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Last Updated: 5/29/2014  

Breast Cancer

Prevention
  • Consider recommending a 5-year course of tamoxifen, raloxifene, or exemestane for primary risk reduction in women at increased risk for breast cancer.

  • Consider prophylactic mastectomy and/or oophorectomy for women with an inherited genetic predisposition.

Screening
  • Consider performing a clinical breast exam annually in women age 40 and older.

  • Recommend screening mammography for women age 50 to 74 every 1 to 2 years; discuss benefits and harms of screening in women age 40 to 49. Individualize screening decisions in women age 75 and older.

  • Consider specialized screening strategies for women at higher risk for breast cancer, in particular women with a genetic predisposition.

Diagnosis
  • Perform ultrasound and/or mammography to evaluate a new abnormal breast exam finding, depending on age.

  • Obtain a tissue diagnosis in women with a suspicious radiologic abnormality or a clinically suspicious breast exam finding; test for hormone receptor status, HER2, and other markers.

  • Perform ultrasound for axillary staging following tissue confirmation of a breast cancer diagnosis before performing definitive surgery.

  • Stage breast cancer using the TNM staging system.

Therapy
  • Select local therapy (mastectomy or breast conservation) based on tumor size, location, and clinical stage of the disease.

  • Perform axillary-node assessment with sentinel lymph-node biopsy or axillary-node dissection in patients with early invasive breast cancer.

  • Provide radiation therapy to patients with invasive breast cancer who were initially treated with breast conservation surgery and to patients who have undergone mastectomy and are at high risk for recurrence.

  • Offer adjuvant systemic hormonal therapy to patients with estrogen receptor-positive tumors.

  • Treat patients with HER2-positive breast cancer with trastuzumab.

  • Treat patients with tumor size >1 cm or positive lymph nodes with adjuvant chemotherapy; consider neoadjuvant chemotherapy for locally advanced disease.

  • Recommend breast-conserving surgery plus radiation therapy for most patients with ductal carcinoma in situ.

  • Consider ovarian ablation or suppression in premenopausal patients with hormone receptor-positive breast cancer.

DOI: 10.7326/d192
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Antonio C. Wolff, MD is a consultant for Pfizer, received honorarium from AstraZeneca, Pfizer, received grants from Roche, Pfizer, Wyeth. John Benson, MA, DM, FRCS(Eng), FRCS(Ed) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Tara Tomlin Barnett, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Shannon M. Haenel, DO has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Courtney S. Yau, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Ashwini Bhat, MBBS has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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