Breast Cancer – Treatment and Diagnosis
Hematological / Oncological
- 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.
- 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.
- Early menarche (<12 yo.).
- Late menopause (>55 yo.).
- 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.
- Clinical breast and axillary lymph node.
- Breast sarcomas are rare, histologically homogeneous tumours that arise from the connective tissue within the breast.
- Fibroadenoma, fibrocystic condition.
- Fat necrosis.
- Breast abscess.
- 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.
Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012;307:1394-1404.
BCGuidelines.ca – Breast cancer management:
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by the BC Emergency Medicine Network and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Jun 04, 2021
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