorinated glucose [18 FDG]), positron emission tomography (PET) can detect changes in metabolic activity, vascularization, oxygen consumption, and tumor receptor status. When PET is combined with computed tomography (CT) to assist in anatomic localization (PET-CT), scans can identify axillary and nonaxillary (eg, internal mammary or supraclavicular) lymph node metastasis for the purposes of staging locally advanced and inflammatory breast cancer before initiation of neoadjuvant therapy and restaging high-risk patients for local or distant recurrences. </s>

What is the role of breast biopsy in the diagnosis of breast cancer?

Percutaneous vacuum-assisted large-gauge core-needle biopsy (VACNB) with image guidance is the recommended diagnostic approach for newly diagnosed breast tumors. Core biopsies can minimize the need for operative intervention (and subsequent scarring, and provide accurate pathologic diagnosis for appropriate management. Excisional biopsy, as the initial operative approach, has been shown to increase the rate of positive margins. Open excisional biopsy is reserved for lesions where the diagnosis remains equivocal despite imaging and core biopsy assessment or for benign lesions that the patient chooses to have removed. Because wide clearance of the lesion is usually not the goal in diagnostic biopsies, unnecessary distortion of the breast is thereby avoided. Ongoing audit is essential to help reduce an excessive benign-to-malignant biopsy ratio.

<s>[INST] What is the role of breast biopsy in the diagnosis of breast cancer? [/INST] Percutaneous vacuum-assisted large-gauge core-needle biopsy (VACNB) with image guidance is the recommended diagnostic approach for newly diagnosed breast tumors. Core biopsies can minimize the need for operative intervention (and subsequent scarring, and provide accurate pathologic diagnosis for appropriate management. Excisional biopsy, as the initial operative approach, has been shown to increase the rate of positive margins. Open excisional biopsy is reserved for lesions where the diagnosis remains equivocal despite imaging and core biopsy assessment or for benign lesions that the patient chooses to have removed. Because wide clearance of the lesion is usually not the goal in diagnostic biopsies, unnecessary distortion of the breast is thereby avoided. Ongoing audit is essential to help reduce an excessive benign-to-malignant biopsy ratio. </s>

What are the histologic findings of lobular carcinoma in situ breast cancer?

Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor: Size Status of surgical margin Presence or absence of estrogen receptor (ER) and progesterone receptor (PR) Nuclear and histologic grade Proliferation Vascular invasion Tumor necrosis Quantity of intraductal component HER2 status

<s>[INST] What are the histologic findings of lobular carcinoma in situ breast cancer? [/INST] Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor: Size Status of surgical margin Presence or absence of estrogen receptor (ER) and progesterone receptor (PR) Nuclear and histologic grade Proliferation Vascular invasion Tumor necrosis Quantity of intraductal component HER2 status </s>

What are the histologic findings of infiltrating ductal carcinoma breast cancer?

Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor (accounting for 75% of breast cancers) and has a tendency to metastasize via lymphatic vessels. This lesion has no specific histologic characteristics other than invasion through the basement membrane. DCIS is a frequently associated finding on pathologic examination.

<s>[INST] What are the histologic findings of infiltrating ductal carcinoma breast cancer? [/INST] Infiltrating ductal carcinoma is the most commonly diagnosed breast tumor (accounting for 75% of breast cancers) and has a tendency to metastasize via lymphatic vessels. This lesion has no specific histologic characteristics other than invasion through the basement membrane. DCIS is a frequently associated finding on pathologic examination. </s>

What are the histologic findings of medullary carcinoma breast cancer?

Lobular carcinoma in situ (LCIS) arises from the terminal duct apparatus and shows a rather diffuse distribution throughout the breast, which explains its presentation as a nonpalpable mass in most cases. Over the past 25 years, the incidence of LCIS has doubled, currently standing at 2.8 per 100,000 women. The peak incidence is in women aged 40-50 years.

<s>[INST] What are the histologic findings of medullary carcinoma breast cancer? [/INST] Lobular carcinoma in situ (LCIS) arises from the terminal duct apparatus and shows a rather diffuse distribution throughout the breast, which explains its presentation as a nonpalpable mass in most cases. Over the past 25 years, the incidence of LCIS has doubled, currently standing at 2.8 per 100,000 women. The peak incidence is in women aged 40-50 years. </s>

Which tumor features affect treatment selection for breast cancer?

Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor: Size Status of surgical margin Presence or absence of estrogen receptor (ER) and progesterone receptor (PR) Nuclear and histologic grade Proliferation Vascular invasion Tumor necrosis Quantity of intraductal component HER2 status

<s>[INST] Which tumor features affect treatment selection for breast cancer? [/INST] Breast cancers usually are epithelial tumors of ductal or lobular origin. All of the following features are important in deciding on a course of treatment for any breast tumor: Size Status of surgical margin Presence or absence of estrogen receptor (ER) and progesterone receptor (PR) Nuclear and histologic grade Proliferation Vascular invasion Tumor necrosis Quantity of intraductal component HER2 status </s>

What are the histologic grades for breast cancer?

Histologic grade is the best predictor of disease prognosis in carcinoma in situ, but it is dependent on the grading system used, such as the Van Nuys classification (high-grade, low-grade comedo, low-grade noncomedo). The grading of invasive carcinoma is also important as a prognostic indicator, with higher grades indicating a worse prognosis

<s>[INST] What are the histologic grades for breast cancer? [/INST] Histologic grade is the best predictor of disease prognosis in carcinoma in situ, but it is dependent on the grading system used, such as the Van Nuys classification (high-grade, low-grade comedo, low-grade noncomedo). The grading of invasive carcinoma is also important as a prognostic indicator, with higher grades indicating a worse prognosis </s>

What are the histologic characteristics of DCIS breast cancer?

Increased use of screening mammography has resulted in a dramatic increase in the detection of ductal carcinoma in situ (DCIS). Approximately 64,000 cases of DCIS are diagnosed annually in the United States. About 90% of DCIS cases are identified on mammography as suspicious calcifications: linear, clustered, segmental, focal, or mixed distribution. DCIS is broadly divided into 2 subtypes: comedo (ie, cribriform, micropapillary, and solid; and noncomedo. The likelihood of progression or local recurrence, as well as the prognosis, varies in accordance with the DCIS subtype present.

<s>[INST] What are the histologic characteristics of DCIS breast cancer? [/INST] Increased use of screening mammography has resulted in a dramatic increase in the detection of ductal carcinoma in situ (DCIS). Approximately 64,000 cases of DCIS are diagnosed annually in the United States. About 90% of DCIS cases are identified on mammography as suspicious calcifications: linear, clustered, segmental, focal, or mixed distribution. DCIS is broadly divided into 2 subtypes: comedo (ie, cribriform, micropapillary, and solid; and noncomedo. The likelihood of progression or local recurrence, as well as the prognosis, varies in accordance with the DCIS subtype present. </s>

What are the histologic findings of infiltrating lobular carcinoma breast cancer?

Infiltrating lobular carcinoma has a much lower incidence than infiltrating ductal carcinoma, accounting for 15-20% of invasive breast cancers. Histologically, it is characterized by the "single-file" arrangement of small tumor cells. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be multifocal and have discontinuous areas of involvement, making mammographic and even MRI staging imprecise.

<s>[INST] What are the histologic findings of infiltrating lobular carcinoma breast cancer? [/INST] Infiltrating lobular carcinoma has a much lower incidence than infiltrating ductal carcinoma, accounting for 15-20% of invasive breast cancers. Histologically, it is characterized by the "single-file" arrangement of small tumor cells. Like ductal carcinoma, infiltrating lobular carcinoma typically metastasizes to axillary lymph nodes first. However, it also has a tendency to be multifocal and have discontinuous areas of involvement, making mammographic and even MRI staging imprecise. </s>

What are the histologic findings of mucinous carcinoma breast cancer?

Mucinous (colloid) carcinoma is another rare histologic type, seen in fewer than 5% of invasive breast cancer cases. It usually presents during the seventh decade of life as a palpable mass or appears mammographically as a poorly defined tumor with rare calcifications. Mucin production is the histologic hallmark. There are 2 main types of lesions, A and B, with AB lesions possessing features of both. Type A mucinous carcinoma represents the classic variety, with larger quantities of extracellular mucin, whereas type B is a distinct variant with endocrine differentiation.

<s>[INST] What are the histologic findings of mucinous carcinoma breast cancer? [/INST] Mucinous (colloid) carcinoma is another rare histologic type, seen in fewer than 5% of invasive breast cancer cases. It usually presents during the seventh decade of life as a palpable mass or appears mammographically as a poorly defined tumor with rare calcifications. Mucin production is the histologic hallmark. There are 2 main types of lesions, A and B, with AB lesions possessing features of both. Type A mucinous carcinoma represents the classic variety, with larger quantities of extracellular mucin, whereas type B is a distinct variant with endocrine differentiation. </s>

What are the histologic findings of tubular carcinoma breast cancer?

