
Contents
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6.1 Breast cancer overview 6.1 Breast cancer overview
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Epidemiology Epidemiology
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Aetiology and risk factors Aetiology and risk factors
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Hormonal and reproductive risk factors Hormonal and reproductive risk factors
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Genetic risk factors Genetic risk factors
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Lifestyle risk factors Lifestyle risk factors
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Radiation exposure Radiation exposure
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Protective factors Protective factors
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Screening Screening
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Screening with clinical examination Screening with clinical examination
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Screening with mammography Screening with mammography
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Screening with breast MRI Screening with breast MRI
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Paget’s disease Paget’s disease
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Further reading Further reading
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6.2 Clinical presentation, diagnosis, and staging of breast cancer 6.2 Clinical presentation, diagnosis, and staging of breast cancer
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Clinical findings Clinical findings
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Diagnosis Diagnosis
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Clinical examination Clinical examination
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Breast imaging Breast imaging
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Biopsy Biopsy
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Pathology diagnosis Pathology diagnosis
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Staging Staging
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Risk assessment Risk assessment
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Pathological factors Pathological factors
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Other factors Other factors
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Prognostic predictive tools Prognostic predictive tools
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Molecular characterization of breast cancer Molecular characterization of breast cancer
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Luminal A Luminal A
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Luminal B Luminal B
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HER2 enriched HER2 enriched
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Triple negative breast cancers (TNBC) Triple negative breast cancers (TNBC)
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MammaPrint-70® MammaPrint-70®
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Oncotype DX® Oncotype DX®
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Prosigna® Prosigna®
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EndoPredict® EndoPredict®
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Further reading Further reading
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Internet resources Internet resources
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6.3 Management of breast cancer: Carcinoma in situ 6.3 Management of breast cancer: Carcinoma in situ
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Ductal carcinoma in situ (DCIS) Ductal carcinoma in situ (DCIS)
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Diagnosis Diagnosis
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Pathology Pathology
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Surgery Surgery
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Radiation therapy (RT) Radiation therapy (RT)
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Chemoprevention Chemoprevention
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Lobular carcinoma in situ (LCIS) Lobular carcinoma in situ (LCIS)
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Diagnosis and pathology Diagnosis and pathology
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Treatment Treatment
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Further reading Further reading
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6.4 Loco-regional treatment of invasive breast cancer: Surgery 6.4 Loco-regional treatment of invasive breast cancer: Surgery
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Introduction Introduction
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Surgery of the breast Surgery of the breast
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Breast conserving surgery Breast conserving surgery
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Margins Margins
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Mastectomy Mastectomy
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Surgery of the axilla Surgery of the axilla
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Oncoplastic surgery Oncoplastic surgery
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Further reading Further reading
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6.5 Loco-regional treatment of invasive breast cancer: Radiation therapy 6.5 Loco-regional treatment of invasive breast cancer: Radiation therapy
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Introduction Introduction
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Indications for adjuvant RT Indications for adjuvant RT
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Breast RT techniques Breast RT techniques
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Indications for axillary RT Indications for axillary RT
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Further reading Further reading
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6.6 Systemic treatment for early breast cancer 6.6 Systemic treatment for early breast cancer
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Introduction Introduction
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Treatment of Luminal breast cancer Treatment of Luminal breast cancer
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Adjuvant endocrine treatment Adjuvant endocrine treatment
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Tamoxifen Tamoxifen
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Aromatase inhibitors (AIs) Aromatase inhibitors (AIs)
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Endocrine therapy in premenopausal women Endocrine therapy in premenopausal women
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Endocrine therapy for postmenopausal women Endocrine therapy for postmenopausal women
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Adjuvant chemotherapy (CT) Adjuvant chemotherapy (CT)
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Treatment of triple negative breast cancer (TNBC) Treatment of triple negative breast cancer (TNBC)
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Treatment of HER2 positive breast cancer Treatment of HER2 positive breast cancer
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Adjuvant anti-HER2 therapy Adjuvant anti-HER2 therapy
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Neoadjuvant anti-HER2 therapy Neoadjuvant anti-HER2 therapy
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Postneoadjuvant anti-HER2 therapy Postneoadjuvant anti-HER2 therapy
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Bisphosphonates in the adjuvant setting Bisphosphonates in the adjuvant setting
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Very young patients Very young patients
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Systemic therapy in pregnant patients Systemic therapy in pregnant patients
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Further reading Further reading
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6.7 Management of locally advanced breast cancer 6.7 Management of locally advanced breast cancer
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Definition/pathology Definition/pathology
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Primary systemic treatment according to BC subtype Primary systemic treatment according to BC subtype
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Neoadjuvant systemic therapy Neoadjuvant systemic therapy
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Surgery according to BC subtype Surgery according to BC subtype
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Radiation therapy according to BC subtype Radiation therapy according to BC subtype
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Further reading Further reading
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6.8 Management of recurrent and metastatic breast cancer (MBC) 6.8 Management of recurrent and metastatic breast cancer (MBC)
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Loco-regional recurrence: general considerations and initial work-up Loco-regional recurrence: general considerations and initial work-up
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Breast recurrence after BCS Breast recurrence after BCS
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Isolated chest wall recurrence after mastectomy Isolated chest wall recurrence after mastectomy
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Regional axilla and/or supraclavicular recurrence Regional axilla and/or supraclavicular recurrence
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Metastatic breast cancer: systemic treatment according to BC subtype Metastatic breast cancer: systemic treatment according to BC subtype
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ER positive and HER2 negative ER positive and HER2 negative
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HER2 positive disease HER2 positive disease
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Previously untreated Previously untreated
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Previously treated with adjuvant trastuzumab Previously treated with adjuvant trastuzumab
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Triple negative Triple negative
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Evaluating treatment response Evaluating treatment response
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Specific metastatic sites Specific metastatic sites
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Brain metastases Brain metastases
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Bone metastases Bone metastases
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Local treatment of primary tumour Local treatment of primary tumour
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Further reading Further reading
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6.9 Male breast cancer 6.9 Male breast cancer
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Introduction Introduction
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Risk factors Risk factors
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Clinical findings and diagnosis Clinical findings and diagnosis
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Pathology and prognosis Pathology and prognosis
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Treatment Treatment
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Further reading Further reading
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6.10 BRCA and hereditary breast cancer 6.10 BRCA and hereditary breast cancer
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Prevalence of BRCA mutations Prevalence of BRCA mutations
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Referral for testing Referral for testing
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Management of asymptomatic carriers Management of asymptomatic carriers
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Special considerations in the treatment of BRCA-associated breast cancer Special considerations in the treatment of BRCA-associated breast cancer
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Further reading Further reading
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Cite
Abstract
Breast cancer is the most frequent cancer in women, and although mortality rates have been decreasing in the last 50 years, it remains a leading cause of death in women. This chapter discusses the epidemiology, aetiology, and risk factors for breast cancer including newer genetic factors as well as lifestyle-related issues. Recommendations for screening programmes are made. Investigations include clinical examination and imaging techniques, and diagnosis and treatment decisions are based on staging, which takes account of biological factors such as grade, proliferation rate, receptor status, and HER2 expression as well as extent of disease. Genetic expression profiling contributes to a prognostic stage and various prognostic assays are used to determine appropriate treatment of different tumour types such as luminal A and B, HER2 positive or triple negative cancers. The chapter discusses treatment with surgery, radiotherapy, and adjuvant systemic therapy for the various types of breast cancer. Consideration is also given to treatment of recurrent and metastatic disease, as well as disease in the elderly or very young, in men, and hereditary breast cancer.
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