Primary invasive breast cancer

Last reviewed: 7 Jan 2023
Last updated: 10 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • breast mass
  • nipple discharge
  • axillary lymphadenopathy
More key diagnostic factors

Other diagnostic factors

  • skin thickening or discoloration
  • retraction or scaling of the nipple
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • mammogram
More 1st investigations to order

Investigations to consider

  • breast ultrasound
  • breast MRI
  • biopsy
  • hormone receptor testing
  • HER2 testing
  • gene expression assays
  • computed tomography
  • genetic testing
  • CBC
  • LFTs
  • alkaline phosphatase
More investigations to consider

Treatment algorithm

ACUTE

early-stage breast cancer (stages I to IIB [T2 N1 M0])

locally advanced breast cancer (stages IIB [T3 N0 M0] to III)

ONGOING

disease recurrence

Contributors

Authors

Krystal Cascetta, MD

Assistant Professor

Division of Hematology and Medical Oncology

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

KC declares that she has no competing interests.

Amy Tiersten, MD

Professor

Division of Hematology and Medical Oncology

Dubin Breast Center of the Tisch Cancer Institute

New York

NY

Disclosures

AT is on the advisory board for Immunomedics, AstraZeneca, Novartis, Eisai, and Healthline. She receives research funding from Pfizer, Novartis, Genentech, Lilly, and AstraZeneca and does expert testimony work.

Acknowledgements

Dr Krystal Cascetta and Professor 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 topic.

Disclosures

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; has been reimbursed for travel by Novartis, Genentech, and Nektar; and has received speaker honorarium from Genomic Health.

Peer reviewers

Kandace P. McGuire, MD

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Disclosures

KPM declares that she has no competing interests.

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.

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