Breast Cancer

Epidemiology and risk factors (Rak ¡uieiiment tool bcrisktool )

• Most common cancer in U.S. women; 2nd most common cause of cancer death in women

• Age: incidence rates t with age. with decrease in slope at age of menopause

• Genetics <nejm 2003:348 2339): 15-20% have FHx

Risk depends on U of affected 1st-degree relatives and their age at dx 45% of cases of familial cases are associated with known germline mutations BRCA1/2:50-85% lifetime risk of breast cancer & I risk of ovarian cancer. IT colon & prostate cancer; BRCA2: also w * mole breast cancer and i T pancreatic cancer

• Endogenous or exogenous estrogen: f risk with early menarche. late menopause, late parity, or nulliparity (NEJM 2006:354:270); t risk with prolonged HRT (RR 1.24 after 5.6 y. /AAM 2003:289.3243); no T risk shown with OCP use (NE/M 2002:346:2025)

• Benign breast conditions: * risk w atypia (atypical ductal or lobular hyperplasia) &

proliferative (ductal hyperplasia, papilloma, radial scar, or sclerosing adenosis) features: no T risk w cysts, fibroadenoma, or columnar changes (NijM 2005:352:229)

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