From the Guidelines
Breast cancer can be broken down into four main categories for easy remembrance on general surgery oral boards: noninvasive carcinomas (such as lobular carcinoma in situ and DCIS), operable locoregional invasive carcinoma, inoperable locoregional invasive carcinoma, and metastatic or recurrent carcinoma. This categorization is based on the treatment approach outlined in studies such as 1 and 1, which emphasize the importance of understanding the local and systemic disease treatment options.
When considering the diagnosis and staging of breast cancer, it's crucial to remember the triple assessment approach, which includes clinical examination, imaging (mammography, ultrasound, MRI), and tissue sampling (core needle biopsy preferred over fine needle aspiration) as highlighted in 1 and 1. The TNM system is used for staging, with T describing tumor size, N for nodal status, and M for metastasis.
Key aspects of management include:
- Surgery (breast-conserving therapy plus radiation or mastectomy)
- Sentinel lymph node biopsy for clinically negative axilla
- Axillary lymph node dissection for positive nodes
- Adjuvant chemotherapy (anthracycline and taxane-based regimens)
- Hormonal therapy (tamoxifen for premenopausal, aromatase inhibitors for postmenopausal women with hormone receptor-positive disease)
- Targeted therapy (trastuzumab for HER2-positive disease)
- Radiation therapy
Molecular subtypes, such as Luminal A, Luminal B, HER2-enriched, and Triple-negative, guide treatment decisions and prognosis, with triple-negative and HER2-positive (without targeted therapy) having worse outcomes, as discussed in 1.
It's also important to discuss screening recommendations and genetic testing for high-risk patients, as outlined in 1, which recommends annual screening with MRI of the breast, in combination with mammography, for women with familial breast cancer.
Overall, understanding these key aspects of breast cancer diagnosis, staging, and management is crucial for general surgery oral boards, and the most recent and highest quality study, such as 1, should be prioritized for definitive recommendations.
From the Research
Malignant Breast Disease Breakdown
To remember malignant breast disease for general surgery oral boards, consider the following key points:
- Mucinous, medullary, and tubular carcinomas are uncommon types of breast cancer, but breast-conserving therapy (BCT) can be an effective treatment strategy for early-stage disease 2
- These subtypes have similar local-regional failure rates to invasive ductal carcinoma, but tubular carcinoma patients tend to have more favorable overall survival (OS) rates 2
- Factors associated with improved OS in breast cancer patients include:
- Age at or below 50 years
- Negative nodal status
- Use of chemotherapy or hormonal therapy
- Tubular histology 2
- It's essential to note that oral cavity cancer is a distinct entity from breast cancer, with unique etiologic, diagnostic, and treatment considerations 3
- For breast cancer, BCT is an appropriate treatment strategy for early-stage mucinous, medullary, and tubular carcinomas, with similar local-regional failure rates to invasive ductal carcinoma 2