Molecular structure pattern

Breast Cancer Disease Summary

Last updated: 14 July 2025
Reviewed by

Key Presenting Symptoms

  • New lump

    Most common symptom; may be painless

  • Breast pain

    May occur with new mass

  • Nipple discharge

    May accompany breast lesion

  • Nipple retraction

    Reported presenting sign

  • Skin changes

    Peau d’orange, scaling, ulceration

Assessment Workflow

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  1. 1. Clinical presentation

    Assess for a breast nodule, mass, abscess, pain, nipple discharge, nipple retraction, or skin changes.

  2. 2. History

    Ask about breast pain, a new breast mass, and risk factors such as prior breast cancer, chest irradiation, and strong family history.

  3. 3. Physical examination

    Inspect and palpate the breasts upright and supine; assess axillary, supraclavicular, and internal mammary lymph nodes and other organs for metastatic disease.

  4. 4. Imaging and biopsy

    Use mammography and/or ultrasound, then biopsy suspicious findings; core needle biopsy is preferred for suspicious or indeterminate solid lesions on ultrasound.

  5. 5. Staging and biomarkers

    Stage with TNM and test all newly diagnosed primary or metastatic cases for HER2; assess ER/PR and other tests when indicated.

Diagnosis

  • Breast cancer is the presence of a malignant breast nodule, mass, or abscess.
  • Patients commonly present with a new lump or mass in the breast.
  • A complete breast examination includes inspection and palpation in upright and supine positions.
  • Breast tissue biopsy is recommended if mammogram and/or ultrasound findings are suspicious or highly suggestive of malignancy.
  • The TNM system is used for staging and determines extent of cancer upon diagnosis.[4][5][17]
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Differential Diagnosis

Differential diagnosisKey Distinguishing Feature
Breast abscess[22]
Breast cyst[22]
Breast sarcoma[22]
Fat necrosis[22]
Fibroadenoma[22]
View More on Differential Diagnosis

Diagnostics: Lab Tests and Imaging

Test / AssessmentClinical Purpose
Breast biopsyConfirm malignancy when imaging is suspicious[5]
FNA cytologyEvaluate palpable lumps or selected nodes[5]
Core needle biopsyPreferred tissue biopsy for suspicious lesions[5]
Sentinel node biopsyPreferred axillary staging in early node-negative disease[5]
HER2 testingGuide HER2-targeted therapy decisions[5]

Pharmacological Management

Treatment roleTherapyKey note
Risk reductionTamoxifenMay be considered for ER-positive DCIS after breast conservation and radiotherapy.[27][28]
Risk reductionRaloxifeneMay be considered in postmenopausal patients with contraindications to tamoxifen.[27][28]
Adjuvant endocrineTamoxifenFirst-line adjuvant endocrine therapy in pre- and postmenopausal patients.[27][28]
HER2-positiveTrastuzumabUsed after surgery, adjuvant or neoadjuvant chemotherapy, and radiotherapy if applicable.[27][28]
HER2-positiveAdo-trastuzumab emtansineUsed instead of trastuzumab if residual disease remains after preoperative therapy.[27][28]

Dosage Guidelines

  • Raloxifene

    Agent Affecting Bone Metabolism

    Dosage: Risk reduction for invasive breast cancer in postmenopausal women: 60 mg PO 24 hourly

  • Tamoxifen

    Cancer Hormone Therapy

    Dosage: 20 mg/day PO in single dose or 40 mg/day PO divided 12 hourly

  • Fulvestrant

    Cancer Hormone Therapy

    Dosage: 250 mg slow IM injection, 1 in each buttock on days 1, 15, 29, then once monthly thereafter

  • Anastrazole

    Cancer Hormone Therapy

    Dosage: 1 mg PO 24 hourly; duration of treatment as adjuvant therapy: 5 years

View More on Drug Summary

Non-pharmacological management

  • Staging determines the extent of cancer upon diagnosis and helps choose treatment.
  • Preoperative systemic therapy may allow breast conservation and make inoperable tumors operable.
  • Preoperative systemic therapy is indicated for inoperable locally advanced breast cancer, including inflammatory tumors, bulky or matted N2 axillary nodes, N3 disease, and/or T4 tumors.
  • Surgery is part of risk reduction for carcinoma in situ, with breast conservation therapy and radiotherapy referenced in the management page.[27][28]

References

  1. Association of Breast Surgery @ BASO, Royal College of Surgeons of England. Guidelines for the management of symptomatic breast disease. Eur J Surg Oncol. 2005 May;31(Supp 1):1-21.
  2. Burnstein HJ. Tumor, node, metastasis (TNM) staging classification for breast cancer. UpToDate. Apr 2024.
  3. Gennari A, André F, Barrios CH, et al; ESMO Guidelines Committee. ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol. 2021 Dec;32(12):1475-1495. doi: 10.1016/j.annonc.2021.09.019. Accessed 11 Apr 2022. PMID: 34678411
  4. Kataja V, Castiglione M; ESMO Guidelines Working Group. Primary breast cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009 May;20(Suppl 4):10-14. doi: 10.1093/annonc/mdp114. PMID: 19454421
  5. Ministry of Health Malaysia, Academy of Medicine Malaysia. Clinical practice guidelines. Management of breast cancer, 2nd edition. Nov 2010. Accessed 12 Sep 2012.
  6. Ministry of Health Malaysia, Academy of Medicine Malaysia. Clinical practice guidelines. Management of breast cancer. Third edition. Academy of Medicine Malaysia. 2019.
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