Breast Diseases - P. Borgen, A. Hill (Landes Vademecum, 2000) WW

210 Pages·2000·6.31 MB·English

V
m

Patrick I. Borgen
Arnold D. K. Hill

a d e m e c u
V
LANDES
B I O S C I E N C E
a d e m e c um

Table of contents

1. Anatomy of the Breast
and Axilla

2. Assessment and Investigation
of Common Breast Symptoms

3. Benign Breast Disease

4. Risk Factors, Screening
and Prevention

5. Pathology, Prognosis
and Staging of Breast
Cancer

6. Breast Imaging

7. Breast Cancer Treatment—
Surgery

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Breast Diseases
a d e m e c u m
V
Borgen
Hill

LANDES
B I O S C I E N C E
LANDES
B I O S C I E N C E

Breast
Diseases

I SBN 1- 57059- 578- X

8. Adjuvant Therapy of Breast
Cancer

9. Treatment—Radiation

10. Sentinel Lymph Node Mapping

11. Hereditary Breast Cancer

Patrick I. Borgen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.

Arnold D.K. Hill, M.Ch., FRCSI
St. Vincent's University Hospital
Dublin, Ireland

Breast Diseases

GEORGETOWN, TEXAS
U.S.A.

v a d e m e c u m

L A N D E S

B I O S C I E N C E

VADEMECUM
Breast Diseases
LANDES BIOSCIENCE
Georgetown, Texas U.S.A.

Copyright ©2000 Landes Bioscience
All rights reserved.
No part of this book may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopy, recording, or any
information storage and retrieval system, without permission in writing from the
publisher.
Printed in the U.S.A.

Please address all inquiries to the Publisher:
Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626
Phone: [phone]; FAX: [phone]

ISBN: 1-57059-578-X

Library of Congress Cataloging-in-Publication Data
Breast diseases / [edited by] Patrick I. Borgen, Arnold Hill.
p.; cm.--(Vademecum)
Includes bibliographical references and index.
ISBN 1-57059-578-X (spiral)
1. Breast--Diseases--Handbooks, manuals, etc. I. Borgen, Patrick I.
II. Hill, Arnold. III. Series.
[DNLM: 1. Breast Diseases--Handbooks. WP 39 B828 2000]
RG491.B743 2000
618.1'9--dc21
99-059769

While the authors, editors, sponsor and publisher believe that drug selection and dosage and
the specifications and usage of equipment and devices, as set forth in this book, are in accord
with current recommendations and practice at the time of publication, they make no
warranty, expressed or implied, with respect to material described in this book. In view of the
ongoing research, equipment development, changes in governmental regulations and the
rapid accumulation of information relating to the biomedical sciences, the reader is urged to
carefully review and evaluate the information provided herein.

Dedication

This work is dedicated to the thousands of women fighting breast cancer
and to their physicians who have chosen to join them in their battle and to
the families of both, whose love and encouragement provides inspiration
and strength.

Contents

1. Anatomy of the Breast and Axilla...................................... 1
Mary L. Gemignani
Embryology/Development .......................................................................... 1
Adult Breast Morphology............................................................................ 2
Thoracic Wall ............................................................................................. 3
Axilla .......................................................................................................... 8

2. Assessment and Investigation
of Common Breast Symptoms ........................................ 14
Leslie L. Montgomery
Routine Screening for Breast Cancer ......................................................... 14
Assessment of Common Breast Symptoms ................................................ 15
Diagnostic Evaluation ............................................................................... 19
Pathologic Evaluation ............................................................................... 20
Evaluation and Management of Common Breast Symptoms .................... 22

3. Benign Breast Disease ..................................................... 30
A.D. Purushotham, P. Britton and L. Bobrow
General Approach to Patients Presenting with Benign Breast Disease ........ 30
Breast Pain ................................................................................................ 31
Nodularity ................................................................................................ 34
Fibroadenoma ........................................................................................... 35
Phyllodes Tumor ....................................................................................... 40
Hamartoma .............................................................................................. 43
Cysts ......................................................................................................... 45
Duct Ectasia ............................................................................................. 49
Periductal Mastitis .................................................................................... 50
Mammary-Duct Fistula ............................................................................ 52
Duct Papilloma ......................................................................................... 52
Multiple Peripheral Papillomas ................................................................. 55
Juvenile Papillomatosis.............................................................................. 55
Abscess...................................................................................................... 56
Nonlactating Breast Infection ................................................................... 58
Hematoma................................................................................................ 59
Fat Necrosis .............................................................................................. 60
Radial Scar ................................................................................................ 62
Sclerosing Adenosis ................................................................................... 63
Epithelial Hyperplasia ............................................................................... 65
Rare Benign Disorders of the Breast .......................................................... 67
Granular Cell Tumors ............................................................................... 67
Fibromatosis ............................................................................................. 69
Sclerosing Lymphocytic Lobulitis/Diabetic Mastopathy ............................ 70
Granulomatous Lesions of the Breast ........................................................ 71
Mondor Disease ........................................................................................ 71
Gynecomastia ........................................................................................... 73

4. Risk Factors, Screening and Prevention .......................... 78
Alexandra S. Heerdt
Risk Factors .............................................................................................. 78
Screening .................................................................................................. 84
Prevention ................................................................................................ 85
Conclusion ............................................................................................... 87

5. Pathology, Prognosis and Staging of Breast Cancer ........ 88
Laura Weldon Hoque
Pathology .................................................................................................. 88
Atypical Hyperplasia ................................................................................. 88
Carcinoma In Situ .................................................................................... 88
Invasive Mammary Carcinoma ................................................................. 89
Special Types of Breast Carcinomas ........................................................... 90
Inflammatory Carcinoma.......................................................................... 94
Sarcomas and Lymphomas of the Breast.................................................... 94
Metastases to the Breast ............................................................................ 95
Male Breast Cancer ................................................................................... 96
Pathologic Examination of Breast Specimens ............................................ 96
Staging of Breast Cancer ........................................................................... 97
Extent of Disease ...................................................................................... 98
Prognosis .................................................................................................. 98

