Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image


Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Breast cancer

Last updated: July 16, 2019


Breast cancer is the most common malignancy in women. The lifetime risk of developing breast cancer for women in the USA is approx. 12%. The most important risk factors include increased estrogen exposure, advanced age, and genetic predisposition (BRCA1/BRCA2 mutations). Most breast cancers are adenocarcinomas. Histopathologic classification differentiates between ductal and lobular carcinomas. The two most common types of breast cancer are invasive ductal carcinoma, which accounts for 70–80% of all cases, and the less aggressive invasive lobular carcinoma. Both types typically develop from noninvasive carcinomas, i.e., ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS), respectively.

The majority of breast cancers are detected during routine mammography screening, which is recommended every two years in women aged 50–74 years. Alternatively, women may present with a self-palpated breast lump. Mammographic abnormalities and breast masses require further radiographic evaluation, and, if there are signs of malignancy or the results are inconclusive, histopathologic analysis (biopsy). The axillary lymph node status is determined through clinical examination and biopsy of a suspicious lymph node or sentinel lymph node.

The treatment approach primarily depends on the histopathologic classification and the disease stage and involves a combination of surgical management, radiation therapy, and systemic therapy. Surgical management is either breast-conserving therapy (BCT) or mastectomy. Systemic therapy has significantly improved in recent years with the development of hormone therapy (tamoxifen) and targeted therapy (trastuzumab). The most important prognostic factors are lymph node status, tumor size, patient's age, and tumor receptor status (hormone receptors and HER2).

Women with a high risk of developing breast cancer (i.e., positive BRCA mutation status) should be offered genetic counseling and risk-reducing prophylactic surgery.


One in 8 women in the USA (∼12 %) will develop invasive breast cancer during their lifetime!


Epidemiological data refers to the US, unless otherwise specified.


Predisposing factors

Associated genetic diseases



Most breast cancers are adenocarcinomas, arising from ductal tissue (80%) or lobular tissue (20%).

Noninvasive (in situ) carcinomas

  • Ductal carcinoma in situ (DCIS)
    • ∼ 25% of all newly diagnosed breast cancers
    • Localization: unifocal
    • Frequently has a pattern of grouped microcalcifications
    • Higher risk of subsequent invasive carcinoma (ipsilateral)
  • Lobular carcinoma in situ (LCIS)
    • 1–5% of all newly diagnosed breast cancers
    • Localization: multifocal
    • Microcalcifications are rare
    • Lower risk of subsequent invasive carcinoma (equal predisposition in both breasts)

The noninvasive carcinomas are characterized by the absence of stromal invasion!

Invasive carcinomas


Clinical features

Patients with breast cancer develop clinical symptoms rather late at advanced tumor stages. Typical signs may include:

  • Changes in breast size and/or shape; asymmetric breasts
  • Palpable mass: typically a single, nontender, firm mass with poorly defined margins; , most commonly in the upper outer quadrant
  • Skin changes
    • Retractions or dimpling (due to tightening of the Cooper ligaments)
    • Peau d'orange: skin resembling an orange peel (due to obstruction of the lymphatic channels)
  • Nipple changes: inversion, blood-tinged discharge
  • Axillary lymphadenopathy: firm, enlarged lymph nodes (> 1 cm in size), that are fixed to the skin or surrounding tissue
  • In advanced stages: ulcerations


Subtypes and variants

Paget disease of the breast

Inflammatory breast cancer



Approach to suspected breast cancer

Most patients present with abnormalities detected during routine mammography screening. Alternatively, young women in particular (who are not routinely screened) present with a self-palpated breast mass. The diagnostic approach involves clinical assessment, radiographic imaging, and biopsy.

Clinical scenario First step
  • Women < 30 years with a self-palpated breast lump
  • Women > 30 years with self-palpated breast lump or mammographic abnormalities detected during breast cancer screening

Clinical assessment

Certain constellations of patient characteristics should raise suspicion for malignancy in a breast lump, warranting further assessment.

