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    Breast Cancer – Treatment and Diagnosis

    Hematological / Oncological

    Last Updated Jun 04, 2021
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    By Julian Marsden, Melissa Lee


    • Breast cancer is the most common type of cancer diagnosed in Canadian women (excluding non-melanoma skin cancer).
    • Over 80% of new breast cancers diagnosed each year in BC are in women age 50 or over.
    • The second leading cause of cancer death in Canadian women after lung cancer.
    • Also occurs in men, but not as common.
    • Each province has mammography programs. BC Breast Cancer Screening.

    Diagnostic Process


    • Classic: painless unilateral breast mass in an older woman.
    • New mass in the breast tissue or axillae region.
    • Heaviness, burning, pain, pruritus or tenderness of the breast, nipple, or areola.
    • Rapid change in shape or increase in size of breast.
    • Nipple discharge or change (sudden inverted nipple).
    • Axillary adenopathy.
    • Skin findings may include: erythema, a pink, reddish, purple, or bruised appearance of the skin thickening, or dimpling of overlying skin (peau d’orange).
    • Symptoms/signs of metastatic disease: bones, liver, lungs and brain.
    • Paget’s disease of the breast presents with similar clinical findings including a scaly, raw, vesicular or ulcerated lesion on the nipple and areola. Biopsy should be performed to distinguish breast cancer from Paget’s disease of the breast.

    Risk Factors

    • Early menarche (<12 yo.).
    • Late menopause (>55 yo.).
    • Nulliparity.
    • Long-term use of hormone replacement therapy.
    • Breast density.
    • Personal / Family history of breast cancer and/or ovarian cancer.
    • Personal or family history of mutation of the BRCA1/BRCA2 genes.

    Physical Exam

    • Clinical breast and axillary lymph node.

    Differential Considerations

    • Breast sarcomas are rare, histologically homogeneous tumours that arise from the connective tissue within the breast.
    • Lymphoma.
    • Fibroadenoma, fibrocystic condition.
    • Fat necrosis.
    • Breast abscess.
    • Mastitis.


    • For symptomatic women aged ≤ 30 years, diagnostic ultrasound is the recommended initial investigation. Mammography may be subsequently indicated.
    • For symptomatic women aged ≥ 30 years, diagnostic mammography and ultrasound are recommended for initial investigation.
    • For symptomatic women of any age who are pregnant or lactating, diagnostic ultrasound is the recommended initial investigation (not mammography).
    • Refer to a local breast specialist for a definitive assessment.
    • Routine labs including liver function tests to assess metastasis.

    Criteria For Hospital Admission

    • Severe pain related to metastatic spread requiring treatment.

    Criteria For Safe Discharge Home

    • Pain is reasonably controlled, and the patient has a plan for ongoing pain problems.
    • Follow-up has been arranged with breast physician/family physician.

    Related Information

    Reference List

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