6. Breast Imaging .............................................................. 100
Laura Liberman and Timothy L. Feng
Screening Mammography ....................................................................... 100
Diagnostic Mammography ..................................................................... 103
Screening with Other Imaging Modalities: Early Investigations .............. 104
The Mammogram Report: The Breast Imaging Reporting
and Data System (BI-RADS™) Lexicon ............................................. 105
Needle Localization ................................................................................ 110
Image-Guided Percutaneous Breast Biopsy.............................................. 111
Stereotactic Biopsy .................................................................................. 111
Summary ................................................................................................ 114

7. Breast Cancer Treatment—Surgery ............................... 117
Patrick I. Borgen and Bruce Mann
Surgery for Invasive Breast Cancer .......................................................... 117
Surgery for Pure DCIS ............................................................................ 121
Breast Reconstruction ............................................................................. 122
Axillary Surgery ...................................................................................... 122
Surgery for Locally Advanced Breast Cancer ........................................... 124
Surgery for Recurrent Disease ................................................................. 124
Surgical Approach ................................................................................... 125

8. Adjuvant Therapy of Breast Cancer .............................. 137
Maura N. Dickler
Tamoxifen for Adjuvant Therapy ............................................................ 138
Tamoxifen and the Risk of Contralateral Breast Cancer:
Role as a Chemopreventive Agent ........................................................... 141
Ovarian Ablation .................................................................................... 142
Chemotherapy in the Adjuvant Setting ................................................... 142
Beyond CMF: The Use of Doxorubicin
and Taxane-Containing Regimens........................................................ 147
Role of High-Dose Chemotherapy for High-Risk Breast Cancer............. 149
Assessment of Risk and Choice of Adjuvant Therapy .............................. 150
New Approaches for Adjuvant Therapy .................................................. 151

9. Treatment—Radiation .................................................. 153
Karen D. Schupak
Radiation Therapy for Early-Stage Breast Cancer .................................... 153
Side Effects ............................................................................................. 156
Radiation Therapy for Axillary Control .................................................. 158
Postmastectomy Radiation Therapy ........................................................ 158
Radiation Therapy for Locally Advanced Breast Cancer .......................... 160
Local Recurrence .................................................................................... 161
Palliation ................................................................................................ 162
Conclusion ............................................................................................. 163

10. Sentinel Lymph Node Mapping .................................... 166
Arnold D.K. Hill
Morbidity of Axillary Dissection ............................................................. 166
The Sentinel Lymph Node...................................................................... 167
Results of Clinical Studies in Breast Cancer ............................................ 169
Axillary Staging and the Sentinel Node ................................................... 172
Internal Mammary Lymph Nodes........................................................... 174
Clinical Issues in Lymph Node Mapping ................................................ 175
Training Issues ........................................................................................ 175
Conclusion ............................................................................................. 176

11. Hereditary Breast Cancer .............................................. 181
Mark E. Robson
Familial Breast Cancer ............................................................................ 181
Hereditary Breast Cancer and the Identification
of BRCA1 and BRCA2 ......................................................................... 181
Functions of BRCA1 and BRCA2
and the Mechanism of Hereditary Susceptibility .................................. 182
Probability of Detecting Mutations in BRCA1 or BRCA2 ....................... 183
Ethnic Status and Mutation Prevalence ................................................... 184
Other Causes of Hereditary Breast Cancer .............................................. 186

Cancer Risks in Individuals with a BRCA1
or BRCA2 Mutation............................................................................. 186
Clinical Aspects of BRCA-Associated Breast
and Ovarian Cancer ............................................................................. 187
Surveillance Options for Individuals with BRCA1
or BRCA2 Mutations ........................................................................... 189
Prevention Strategies for Women with BRCA1 or BRCA2 Mutations ...... 190
Summary ................................................................................................ 192

Index ............................................................................. 195

Editors

Contributors

Patrick I. Borgen, M.D.
Department of Surgery
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 7

Arnold D.K. Hill, M.Ch., FRCSI
St. Vincent's University Hospital
Dublin, Ireland
Chapter 10

Mary L. Gemignani
Breast & Gynecology Services
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 1

Leslie L. Montgomery
Breast Service
Department of Surgery
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 2

A.D. Purushotham
Addenbrooke’s Hospital
University of Cambridge
Cambridge, U.K.
Chapter 3

P. Britton
Addenbrooke’s Hospital
University of Cambridge
Cambridge, U.K.
Chapter 3

L. Bobrow
Addenbrooke’s Hospital
University of Cambridge
Cambridge, U.K.
Chapter 3

Alexandra S. Heerdt
Breast Service
Department of Surgery
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 4

Laura Weldon Hoque
Kapiolani Breast Center
Honolulu, Hawaii, U.S.A.
Chapter 5

Laura Liberman
Department of Radiology
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 6

Timothy L. Feng
Valley Radiology Consultants
Medical Group
San Diego, California, U.S.A.
Chapter 6

Bruce Mann
Department of Surgery
The Royal Melbourne Hospital
The University of Melbourne
Parkville, Australia
Chapter 7

Maura N. Dickler
Breast Cancer Medicine Service
Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 8

Karen D. Schupak
Radiation Oncology
Memorial Sloan-Kettering at Saint Clare’s
Denville, New Jersey, U.S.A.
Chapter 9

Mark E. Robson
Clinical Genetics and Breast Cancer
Medicine Services
Departments of Human Genetics
and Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York, U.S.A.
Chapter 11