Nonsuspicious Suspicious

Radiographic imaging


Although mammography does not confirm the diagnosis, it is primarily useful for early detection of breast abnormalities!

Benign Malignant
  • Well-defined, circumscribed mass
  • Radiolucent ring surrounding the lesion (halo sign)
  • Diffuse microcalcification or coarse calcification
  • Focal mass or density with poorly defined margins
  • Spiculated margins
  • Clustered microcalcifications

Breast ultrasound


Core needle biopsy (CNB) : confirms the diagnosis (preferred test) and can distinguish between noninvasive and invasive carcinoma based on histology; indicated for a suspicious breast mass on ultrasound or mammography.

Workup of diagnosed breast cancer

Axillary lymph node involvement suggests that hematogenic spread has already occurred!



Noninvasive carcinomas

Type Characteristics Growth pattern
  • Macroscopic: firm mass may be visible
  • Microscopic
    • Enlarged ducts lined with atypical epithelium
    • Intact basal membrane
    • Microcalcifications are noted occasionally.
  • Macroscopic: not visible
  • Microscopic
    • The lobules are filled with monomorphic cells.
    • Intact basal membrane
  • Diffuse

Invasive carcinomas

Type Characteristics Growth pattern
Invasive ductal
  • Macroscopic: firm tumor, fibrous, grayish-white cut surface
  • Microscopic: disorganized, small duct-like glandular cells with stromal invasion, microcalcifications, and fibrosis in surrounding tissue
  • Unilateral
Invasive lobular
  • Macroscopic: solid
  • Microscopic
    • Malignant cells in lobules
    • Monomorphic cells in a single file pattern ("Indian file" pattern
  • Unilateral or bilateral
  • Rapid growth
  • Well circumscribed tumor
  • Extracellular mucus
  • Slow growth
  • Well-differentiated tubular structures, stromal invasion (radial pattern)
  • Slow growth
  • Dermal lymphatic invasion, angioinvasion
  • Rapid growth


Differential diagnoses

Breast mass Nipple discharge Skin changes Ultrasound/Mammography Biopsy
Benign Nonneoplastic Fibrocystic breast changes
  • Clear or slightly milky
  • None
  • Normal appearance or focal regions of thick parenchyma
  • Clear borders
  • +/- cysts
  • +/- dispersed calcifications
  • Firm, concentric, sometimes tender mass at the nipple areolar complex
  • None
  • None
  • Mammogram only required in doubtful or persistent cases)
  • Unnecessary
Inflammatory Mastitis
  • Milky
  • Bloody
  • Unnecessary
  • Unnecessary
  • Milk sampling + culture only if initial treatment fails
Fat necrosis
  • Irregularly defined and dense periareolar breast mass
  • Fluid-filled cyst
  • Course rim calcification
Breast abscess
Eczema of the breast
  • None
  • None
  • Eczematous rash with poorly defined margins and no infiltration
  • Unnecessary
  • Only if diagnosis is inconclusive or malignancy is suspected
Neoplastic Fibroadenoma
  • Solitary, well-defined, non-tender, rubbery and mobile mass
  • Well-defined mass
  • Possibly popcorn-like calcifications
Phyllodes tumor
  • Painless, smooth, multinodular lump
  • Variable growth rate
  • Generally > 3 cm
Intraductal papilloma
  • Solitary lesions: palpable breast tumor close to or behind the nipple
  • Multiple lesions: usually asymptomatic
  • Bloody (most common cause)
  • None
Malignant Invasive carcinoma (ductal and lobular)
  • Bloody
  • Focal mass or density with poorly defined margins
  • Spiculated margins
  • Clustered microcalcifications
  • Ductal: malignant cells in duct, stromal invasion, microcalcifications, fibrosis in surrounding tissue
  • Lobular: malignant cells in lobules; monomorphic cells in a single file pattern ("Indian file" pattern)
Inflammatory breast cancer
  • Blood-tinged
  • Dermal lymphatic invasion, angioinvasion
Paget disease of the breast
  • Blood-tinged (when the lesion ulcerates)
Other rare breast malignancies


The differential diagnoses listed here are not exhaustive.