Tubular carcinoma of the breast is an uncommon histologic type, accounting for only 1-2% of all breast cancers. Characteristic features of this type include a single layer of epithelial cells with low-grade nuclei and apical cytoplasmic snoutings arranged in well-formed tubules and glands. Tubular components make up more than 90% of pure tubular carcinomas and at least 75% of mixed tubular carcinomas. This type of breast cancer has a low incidence of lymph node involvement and a very high overall survival rate. Because of its favorable prognosis, patients are often treated with only breast-conserving surgery and local radiation therapy.

<s>[INST] What are the histologic findings of tubular carcinoma breast cancer? [/INST] Tubular carcinoma of the breast is an uncommon histologic type, accounting for only 1-2% of all breast cancers. Characteristic features of this type include a single layer of epithelial cells with low-grade nuclei and apical cytoplasmic snoutings arranged in well-formed tubules and glands. Tubular components make up more than 90% of pure tubular carcinomas and at least 75% of mixed tubular carcinomas. This type of breast cancer has a low incidence of lymph node involvement and a very high overall survival rate. Because of its favorable prognosis, patients are often treated with only breast-conserving surgery and local radiation therapy. </s>

What are the histologic findings of papillary carcinoma breast cancer?

Papillary carcinoma of the breast encompasses a spectrum of histologic subtypes. There are 2 common types: cystic (noninvasive form) and micropapillary ductal carcinoma (invasive form). This form of breast cancer is usually seen in women older than 60 years and accounts for approximately 1-2% of all breast cancers. Papillary carcinomas are centrally located in the breast and can present as bloody nipple discharge. They are strongly ER- and PR-positive.

<s>[INST] What are the histologic findings of papillary carcinoma breast cancer? [/INST] Papillary carcinoma of the breast encompasses a spectrum of histologic subtypes. There are 2 common types: cystic (noninvasive form) and micropapillary ductal carcinoma (invasive form). This form of breast cancer is usually seen in women older than 60 years and accounts for approximately 1-2% of all breast cancers. Papillary carcinomas are centrally located in the breast and can present as bloody nipple discharge. They are strongly ER- and PR-positive. </s>

What are histologic findings of metaplastic breast cancer?

Metaplastic breast cancer (MBC) accounts for fewer than 1% of breast cancer cases. It tends to occur in older women (average age of onset in the sixth decade) and has a higher incidence in Black women. It is characterized by a combination of adenocarcinoma plus mesenchymal and epithelial components. A wide variety of histologic patterns includes the following: Spindle-cell carcinoma Carcinosarcoma Squamous cell carcinoma of ductal origin Adenosquamous carcinoma Carcinoma with pseudosarcomatous metaplasia Matrix-producing carcinoma

<s>[INST] What are histologic findings of metaplastic breast cancer? [/INST] Metaplastic breast cancer (MBC) accounts for fewer than 1% of breast cancer cases. It tends to occur in older women (average age of onset in the sixth decade) and has a higher incidence in Black women. It is characterized by a combination of adenocarcinoma plus mesenchymal and epithelial components. A wide variety of histologic patterns includes the following: Spindle-cell carcinoma Carcinosarcoma Squamous cell carcinoma of ductal origin Adenosquamous carcinoma Carcinoma with pseudosarcomatous metaplasia Matrix-producing carcinoma </s>

What are the histologic findings of mammary Paget disease?

Mammary Paget disease is relatively rare, accounting for 1-4% of all breast cancers. The peak incidence is seen in the sixth decade of life. This adenocarcinoma is localized within the epidermis of the nipple-areola complex and is composed of the histologic hallmark Paget cells within the basement membrane. Paget cells are large, pale epithelial cells with hyperchromatic, atypical nuclei, dispersed between the keratinocytes singly or as a cluster of cells.

<s>[INST] What are the histologic findings of mammary Paget disease? [/INST] Mammary Paget disease is relatively rare, accounting for 1-4% of all breast cancers. The peak incidence is seen in the sixth decade of life. This adenocarcinoma is localized within the epidermis of the nipple-areola complex and is composed of the histologic hallmark Paget cells within the basement membrane. Paget cells are large, pale epithelial cells with hyperchromatic, atypical nuclei, dispersed between the keratinocytes singly or as a cluster of cells. </s>

What is the AJCC staging system for breast cancer?

