Epidemiology Male breast cancer (MBC) is a rare diagnosis, with approximately 2650 estimated cases and 530 deaths in the United States in 2021. MBC accounts for less than 1% of all breast cancers and less than 0.2% of all male cancer deaths in the United States. Globally, the highest incidence of MBC is seen in Central-Eastern Europe, with a rate of 2.85/1,000,000, and Russia (2.22), while…
In 1945 Foote and Stewart memorably stated that “the most frequent antecedent of cancer of one breast is the history of having had cancer in the opposite breast,” and contralateral breast cancer (CBC) remains the most frequent second-cancer event, historically reported as having an incidence rate of 0.5% to 1.0% per year. CBC risk is even higher among carriers of BRCA1 or BRCA2 mutations and among…
Incidence and Risk Factors Brain Metastases In 2021 there are projected to be 284,200 new cases of breast cancer and 44,130 deaths from breast cancer in the United States alone. Presenting stage and current disease status (i.e., metastatic or not) are highly associated with the risk of brain metastases. Other risk factors include HER2-positive subtype, triple-negative subtype, young age, overall disease burden, and germline BRCA1/2 status.…
Pleural metastases and malignant pleural effusion (MPE) may occur with metastatic breast cancer. Presentation can vary widely from an incidental finding on imaging to a large effusion with severe dyspnea. Any pleural effusion in a breast cancer patient can be suspected to be a malignant effusion until proven otherwise. The focus of the clinician should be to provide the most efficient, accurate diagnosis, and palliation of…
Principles of Breast Cancer Immunotherapy Immunology of Breast Cancer The association of breast tumor immune cell (IC) infiltration and prognosis has been appreciated for decades. Given the correlation between tumor infiltrating lymphocytes (TILs), treatment response, and outcome, guidelines have been developed to enable characterization (stromal vs. intratumoral) and quantification of TILs. Although cytotoxic CD8 positive T cells are perhaps the most well-recognized TIL, a number of…
History of Endocrine Therapy in Breast Cancer Linking the Course of Advanced Breast Cancer to Female Reproductive Organs In 1836 Sir Astley Cooper made one of the earliest known observations suggesting a role for endocrine therapy in treating breast cancer. He observed that advanced breast cancer appeared to wax and wane during a woman’s menstrual cycle. In 1889 Schinzinger proposed making younger women “older” by removing…
Introduction Despite significant advances and the introduction of new therapeutics for patients with metastatic breast cancer (MBC), based on estimates from the World Health Organization there were approximately 685,000 deaths globally in 2020 from breast cancer, which remains incurable in the vast majority of patients. In recent years, continued progress has been made in the development of new human epidermal growth factor receptor (HER2)-targeted therapies as…
Introduction Bone is the most common site of first recurrence in patients with breast cancer, affecting up to 70% of patients with metastatic disease. Patients with bone metastases are at high risk for developing clinically significant complications, often referred to as skeletal-related events (SREs), including radiation therapy or surgery to prevent or treat a bone fracture and palliate pain, pathologic fracture, spinal cord compression, and hypercalcemia,…
Over the past 40 years, new and advanced breast cancer multimodality treatments have resulted in improved median survival times for patients with metastatic breast cancer (MBC). Breast cancer most commonly metastasizes to bone, followed by lung, brain, and liver. Until now, the treatment focus for MBC has been on palliative care rather than cure. However, a more aggressive treatment approach may be appropriate for patients with…
Introduction Overall, around 15% to 20% of breast cancers recur as distant metastatic disease, and recurrence rates are higher if local recurrences or second breast cancers are also included. Clinically apparent metastatic breast cancer is not curable with current treatment modalities. Current clinical guidelines discourage routine testing of asymptomatic patients during follow-up who have completed therapy with curative intent, because two randomized clinical trials conducted 30…
Locally advanced breast cancer (LABC) and inflammatory breast cancer (IBC), a special subtype of stage III breast cancer, were historically associated with a high risk of recurrence, for which a multimodality management approach has been the cornerstone of treatment. In recent years, refining of prognostic information based on estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor-2 (HER2) biomarkers and the use of targeted therapies (antihormonal…
The prevention of locoregional recurrence (LRR) continues to be an important goal of breast cancer treatments today. Since its inception in the late 19th century, the primary objective of surgery has been local control of disease. Despite innovations in the surgical arena, improvements in radiation techniques, and advances in systemic therapies, LRR remains a problem and an indicator of poor prognosis. Isolated locoregional recurrence (ILRR) events…
Introduction About 6% of all breast cancer patients present with an intact primary tumor and synchronous distant disease, a rate largely unchanged over the past 20 years. For these patients, overall survival is dictated by their systemic disease rather than the primary tumor status. Consequently, systemic therapy has been considered first-line treatment, and resection of the intact breast tumor is generally not recommended, as most patients…
Introduction As recent as the early 2000s, locally advanced breast cancer (LABC) carried a grim prognosis, and surgery was thought to play a more palliative role in its management. However, in more recent years, the understanding of the disease process has led to new systemic therapies that have transformed the role of surgery in this particular patient population. These targeted therapies have provided key information regarding…
Introduction HER2 (also known as ERBB2) represents a potent oncogenic driver in 15% to 20% of breast carcinomas and is associated with an aggressive phenotype and poor patient outcome if not treated. The addition of trastuzumab, the first monoclonal antibody targeting HER2, to chemotherapy for early-stage, HER2-positive breast cancer has significantly reduced recurrence of and mortality from breast cancer by a third, irrespective of patient and…
Introduction Triple-negative breast cancer (TNBC) accounts for 10% to 20% of early-stage breast cancers and is characterized by tumors without expression of estrogen or progesterone receptors and that lack HER2 overexpression and/or amplification. Although these tumors are heterogeneous with regards to biology and natural history, as a group TNBC is the most aggressive breast cancer subtype, with a higher likelihood of presenting at more advanced stages,…
Introduction Breast cancer is the most common malignancy diagnosed in women worldwide. In the United States alone, more than 284,000 new cases are expected in 2021. Breast cancer mortality has declined in recent years, in part due to early diagnosis via screening, and in part due to advances in systemic therapy for early stage disease. Today, most patients diagnosed with breast cancer have early-stage disease, for…
Introduction Locally advanced breast cancer (LABC) comprises a heterogeneous group of tumors with a wide range of disease at diagnosis. Patients with LABC may present with large primary breast tumors with or without involvement of the chest wall or ulceration of the skin, moderate to advanced regional nodal burden, clinical inflammatory breast cancer (IBC), or inoperable disease. Radiotherapy to the breast or chest wall/reconstructed breast is…
Introduction This chapter discusses the potential complications associated with the use of radiotherapy for breast cancer. These may occur in the weeks during or after radiation, decades after treatment, or even years after treatment in some cases. The time course for the different complications discussed is different from each other—for example, skin complications typically occur during or shortly after radiation, while cardiac effects are expected years…
Background and Rationale Randomized studies with greater than 20 years of long-term follow-up data have established equivalent outcomes in patients who undergo mastectomy or breast-conserving therapy. Studies have further shown increased rates of local recurrence with the omission of radiation therapy following breast-conserving surgery, and a large meta-analysis has demonstrated an improvement in breast cancer mortality with the addition of radiation therapy to breast-conserving surgery. Historically…