Treatment Guideline Chart
Breast cancer is the presence of a malignant breast nodule, mass or abscess.
Most common symptom of breast cancer is a new lump or mass in the breast. The lump or mass is usually painless, hard and irregular but it can also be tender, soft, rounded or painful.
Other signs and symptoms include breast pain or nipple pain, nipple discharge, nipple retraction and presence of breast skin changes (eg peau d' orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess).

Breast%20cancer Signs and Symptoms


  • Refers to both invasive and in situ carcinoma of the breast
  • Most common and frequently diagnosed noncutaneous cancer in women


  • Highest incidence among all cancers globally
  • Fifth leading cause of mortality globally
  • Occurs commonly in women >50 years old


  • Malignant proliferation of epithelial cells lining the ducts or lobules of the breast
    • Initially limited to a duct or lobule (in situ) without metastasis potential which may progress as time passes and spread in the breast tissue, lymph nodes, or other organs

Signs and Symptoms

  • Presence of breast nodule, mass, or abscess
    • Most common symptom of breast cancer is a new lump or mass in the breast
    • Painless, hard, and irregular mass is more likely to be cancerous, but can also be tender, soft, rounded, or painful
  • Breast pain or nipple pain (very rare)
  • Nipple discharge
  • Nipple retraction
  • Presence of breast skin changes (eg peau d’ orange, nipple excoriation, scaling, inflammation, skin tethering, ulceration, abscess)

Risk Factors

  • History of breast cancer
    • Previous history of breast cancer has an increased risk of developing new primary breast cancer
      • History of invasive breast cancer, lobular neoplasia (formerly called lobular carcinoma in situ [LCIS]) and ductal carcinoma in situ (DCIS) have the highest risk
      • Lifetime risk at ≥20% based on history of LCIS or atypical ductal hyperplasia (ADH)/atypical lobular hyperplasia (ALH)

  • Previous history of epithelial ovarian or exocrine pancreatic cancer at any age, or prostate cancer at any age with metastatic, intraductal or cribriform histology, those belonging to high- or very high-risk group, or with the following family history: Ashkenazi Jewish ancestry, ≥1 close relative with breast cancer at ≤50 years of age or ovarian, pancreatic, metastatic, or intraductal/cribriform prostate cancer at any age, or ≥2 close relatives with breast or prostate cancer at any age 
  • Confirmed biopsy of benign proliferative breast disease
    • Breast tissue biopsy showing proliferative disease with and without atypical cells has an elevated risk of developing breast cancer
      • Patients with benign breast disease that presents with atypical hyperplasia carry the highest risk

  • History of high-dose radiation exposure
    • Multiple exposures of therapeutic radiation to the chest for cancer at an early age (<30 years old) increase the risk of breast cancer
    • Contralateral breast cancer has been shown to develop after high-dose radiation exposure
    • Patients with Hodgkin’s disease receiving radiotherapy at high doses are also at risk

  • Reproductive factors
    • Nulliparity or first full-term pregnancy at age >30 years
      • Breastfeeding for >12 months is protective against breast cancer
    • Menarche at age <12 years and menopause at age >55 years
    • Oral contraceptive use before the first full-term pregnancy, combination hormone replacement therapy, and long-term use of unopposed estrogen for >15 years by hysterectomized women have mild increased risk for breast cancer
      • Use of low-dose preparations poses a lower risk

  • Advanced age
    • Woman ≥35 years with a 5-year risk ≥1.7% for invasive breast cancer assessed using the modified Gail model
      • Modified Gail model calculates the 5-year and lifetime probabilities of developing invasive breast cancer which can be used to identify women at increased risk by evaluating the risk of invasive breast cancer as a function of age, menarche, age at 1st live birth or nulliparity, number of 1st-degree relatives with breast cancer, number of benign breast biopsies, atypical hyperplasia in a previous breast biopsy and race  
    • Risk increases from 40 years old for premenopausal women and 50 years old for postmenopausal women
  • Family history of breast cancer
    • Increased risk in women with breast cancer among young first-degree relatives
      • Sister has a higher risk than a mother
    • Carriers of BRCA1 and BRCA2 genetic mutations are also at high risk
      • Women with these have increased risk of developing other cancers like ovarian cancer
      • Other genes associated with genetic susceptibility to breast cancer include PTEN, TP53, CDH1, STK11, MLH1, MSH2, MSH6, and PMS2; genes currently being investigated include PALB2, CHEK2, ATM, RAD51C, RAD51D, and BRIP1
  • Individuals with characteristics for Li-Fraumeni syndrome (LFS) or Cowden syndrome/PTEN hamartoma tumor syndrome testing criteria 
  • Breast density: Higher breast density has increased risk
  • Lifestyle
    • Body mass index of >25 has an increased risk of developing breast cancer with higher death rate
    • Lack of exercise
    • Alcohol consumption (eg beer) of >10 g/day especially in postmenopausal women has increased risk for invasive breast cancer

Risk Factors for Disease Recurrence

  • Palpable mass
  • Larger mass size
  • Higher grade tumors
  • Close or involved margins
  • Age <50 years
  • Presence of lymphovascular space invasion
  • Lymph node involvement
  • Human epidermal growth factor receptor 2 (HER2) status of the cancer cells
  • Proliferative marker Ki67 index
Editor's Recommendations
Special Reports