The American Joint Committee on Cancer (AJCC) provides two principal groups for breast cancer staging: anatomic, which is based on extent of cancer as defined by tumor size (T), lymph node status (N), and distant metastasis (M); and prognostic, which includes anatomic TNM plus tumor grade and the status of the biomarkers human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR). The prognostic stage group is preferred for patient care and is to be used for reporting of all cancer patients in the United States.

<s>[INST] What is the AJCC staging system for breast cancer? [/INST] The American Joint Committee on Cancer (AJCC) provides two principal groups for breast cancer staging: anatomic, which is based on extent of cancer as defined by tumor size (T), lymph node status (N), and distant metastasis (M); and prognostic, which includes anatomic TNM plus tumor grade and the status of the biomarkers human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR). The prognostic stage group is preferred for patient care and is to be used for reporting of all cancer patients in the United States. </s>

What are the prognostic stages for breast cancer?

Histologic grade (G) GX Grade cannot be assessed G1 Low combined histologic grade (favorable) G2 Intermediate combined histologic grade (moderately favorable) G3 High combined histologic grade (unfavorable)

<s>[INST] What are the prognostic stages for breast cancer? [/INST] Histologic grade (G) GX Grade cannot be assessed G1 Low combined histologic grade (favorable) G2 Intermediate combined histologic grade (moderately favorable) G3 High combined histologic grade (unfavorable) </s>

According to ASCO guidelines, which patients with breast cancer should be offered sentinel lymph node (SLN) biopsy?

Evaluation of lymph node involvement by means of sentinel lymph node biopsy or axillary lymph node dissection (ALND) has also been considered necessary for staging and prognosis. A 2014 update on sentinel lymph node biopsy for patients with early-stage breast cancer by the American Society of Clinical Oncology (ASCO) advises that sentinel lymph node biopsy may be offered to the following patients: Women with operable breast cancer and multicentric tumors Women with DCIS who will be undergoing mastectomy Women who previously underwent breast and/or axillary surgery Women who received preoperative/neoadjuvant systemic therapy

<s>[INST] According to ASCO guidelines, which patients with breast cancer should be offered sentinel lymph node (SLN) biopsy? [/INST] Evaluation of lymph node involvement by means of sentinel lymph node biopsy or axillary lymph node dissection (ALND) has also been considered necessary for staging and prognosis. A 2014 update on sentinel lymph node biopsy for patients with early-stage breast cancer by the American Society of Clinical Oncology (ASCO) advises that sentinel lymph node biopsy may be offered to the following patients: Women with operable breast cancer and multicentric tumors Women with DCIS who will be undergoing mastectomy Women who previously underwent breast and/or axillary surgery Women who received preoperative/neoadjuvant systemic therapy </s>

What are the contraindications for sentinel lymph node (SLN) biopsy in breast cancer?

According to the ASCO guidelines, sentinel lymph node biopsy should not be performed in patients with any of the following: 1) Large or locally advanced invasive breast cancer (tumor size T3/T4) 2) Inflammatory breast cancer 3) DCIS (when breast-conserving surgery is planned) 4) Pregnancy

<s>[INST] What are the contraindications for sentinel lymph node (SLN) biopsy in breast cancer? [/INST] According to the ASCO guidelines, sentinel lymph node biopsy should not be performed in patients with any of the following: 1) Large or locally advanced invasive breast cancer (tumor size T3/T4) 2) Inflammatory breast cancer 3) DCIS (when breast-conserving surgery is planned) 4) Pregnancy </s>

What are the ASCO guidelines for axillary lymph node dissection (ALND) in breast cancer?

ASCO recommendations regarding ALND in patients who have undergone sentinel lymph node biopsy are as follows: 1) ALND should not be performed in women with no sentinel lymph node (SLN) metastases 2) In most cases, ALND should not be performed in women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy 3) ALND should be offered to women with SLN metastases who will be undergoing mastectomy

<s>[INST] What are the ASCO guidelines for axillary lymph node dissection (ALND) in breast cancer? [/INST] ASCO recommendations regarding ALND in patients who have undergone sentinel lymph node biopsy are as follows: 1) ALND should not be performed in women with no sentinel lymph node (SLN) metastases 2) In most cases, ALND should not be performed in women with one to two metastatic SLNs who are planning to undergo breast-conserving surgery with whole-breast radiotherapy 3) ALND should be offered to women with SLN metastases who will be undergoing mastectomy </s>

What are the NCCN guidelines for sentinel lymph node (SLN) biopsy in breast cancer?