The treatment approach primarily depends on the histopathologic classification and disease stage and involves a combination of surgical management and systemic therapy (chemotherapy, hormone therapy, targeted therapy). Patient preference for more or less aggressive management also plays a significant role in selecting the treatment approach.

Invasive carcinoma

Noninvasive carcinoma

Systemic therapy

Indications Agents Side effects and contraindications
Hormone therapy
  • ER or PR positive tumors
Targeted therapy
  • HER2-positive tumors

Tamoxifen acts as an agonist on endometrial estrogen receptors, thereby increasing the risk of endometrial cancer.



Relapse typically occurs within the first five years after completion of treatment!


We list the most important complications. The selection is not exhaustive.


Prognostic factors

  • Axillary lymph node status (most important prognostic factor)
  • Tumor size
  • Patient's age
  • Receptor status (ER/PR-negative and triple-negative disease are associated with a worse prognosis)
    • Histologic grade and subtype

HER2-positive cancers demonstrate a more aggressive tumor growth and higher recurrence rates and therefore are associated with a poor prognosis. Since the development of targeted therapy with trastuzumab, the prognosis for patients with HER2-positive cancers has improved!


  • Early-stage disease without lymph node involvement
    • 10-year survival rate: 70%
  • Node-positive disease: high risk of recurrence
  • Metastatic disease: 3-year survival rate of 48–71%



Breast cancer screening

  • Mammography: every 2 years in average-risk women aged 50–74 years
    • Two views of the breast are obtained: mediolateral oblique and craniocaudal
  • Physical examination plays a minor role in screening for breast cancer.

If the cancerous lesion is detectable by palpation, a stage II tumor or higher (size > 2 cm) is very likely!
Mammography has greatly improved early detection of noninvasive carcinomas! While DCIS can occasionally be detected as a palpable lump, LCIS cannot be detected by clinical examination.

Prevention in high-risk women



Early stage disease
  • Localized tumor (< 5 cm)
  • ≤ 3 nodes involved, including the sentinel lymph node
Locally advanced disease
Advanced metastatic disease



