Breast cancer is a malignant growth that usually starts in the milk ducts or lobules and is the most common cancer in women in the US. Finding it early through screening and prompt workup of a new lump greatly improves the chance of cure.
Key symptoms
- A new painless, firm lump in the breast or armpit
- Change in breast size, shape or skin, such as dimpling
- Nipple inversion, scaling or bloody discharge
- Often no symptoms; found on a screening mammogram
- Bone pain, weight loss or breathlessness in advanced disease
What you find on exam
- Hard, irregular, fixed mass on clinical breast exam
- Skin dimpling, redness or orange peel skin (peau d'orange)
- Nipple retraction or discharge
- Enlarged axillary or supraclavicular lymph nodes
Tests
- Diagnostic mammogram and breast ultrasound
- Core needle biopsy to confirm the diagnosis
- Tumor markers on the biopsy: estrogen and progesterone receptors and HER2
- Staging scans and genetic testing (BRCA1, BRCA2) when indicated
Treatment basics
- Surgery: lumpectomy with radiation, or mastectomy, plus lymph node sampling
- Endocrine therapy for receptor-positive cancer: tamoxifen or an aromatase inhibitor such as letrozole
- Chemotherapy based on stage and tumor type
- HER2-targeted therapy such as trastuzumab for HER2-positive cancer
- Multidisciplinary team care and emotional support
Red flags
- Red, swollen, warm breast that appears fast without fever (inflammatory breast cancer)
- New back pain or leg weakness suggesting spinal cord compression
- Breathlessness, confusion or severe bone pain from spread
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.