National Comprehensive Cancer Network (NCCN) recommendations differ from those of ASCO in that the NCCN considers that women with clinical stage as high as IIIA T3, N1, M0 may be candidates for SLN biopsy. In addition, the NCCN concluded that there is insufficient evidence to make recommendations for or against SLN biopsy in pregnant patients; the NCCN recommends that decisions regarding use of SLN biopsy in pregnancy be individualized. However, isosulfan blue or methylene blue dye is contraindicated for SLNB in pregnancy; radiolabeled sulfur colloid appears to be safe.

<s>[INST] What are the NCCN guidelines for sentinel lymph node (SLN) biopsy in breast cancer? [/INST] National Comprehensive Cancer Network (NCCN) recommendations differ from those of ASCO in that the NCCN considers that women with clinical stage as high as IIIA T3, N1, M0 may be candidates for SLN biopsy. In addition, the NCCN concluded that there is insufficient evidence to make recommendations for or against SLN biopsy in pregnant patients; the NCCN recommends that decisions regarding use of SLN biopsy in pregnancy be individualized. However, isosulfan blue or methylene blue dye is contraindicated for SLNB in pregnancy; radiolabeled sulfur colloid appears to be safe. </s>

What are the NCCN guidelines for axillary lymph node dissection (ALND) in breast cancer?

The NCCN breast cancer guidelines state that lymph node dissection is optional in the following cases: 1) Strongly favorable tumors 2) When no result would affect the choice of adjuvant systemic therapy 3) Elderly patients 4) Patients with comorbid conditions

<s>[INST] What are the NCCN guidelines for axillary lymph node dissection (ALND) in breast cancer? [/INST] The NCCN breast cancer guidelines state that lymph node dissection is optional in the following cases: 1) Strongly favorable tumors 2) When no result would affect the choice of adjuvant systemic therapy 3) Elderly patients 4) Patients with comorbid conditions </s>

What are the NCCN guidelines for evaluation of asymptomatic women with early-stage breast cancer (stages I–IIB)?

The NCCN guidelines [72] recommend the following laboratory studies for all asymptomatic women with early-stage breast cancer (stages I–IIB): 1) Complete blood count (CBC) with differential 2) Comprehensive metabolic panel, with liver function tests (LFTs) and alkaline phosphatase Additional studies indicated in specific settings include the following: 1) Bone scan, in patients with localized bone pain or alkaline phosphatase elevation 2) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast, in patients with elevated alkaline phosphatase, abnormal liver function tests, abdominal symptoms, or abnormal physical examination of the abdomen or pelvis 3) Chest diagnostic CT with contrast, in patients with pulmonary symptoms For women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows: 1) CBC 2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase 3) Chest diagnostic CT with contrast 4) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast 5) Bone scan or sodium fluoride PET/CT (category 2B) 6) FDG PET/CT (optional)

<s>[INST] What are the NCCN guidelines for evaluation of asymptomatic women with early-stage breast cancer (stages I–IIB)? [/INST] The NCCN guidelines [72] recommend the following laboratory studies for all asymptomatic women with early-stage breast cancer (stages I–IIB): 1) Complete blood count (CBC) with differential 2) Comprehensive metabolic panel, with liver function tests (LFTs) and alkaline phosphatase Additional studies indicated in specific settings include the following: 1) Bone scan, in patients with localized bone pain or alkaline phosphatase elevation 2) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast, in patients with elevated alkaline phosphatase, abnormal liver function tests, abdominal symptoms, or abnormal physical examination of the abdomen or pelvis 3) Chest diagnostic CT with contrast, in patients with pulmonary symptoms For women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows: 1) CBC 2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase 3) Chest diagnostic CT with contrast 4) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast 5) Bone scan or sodium fluoride PET/CT (category 2B) 6) FDG PET/CT (optional) </s>

What are the NCCN guidelines for evaluation of women with clinical stage IIIA (T3, N1, M0) breast cancer?

For women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows: 1) CBC 2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase 3) Chest diagnostic CT with contrast 4) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast 5) Bone scan or sodium fluoride PET/CT (category 2B) 6) FDG PET/CT (optional)

<s>[INST] What are the NCCN guidelines for evaluation of women with clinical stage IIIA (T3, N1, M0) breast cancer? [/INST] For women with clinical stage lllA (T3, N1, M0) disease, tests to consider are as follows: 1) CBC 2) Comprehensive metabolic panel, including LFTs and alkaline phosphatase 3) Chest diagnostic CT with contrast 4) Abdominal ± pelvic diagnostic CT with contrast or MRI with contrast 5) Bone scan or sodium fluoride PET/CT (category 2B) 6) FDG PET/CT (optional) </s>

How is HER2 testing performed in the evaluation of breast cancer?

