Summary
Definition
History and exam
Key diagnostic factors
- breast mass
- nipple discharge
- axillary lymphadenopathy
Other diagnostic factors
- skin thickening or discoloration
- retraction, inversion, or scaling of the nipple
Risk factors
- increasing age
- female sex
- ethnic origin
- positive family history
- genetic mutations
- endogenous estrogen exposure
- exogenous estrogen/progestin exposure
- alcohol consumption
- radiation exposure
- atypical breast disease
- increased breast density
- mild, moderate, or marked background parenchymal enhancement (BPE) on breast MRI
- reduced physical activity
- poor diet
- high socioeconomic status
- smoking
- obesity
- high dibutyl-phthalate exposure
Diagnostic tests
1st tests to order
- mammogram
Tests to consider
- breast ultrasound
- breast MRI
- biopsy
- hormone receptor testing
- HER2 testing
- gene expression assays
- computed tomography
- genetic testing
- CBC
- LFTs
- alkaline phosphatase
Treatment algorithm
early-stage breast cancer (stages I to IIB [T2 N1 M0])
locally advanced breast cancer (stages IIB [T3 N0 M0] to III)
disease recurrence
Contributors
Authors
Kandace P. McGuire, MD
Professor of Surgery
Virginia Commonwealth University
Richmond
VA
Disclosures
KPM declares that she has no competing interests.
Acknowledgements
Dr Kandace McGuire would like to gratefully acknowledge Dr Krystal Cascetta, Professor Amy Tiersten, Dr Hope S. Rugo, Dr Amal Melhem-Bertrandt, Dr Gabriel N. Hortobagyi, and Dr Phuong Khanh H. Morrow, the previous contributors to this topic.
Disclosures
KC, AMB, GNH, and PKHM declare that they have no competing interests. AT is on the advisory board for Immunomedics, AstraZeneca, Novartis, Eisai, and Healthline; receives research funding from Pfizer, Novartis, Genentech, Lilly, and AstraZeneca; and does expert testimony work. HSR receives research funding through the University of California from Novartis, Pfizer, Genentech, Macrogenics, Plexxikon, Merck, Nektar, and GSK; has been reimbursed for travel by Novartis, Genentech, and Nektar; and has received speaker honorarium from Genomic Health.
Peer reviewers
Katherine H.R. Tkaczuk, MD, FACP
Professor of Medicine
University of Maryland School of Medicine
Baltimore
MD
Disclosures
KHRT declares that she has no competing interests.
Susan Tannenbaum, MD
Associate Professor, Medicine
Chief, Division of Hematology/Oncology
Medical Director, Neag Comprehensive Cancer Center
University of Connecticut
Farmington
CT
Disclosures
ST declares that she has no competing interests.
Emily Hsu, MD
Fellow
Division of Hematology/Oncology
University of Connecticut
Farmington
CT
Disclosures
EH declares that she has no competing interests.
Anees Chagpar, MD
Assistant Professor
University of Louisville
Louisville
KY
Disclosures
AC declares that she has no competing interests.
Gurhan Celik, MD
General Surgeon
General Surgery Department
Istanbul Training and Research Hospital
Istanbul
Turkey
Disclosures
GC is an author of a number of references cited in this topic.
Edward R. Sauter, MD, PhD
Medical Officer
Breast and Gynecologic Cancer Working Group
Division of Cancer Prevention
National Cancer Institute
Bethesda
MD
Disclosures
ERS declares that he has no competing interests.
Differentials
- Fibrocystic changes
- Fibroadenoma
- Mastitis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: breast cancer risk reduction
- Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up
More GuidelinesPatient information
Breast cancer, locally advanced: what is it?
Breast cancer: breast-conserving surgery
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer