Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- breast mass
- nipple discharge
- axillary lymphadenopathy
Otros factores de diagnóstico
- skin thickening or discoloration
- retraction, inversion, or scaling of the nipple
Factores de riesgo
- increasing age
- female sex
- ethnic origin
- positive family history of breast and/or other cancers
- genetic mutations in breast cancer susceptibility genes
- 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 magnetic resonance imaging (MRI)
- reduced physical activity
- poor diet
- high socioeconomic status
- smoking
- obesity
- high dibutyl-phthalate exposure
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- mammogram
Pruebas diagnósticas que deben considerarse
- breast ultrasound
- breast MRI
- biopsy
- hormone receptor testing
- HER2 testing
- gene expression assays
- computed tomography
- bone scan
- genetic testing
- CBC
- LFTs
- alkaline phosphatase
Algoritmo de tratamiento
early-stage breast cancer (stages I to IIB [T2 N1 M0])
locally advanced breast cancer (stages IIB [T3 N0 M0] to III)
disease recurrence
Colaboradores
Autores
Kandace P. McGuire, MD
Professor of Surgery
Virginia Commonwealth University
Richmond
VA
Divulgaciones
KPM declares that she has no competing interests.
Agradecimientos
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.
Divulgaciones
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.
Revisores por pares
Katherine H.R. Tkaczuk, MD, FACP
Professor of Medicine
University of Maryland School of Medicine
Baltimore
MD
Divulgaciones
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
Divulgaciones
ST declares that she has no competing interests.
Emily Hsu, MD
Fellow
Division of Hematology/Oncology
University of Connecticut
Farmington
CT
Divulgaciones
EH declares that she has no competing interests.
Anees Chagpar, MD
Assistant Professor
University of Louisville
Louisville
KY
Divulgaciones
AC declares that she has no competing interests.
Gurhan Celik, MD
General Surgeon
General Surgery Department
Istanbul Training and Research Hospital
Istanbul
Turkey
Divulgaciones
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
Divulgaciones
ERS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis [internet publication].Texto completo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer [internet publication].Texto completo
Loibl S, André F, Bachelot T, et al. Early breast cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024 Feb;35(2):159-82.Texto completo Resumen
Denduluri N, Somerfield MR, Eisen A, et al. Selection of optimal adjuvant chemotherapy regimens for human epidermal growth factor receptor 2 (HER2)-negative and adjuvant targeted therapy for HER2-positive breast cancers: an American Society of Clinical Oncology guideline adaptation of the Cancer Care Ontario clinical practice guideline. J Clin Oncol. 2016 Jul 10;34(20):2416-27.Texto completo Resumen
Park KU, Somerfield MR, Anne N, et al. Sentinel lymph node biopsy in early-stage breast cancer: ASCO guideline update. J Clin Oncol. 2025 May 10;43(14):1720-41.Texto completo Resumen
Lyman GH, Somerfield MR, Bosserman LD, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017 Feb 10;35(5):561-64.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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