BREAST CANCER

INTRODUCTION
- The most common cancer in women. Early detection is key

INCIDENCE
- Age-standardized Incidence for female 39.3/100000
- Male Breast Cancer incidence 1.15/100000
- Increasing with age
 40 – 49 : 33.6%
 50 – 59 : 50%
- Ethnicity : Chinese > Indian > Malay

RISK FACTOR

CLINICAL PRESENTATION
- Abnormal MMG on screening
- Breast
 Nipple discharge, nipple retraction.
 Breast lump
 Early : Hard, mobile, irregular lump < 5cm
 LABC : Lump > 5cm. Skin or chest wall involvement. Inflammatory breast cancer.
- Axillary LN : Mobile, fixed or supraclavicular fossa LN
- Metastatic : Lung, liver, bone.

EVALUATION
- Triple assessment.
HISTOPATHOLOGICAL CLASSIFICATION
- Divided into:
 Carcinoma  Papillary
 IDC (NOS most common) 55%  Sarcoma
 DCIS 15%  Breast Sarcoma < 5%
 ILC 8%  Phyllodes tumor < 1%
 Mixed ductal carcinoma 7%  Precursor lesion
 Others 5%  LCIS
 Metaplastic  Intraductal proliferative lesion
 Mucinous  Others
 Tubular  Paget’s disease
 Medullary  Non Hodgkin Lymphoma
- Modified Bloom & Richardson Grade

 Score 3 – 5 : Grade 1. Well differentiated

 Score 6 – 7 : Grade 2. Moderately differentiated
 Score 8 – 9 : Grade 3. Poorly differentiated.
- Receptor Status
 ER & PR : Considered positive if > 1% cell have the receptor
- HER-2 (Human Epidermal Growth Factor Receptor 2)
 All breast cancer should have IHC HER-2 test. 0, 1+ is negative. 2+ or 3+ is equivocal
 Fluorescent in site hybridization (FISH), silver enhanced (SISH) or chromogenic (CISH) is done
when result is equivocal on IHC.
MOLECULAR SUBTYPE

- Pathology review post resection

 Location (side & quadrant), maximum diameter
 Multifocal : ≥ 2 lesion involving single quadrant, < 5cm apart
 Multicentric : ≥ 2 lesion involving ≥ 1 quadrant, > 5cm apart
 Tumor
 Histology & grade
 ER, PR & HER2
 LVI (lymphovascular invasion)
 Resection margin : On the ink for IDC.
 LN involvement : > 10 LN is adequate. Currently 6 LN adequate?
TNM STAGING
 TNM STAGE 5 YEAR SURVIVAL
0 100%
1 100%
2 86%
3 60%
4 20%

PROGNOSIS
- Nottingham Prognostic Index
 NPI = (0.2 X S) + N + G
 S : Size of index lesion in cm
 N : 0 LN = 1, 1 – 3 LN = 2, ≥ LN = 3
 G : Grade I = 1, Grade II = 2, Grade III = 3

- Prognostic factor is defined as clinical or biologic characteristic that provides information on

outcome of cancer in untreated individual.

- Predictive factor is defined as clinical or biologic characteristic that provides information on benefit
from treatment.