Last reviewed:December 2019
Last updated:May  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • breast mass
  • nipple discharge
  • axillary lymphadenopathy

Risk factors

  • increasing age
  • female sex
  • ethnic origin
  • high socioeconomic class
  • positive FHx/genetic predisposition
  • endogenous oestrogen exposure
  • exogenous oestrogen/progestin exposure
  • reduced physical activity
  • poor diet
  • high levels of alcohol consumption
  • radiation exposure
  • smoking
  • benign breast disease
  • increased breast density

Diagnostic investigations

Investigations to consider

  • breast ultrasound
  • breast MRI
  • biopsy
  • hormone receptor testing
  • HER2 receptor testing
Full details

Emerging tests

  • gene expression assays
  • tomosynthesis
Full details

Treatment algorithm


Assistant Professor

Division of Hematology and Medical Oncology

Icahn School of Medicine at Mount Sinai

New York



KC declares that she has no competing interests.

Associate Professor

Division of Hematology and Medical Oncology

Dubin Breast Center of the Tisch Cancer Institute

New York



AT has participated in speakers' bureaux for Pfizer, Celgene, and Amgen.

Dr Krystal Cascetta and Dr Amy Tiersten would like to gratefully acknowledge Dr Hope S. Rugo, Dr Amal Melhem-Bertrandt, Dr Gabriel N. Hortobagyi, and Dr Phuong Khanh H. Morrow, the previous contributors to this monograph. AMB, GNH, and PKHM declare that they have no competing interests. HSR receives research funding through the University of California from Novartis, Pfizer, Genentech, Macrogenics, Plexxikon, Merck, Nektar, and GSK. She has been reimbursed for travel by Novartis, Genentech, and Nektar. She has received speaker honorarium from Genomic Health.

Peer reviewersVIEW ALL

Assistant Professor

University of Louisville




AC declares that she has no competing interests.

General Surgeon

General Surgery Department

Istanbul Training and Research Hospital




GC is an author of a number of references cited in this monograph.

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