Last reviewed: 27 Jun 2021
Last updated: 22 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • breast mass
  • nipple discharge
  • axillary lymphadenopathy

Other diagnostic factors

  • skin thickening or discoloration
  • retraction 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
  • benign breast disease
  • increased breast density
  • mild, moderate, or marked background parenchymal enhancement (BPE) on breast MRI
  • reduced physical activity
  • poor diet
  • high socioeconomic class
  • smoking
  • obesity
  • high dibutyl-phthalate exposure

Diagnostic investigations

Investigations 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

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

Peer reviewers

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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