Info
🌱 來自: breast cancer
breast cancer
Epidemiology
- Most common CA affecting women & 2nd most common cause of CA death in the United States
- In the United States, approx 286,000 new cases in 2019 & 42,000 deaths. Approx 2.2 million new cases dx’d worldwide in 2020
- ↑ incidence, but ↓ mortality in past decades (↑ screening, ↑ therapeutic options)
Risk factors
- Strongest: Female gender, ↑ age
- ↑ Estrogen: Early menarche, late menopause, late/nulliparity (NEJM 2006;354:270); prolonged HRT (JAMA 2003;289:3243); no increased risk w/ OCP
- Certain benign conditions ↑ risk: Proliferative features (ductal hyperplasia, papilloma, radial scars, sclerosing adenosis); atypia (atypical ductal or lobular hyperplasia); dense breast tissue (decreased mammographic sensitivity)
- No ↑ risk from: Cysts, fibroadenoma, columnar Δs (NEJM 2005;353:229)
- Other: BMI, FHx, smoking, EtOH, prior thoracic irradiation
- Modified Gail model: (<www.cancer.gov/bcrisktool>). Provides 5 y & lifetime risk. Average risk is → <15%. Do not use Gail model if prior Dx of breast CA, DCIS, LCIS, or inherited breast CA
Genetics
- BRCA1/2 mt: 56-84% lifetime risk of breast CA
- Other familial/hereditary breast CA: CDH1 (lobular), CHEK2 (ER+), TP53, PALB2, PTEN, ATM, NF1, STK11