Info

Cysts

Usually soft to firm, round, mobile; often tender

Fibrocystic changes Cancer

Nodular, ropelike

Irregular, stellate, firm, not clearly delineated from surrounding tissue

Over 50

Cancer until proven otherwise

Lactating adenomas, cysts, mastitis, and cancer

As above

Pregnancy/lactation

As above

Adapted from Schultz MZ, Ward BA, Reiss M: Ch. 149. Breast Diseases. In Noble J, Greene HL, Levinson W, Modest GA, Young MJ (eds): Primary Care Medicine, 2nd ed. St. Louis, Mosby, 1996.

Risk Factors for Breast Cancer. Breast cancer is the most common cause of cancer in women worldwide, accounting for 18% of all female malignancies. In the United States, a woman has more than a 12% lifetime risk of developing breast cancer and an approximately 22% risk of dying from the disease.* Although 70% of affected women have no known predisposing factors, definite risk factors are well-established. The clinician and the inquiring patient should understand and review factors such as age, family history, reproductive history, and previous history of benign breast disease, especially if a previous biopsy showed atypical hyperplasia or lobular carcinoma in situ.

To calculate an individual woman's risk of breast cancer, you may wish to make use of the Breast Cancer Risk Assessment Tool of the National Cancer Institute (www.brca.nci.gov) or other available clinical models such as the Gail model (see Bibliography). Advise your patients that more than two thirds of new cases of breast cancer localized to the breast are attributed to earlier detection.

Age. Although one in eight women will eventually develop breast cancer, it is important to note that this is a cumulative lifetime risk that increases with age. More than three fourths of breast cancer cases occur in women 50 years or older; more than half in women older than age 65. For women between the ages of 35 and 55 without major risk factors, the chance of developing breast cancer is approximately 2.5%.

Family History. The relative risk (or risk relative to an individual without a given risk factor) of breast cancer associated with menstrual history, preg-

*Harris JR, Morrow M, Bonadonna G: Cancer of the breast. In DeVita VT, Hellman S, Rosenberg SA (eds): Cancer Principles & Practice of Oncology, 5th ed. Philadelphia, Lippincott-Raven, 1997.

Factor

Relative Risk (%)

Factor

Relative Risk (%)

Family History

First-degree relative with breast cancer

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