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Upon completion of the chapter, the reader will be able to:

  1. List factors associated with an increased risk of breast cancer in the United States.

  2. Assess patients for signs and symptoms related to breast cancer in early and late stages of the disease.

  3. List all modalities that are appropriate screening tools for breast cancer and determine how they should best be used in the public domain.

  4. Discuss available options for breast cancer prevention.

  5. Critique available prognostic variables for clinical utility.

  6. Determine which patient populations may benefit from systemic adjuvant therapy for breast cancer.

  7. Determine the treatment goals for early stage, locally advanced, and metastatic breast cancer.

  8. Determine appropriate indications for endocrine therapy, chemotherapy, and biologic therapy for patients with metastatic breast cancer.

  9. Evaluate available chemotherapy options for patients with metastatic breast cancer based on pertinent patient and disease state characteristics.

  10. Discuss the role of trastuzumab in the management of early and advanced stage breast cancer.




  • Image not available. Breast cancer is the most common neoplasm diagnosed in American women, although the disease risk varies by ethnicity.

  • Image not available. Classic breast cancer risk factors, initially derived from epidemiologic studies, now include genetic and nongenetic components.

  • Image not available. Most patients diagnosed with breast cancer have early stage, and potentially curable, disease.

  • Image not available. Early breast cancer is now treated with less aggressive surgical procedures that involve the primary tumor and regional lymph nodes.

  • Image not available. The presence of two receptors, estrogen and HER2/neu, guides the application of systemic therapy for both early and advanced breast cancers.

  • Image not available. Appropriate application of adjuvant endocrine therapy with or without chemotherapy plus trastuzumab (if indicated) reduces the rates of relapse and death.

  • Image not available. Goals of therapy differ between early and metastatic breast cancer—cure in the former and preserving or improving quality of life in the latter.

  • Image not available. In the absence of acute life-threatening complications, initial therapy of estrogen receptor (ER)–positive advanced breast cancer is endocrine therapy.

  • Image not available. Approximately 50% to 60% of women who have not received prior chemotherapy for metastatic disease will respond to chemotherapy regimens; anthracycline- and taxane-containing regimens are the most active.

  • Image not available. Chemotherapy plus trastuzumab (if indicated) is the strategy of choice for ER-negative metastatic disease.


After a sharp increase in new breast cancer diagnoses during the early 1980s and a more modest rise during the latter half of the 1990s, the incidence of invasive disease has decreased slightly over the past 10 years.1 Moreover, the 5-year survival rates has also improved significantly from 75% to 89% during the mid-1970s and 1996 to 2004, respectively. The latter finding is likely attributable to early detection and the development of effective treatment regimens. Treatment strategies for most breast cancer patients include surgical, radiologic, and pharmacologic therapies.




Breast cancer is the most common type of cancer and is second only to lung cancer as a cause of cancer death in American women. In 2012 alone, an ...

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