Breast carcinoma

Definition:

• Breast carcinoma refers to malignant tumours originating from breast tissue, the most common being ductal and lobular carcinomas.

Epidemiology:

• Most common cancer in women in the UK.
• Risk factors include age, female gender, family history, BRCA1/BRCA2 mutations, early menarche, late menopause, and hormone replacement therapy (HRT).

Classification:

• Invasive ductal carcinoma (most common).
• Invasive lobular carcinoma.
• Ductal carcinoma in situ (DCIS).
• Lobular carcinoma in situ (LCIS).
• Other rarer subtypes.

Clinical Presentation:

• Painless breast lump (most common).
• Nipple discharge, retraction, or eczema-like changes.
• Skin dimpling or “peau d’orange” appearance.
• Swelling and inflammation in inflammatory breast cancer.

Investigations:

• Mammography: Gold standard imaging for women over 35.
• Ultrasound: Useful in younger women with dense breast tissue.
• Core biopsy or fine needle aspiration: For histological diagnosis.
• MRI: In selected cases, especially for those with BRCA mutations or dense breasts.

Management:

• Surgery: Lumpectomy or mastectomy, often with sentinel lymph node biopsy or axillary dissection.
• Radiotherapy: Often post-lumpectomy or after mastectomy in certain cases.
• Chemotherapy: Depending on tumour size, grade, lymph node involvement, and other factors.
• Hormonal therapy: e.g., tamoxifen or aromatase inhibitors for hormone receptor-positive cancers.
• Targeted therapies: e.g., trastuzumab for HER2-positive tumours.

Prognosis:

• Depends on stage at diagnosis, grade, lymph node involvement, and molecular characteristics.
• Early detection improves prognosis significantly.

Screening:

• The NHS Breast Screening Programme offers mammography every three years to women aged 50-70, with the age range set to expand to 47-73.