Although several methods for HER2 testing have been developed, approximately 20% of current HER2 testing may be inaccurate; accordingly, the American Society of Clinical Oncology (ASCO) and CAP have recommended guidelines to ensure the accuracy of HER2 testing. Breast cancer specimens should initially undergo HER2 testing by a validated immunohistochemistry (IHC) assay (eg, HercepTest; Dako, Glostrup, Denmark) for HER2 protein expression. For more visit: (https://www.medscape.com/answers/1947145-155341/how-is-her2-testing-performed-in-the-evaluation-of-breast-cancer)

<s>[INST] How is HER2 testing performed in the evaluation of breast cancer? [/INST] Although several methods for HER2 testing have been developed, approximately 20% of current HER2 testing may be inaccurate; accordingly, the American Society of Clinical Oncology (ASCO) and CAP have recommended guidelines to ensure the accuracy of HER2 testing. Breast cancer specimens should initially undergo HER2 testing by a validated immunohistochemistry (IHC) assay (eg, HercepTest; Dako, Glostrup, Denmark) for HER2 protein expression. For more visit: (https://www.medscape.com/answers/1947145-155341/how-is-her2-testing-performed-in-the-evaluation-of-breast-cancer) </s>

What is the role of molecular profiling assays in the workup of breast cancer?

Molecular profiling assays The Onco type Dx assay (Genomic Health, Inc, Redwood City, CA) has been approved by the US Food and Drug Administration (FDA) for women with early-stage ER-positive, node-negative breast cancer treated with tamoxifen, where the recurrence score (RS) correlated with both relapse-free interval and overall survival. This assay is an RT-PCR–based assay of 21 genes (16 cancer genes and 5 reference genes) performed on paraffin-embedded breast tumor tissue. By using a formula based on the expression of these genes, an RS can be calculated that correlates with the likelihood of distant recurrence at 10 years. Breast tumor RSs and risk levels are as follows: < 18, low risk 18-30, intermediate risk >30, high risk For more visit: https://emedicine.medscape.com/article/1947145-workup#c14

<s>[INST] What is the role of molecular profiling assays in the workup of breast cancer? [/INST] Molecular profiling assays The Onco type Dx assay (Genomic Health, Inc, Redwood City, CA) has been approved by the US Food and Drug Administration (FDA) for women with early-stage ER-positive, node-negative breast cancer treated with tamoxifen, where the recurrence score (RS) correlated with both relapse-free interval and overall survival. This assay is an RT-PCR–based assay of 21 genes (16 cancer genes and 5 reference genes) performed on paraffin-embedded breast tumor tissue. By using a formula based on the expression of these genes, an RS can be calculated that correlates with the likelihood of distant recurrence at 10 years. Breast tumor RSs and risk levels are as follows: < 18, low risk 18-30, intermediate risk >30, high risk For more visit: https://emedicine.medscape.com/article/1947145-workup#c14 </s>

What is the MammaPrint assay for breast cancer?

The MammaPrint assay (Agendia, The Netherlands) is a genetic test that measures the activity of 70 genes to determine the 5- to 10-year relapse risk for women diagnosed with early breast cancer. It was approved for use by the FDA in 2007 and is an alternative platform to Oncotype DX. MammaPrint test results are reported as either a low-risk or a high-risk RS: 1) A low-risk score means that the cancer has a 10% risk of coming back within 10 years without any additional treatments after surgery 2) A high-risk score means that the cancer has a 29% risk of coming back within 10 years without any additional treatments after surgery

<s>[INST] What is the MammaPrint assay for breast cancer? [/INST] The MammaPrint assay (Agendia, The Netherlands) is a genetic test that measures the activity of 70 genes to determine the 5- to 10-year relapse risk for women diagnosed with early breast cancer. It was approved for use by the FDA in 2007 and is an alternative platform to Oncotype DX. MammaPrint test results are reported as either a low-risk or a high-risk RS: 1) A low-risk score means that the cancer has a 10% risk of coming back within 10 years without any additional treatments after surgery 2) A high-risk score means that the cancer has a 29% risk of coming back within 10 years without any additional treatments after surgery </s>