  1. Le T, Bhushan V. First Aid for the USMLE Step 1 2015. McGraw-Hill Education ; 2014
  2. Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast cancer before age 40 years. Semin Oncol. 2009; 36 (3): p.237-249. doi: 10.1053/j.seminoncol.2009.03.001 . | Open in Read by QxMD
  3. Breast Cancer Risk in American Women. https://www.cancer.gov/types/breast/risk-fact-sheet. Updated: September 24, 2012. Accessed: March 16, 2017.
  4. Jenkins B, McInnis M, Lewis C. Step-Up to USMLE Step 2 CK. Lippincott Williams & Wilkins ; 2015
  5. Le T, Bhushan V, Bagga HS. First Aid for the USMLE Step 2 CK. McGraw-Hill Medical ; 2009
  6. Chalasani P. Breast Cancer. Breast Cancer. New York, NY: WebMD. http://emedicine.medscape.com/article/1947145-overview. Updated: January 30, 2017. Accessed: February 20, 2017.
  7. How does radiation therapy affect the risk of second cancers?. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/second-cancers-in-adults/radiation-therapy.html. Updated: December 11, 2014. Accessed: March 16, 2017.
  8. De bruin ML, Sparidans J, Van't veer MB, et al. Breast cancer risk in female survivors of Hodgkin's lymphoma: lower risk after smaller radiation volumes. J Clin Oncol. 2009; 27 (26): p.4239-4246. doi: 10.1200/JCO.2008.19.9174 . | Open in Read by QxMD
  9. Peshkin BN, Isaacs C. BRCA1 and BRCA2-associated hereditary breast and ovarian cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/brca1-and-brca2-associated-hereditary-breast-and-ovarian-cancer.Last updated: April 4, 2016. Accessed: March 16, 2017.
  10. Evans DG. Li-Fraumeni syndrome. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/li-fraumeni-syndrome.Last updated: November 23, 2016. Accessed: March 16, 2017.
  11. Schwartz RA. Mammary Paget Disease. Mammary Paget Disease. New York, NY: WebMD. http://emedicine.medscape.com/article/1101235. Updated: June 22, 2016. Accessed: March 16, 2017.
  12. Merajver SD. Inflammatory breast cancer: Pathology and molecular pathogenesis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/inflammatory-breast-cancer-pathology-and-molecular-pathogenesis.Last updated: February 7, 2017. Accessed: March 16, 2017.
  13. Taghian A, El-Ghamry M, Merajver SD. Overview of the treatment of newly diagnosed, non-metastatic breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-newly-diagnosed-non-metastatic-breast-cancer?source=machineLearning&search=breast%20cancer%20treatment&selectedTitle=1~150§ionRank=1&anchor=H528513260#H3101248.Last updated: August 10, 2016. Accessed: February 20, 2017.
  14. Esserman LJ, Joe BN. Clinical features, diagnosis, and staging of newly diagnosed breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-features-diagnosis-and-staging-of-newly-diagnosed-breast-cancer?source=search_result&search=breast%20cancer&selectedTitle=2~150.Last updated: February 2, 2017. Accessed: February 21, 2017.
  15. Sloane PD, Slatt LM, Ebell MH, Jacques LB, Smith MA. Essentials of Family Medicine. Lippincott Williams & Wilkins ; 2008
  16. Esserman LJ, Joe BN. Diagnostic evaluation of women with suspected breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/diagnostic-evaluation-of-women-with-suspected-breast-cancer?source=machineLearning&search=breast%20cancer%20biopsy&selectedTitle=2~150§ionRank=1&anchor=H969399129#H969399129.Last updated: March 21, 2016. Accessed: February 21, 2017.
  17. Sabel MS. Clinical manifestations and diagnosis of a palpable breast mass. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-a-palpable-breast-mass?source=search_result&search=breast%20mass%20palpation&selectedTitle=1~150.Last updated: April 24, 2015. Accessed: February 21, 2017.
  18. Joe BN, Esserman LJ. Breast biopsy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/breast-biopsy?source=see_link#H18.Last updated: October 3, 2016. Accessed: February 20, 2017.
  19. Anders CK, Carey LA. Epidemiology, risk factors and the clinical approach to ER/PR negative, HER2-negative (Triple-negative) breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-risk-factors-and-the-clinical-approach-to-er-pr-negative-her2-negative-triple-negative-breast-cancer?source=search_result&search=triple%20negative&selectedTitle=1~150.Last updated: November 17, 2016. Accessed: February 21, 2017.
  20. Yamauchi H, Hayes DF. HER2 and predicting response to therapy in breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/her2-and-predicting-response-to-therapy-in-breast-cancer?source=search_result&search=HER2%2Fneu&selectedTitle=1~131.Last updated: January 11, 2016. Accessed: February 21, 2017.
  21. Harlow SP, Weaver DL. Overview of sentinel lymph node biopsy in breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-sentinel-lymph-node-biopsy-in-breast-cancer?source=see_link§ionName=Indications&anchor=H3#H1817754.Last updated: December 12, 2016. Accessed: February 21, 2017.
  22. Loeffler JS. Epidemiology, Clinical Manifestations, and Diagnosis of Brain Metastases. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-brain-metastases.Last updated: August 25, 2015. Accessed: February 20, 2017.
  23. Goljan EF. Rapid Review Pathology. Elsevier Saunders ; 2018
  24. Braunstein GD, Anawalt BD. Epidemiology, Pathophysiology, and Causes of Gynecomastia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/epidemiology-pathophysiology-and-causes-of-gynecomastia.Last updated: February 10, 2017. Accessed: March 7, 2018.
  25. Elmore JG. Screening for breast cancer: Strategies and recommendations. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/screening-for-breast-cancer-strategies-and-recommendations?source=search_result&search=high%20risk%20breast%20cancer&selectedTitle=1~150#H37741109.Last updated: August 26, 2016. Accessed: February 21, 2017.
  26. Collins LC, Laronga C, Wong JS. Ductal carcinoma in situ: Treatment and prognosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/ductal-carcinoma-in-situ-treatment-and-prognosis?source=search_result&search=DCIS%20treatment&selectedTitle=1~56.Last updated: September 6, 2016. Accessed: February 20, 2017.
  27. Sabel MS, Collins LC. Atypia and lobular carcinoma in situ: High risk lesions of the breast. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/atypia-and-lobular-carcinoma-in-situ-high-risk-lesions-of-the-breast?source=see_link#H12.Last updated: January 19, 2017. Accessed: February 21, 2017.
  28. Sporn MB, Liby KT. Cancer chemoprevention: scientific promise, clinical uncertainty. Nat Clin Pract Oncol. 2005; 2 (10): p.518-525. doi: 10.1038/ncponc0319 . | Open in Read by QxMD
  29. Breast cancer chemoprevention. http://www.tandfonline.com/doi/abs/10.1586/era.11.206?journalCode=iery20. Updated: February 1, 2012. Accessed: February 20, 2017.
  30. Litton JK. Gestational breast cancer: Treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/gestational-breast-cancer-treatment?source=search_result&search=breast%20cancer%20and%20pregnancy&selectedTitle=1~150#H84662789.Last updated: November 20, 2015. Accessed: February 21, 2017.
  31. Sabel MS. Breast conserving therapy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/breast-conserving-therapy?source=search_result&search=breast%20cancer%20surgery&selectedTitle=3~150#H15.Last updated: October 31, 2016. Accessed: February 21, 2017.
  32. Mohler ER III, Mehrara B. Clinical staging and conservative management of peripheral lymphedema. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-staging-and-conservative-management-of-peripheral-lymphedema.Last updated: January 22, 2016. Accessed: March 17, 2017.
  33. Hurria A, Come SE, Pierce LJ. Patterns of relapse and long-term complications of therapy in breast cancer survivors. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/patterns-of-relapse-and-long-term-complications-of-therapy-in-breast-cancer-survivors.Last updated: December 14, 2016. Accessed: March 17, 2017.
  34. American Cancer Society Guidelines for the Early Detection of Cancer. https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html. Updated: July 26, 2016. Accessed: March 17, 2017.
  35. Lambert M. ACOG Guidelines for Managing Hereditary Breast and Ovarian Cancer Syndrome. Am Fam Physician. 2009; 80 (12): p.1505-1507.
  36. Isaacs C, Peshkin BN. Management of patients at high risk for breast and ovarian cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-patients-at-high-risk-for-breast-and-ovarian-cancer.Last updated: October 11, 2016. Accessed: March 17, 2017.
  37. Bleiweiss IJ. Pathology of breast cancer. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/pathology-of-breast-cancer.Last updated: June 17, 2016. Accessed: March 16, 2017.
  38. WebMD. Ductal Carcinoma (Invasive and In Situ). Ductal Carcinoma (Invasive and In Situ). New York, NY: WebMD. http://www.webmd.com/breast-cancer/ductal-carcinoma-invasive-in-situ#1. Updated: July 21, 2015. Accessed: March 16, 2017.
  39. Cancer Facts & Figures 2017. https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21387. Updated: January 5, 2017. Accessed: August 23, 2019.
  40. Britt K, Short R.. The plight of nuns: hazards of nulliparity. The Lancet. 2012 .
  41. Christopher I. Li, Kathleen E. Malone, Peggy L. Porter, Thomas J. Lawton, Lynda F. Voigt, Kara L. Cushing-Haugen, Ming Gang Lin, Xiaopu Yuan, and Janet R. Daling. Relationship between Menopausal Hormone Therapy and Risk of Ductal, Lobular, and Ductal-Lobular Breast Carcinomas. Cancer Epidemiology, Biomarkers & Prevention. 2008 .
  42. Stevens KN, Vachon CM, Couch FJ.. Genetic susceptibility to triple-negative breast cancer.. Cancer Research. 2013 .
  43. Breast Cancer: Risk Factors and Prevention. https://www.cancer.net/cancer-types/breast-cancer/risk-factors-and-prevention. Updated: October 1, 2018. Accessed: August 23, 2019.
  44. Ganesh N. Sharma, Rahul Dave, Jyotsana Sanadya, Piush Sharma, and K. K Sharma. VARIOUS TYPES AND MANAGEMENT OF BREAST CANCER: AN OVERVIEW. Journal of Advanced Pharmaceutical Technology & Research. 2010 .
  45. Hannah Y Wen, MD, PhD and Edi Brogi, MD, PhD. Lobular Carcinoma in Situ. Surgical Pathology Clinics. 2019 .
  46. Wingo PA, Jamison PM, Young JL, Gargiullo P.. Population-based statistics for women diagnosed with inflammatory breast cancer (United States).. Cancer Causes & Control. 2004 .
  47. Harris EE, Schultz D, Bertsch H, Fox K, Glick J, Solin LJ.. Ten-year outcome after combined modality therapy for inflammatory breast cancer.. International Journal of Radiation Oncology, Biology, Physics. 2003 .
  48. Huang SF, Chang RF, Chen DR, Moon WK.. Characterization of spiculation on ultrasound lesions.. IEEE Transactions on Medical Imaging. 2004 .
  49. Ewa Łukasiewicz, Agnieszka Ziemiecka, Wiesław Jakubowski, Jelena Vojinovic, Magdalena Bogucevska, and Katarzyna Dobruch-Sobczak. Fine-needle versus core-needle biopsy – which one to choose in preoperative assessment of focal lesions in the breasts? Literature review. Journal of Ultrasonography. 2017 .
  50. Biopsy. https://www.cancerquest.org/patients/detection-and-diagnosis/biopsy. . Accessed: August 29, 2019.
  51. Carcinoma subtypes: Carcinoma with medullary features (CMF). http://www.pathologyoutlines.com/topic/breastmalignantmedullary.htmlhttp://www.pathologyoutlines.com. Updated: January 25, 2019. Accessed: August 29, 2019.
  52. Adam M.Brufsky. Long-term management of patients with hormone receptor-positive metastatic breast cancer: Concepts for sequential and combination endocrine-based therapies. Cancer Treatment Reviews. 2017 .
  53. Franco Lumachi, Davide A Santeufemia, and Stefano MM Basso. Current medical treatment of estrogen receptor-positive breast cancer. World Journal of Biological Chemistry. 2015 .
  54. Beth N. Peshkin, MS, CGC,Michelle L. Alabek, MS, and Claudine Isaacs, MD. BRCA1/2 mutations and triple negative breast cancers.. Breast Disease. 2010 .
  55. Ariel Toomey; Jacqueline K. Le.. Abscess, Breast. StatPearls. 2019 .
  56. Intraductal papilloma of breast. https://radiopaedia.org/articles/intraductal-papilloma-of-breast. Updated: March 12, 2019. Accessed: September 12, 2019.
  57. Julie Margenthaler. Technique of axillary lymph node dissection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/technique-of-axillary-lymph-node-dissection.Last updated: February 13, 2019. Accessed: September 13, 2019.
  58. Robertson JF, Blamey RW.. The use of gonadotrophin-releasing hormone (GnRH) agonists in early and advanced breast cancer in pre- and perimenopausal women.. European Journal of Cancer. 2003 .
  59. Irene E. G. van Hellemond, MD, Sandra M. E. Geurts, Msc, PhD, and Vivianne C. G. Tjan-Heijnen, MD, PhD. Current Status of Extended Adjuvant Endocrine Therapy in Early Stage Breast Cancer. Current Treatment Options in Oncology. 2018 .
  60. Ammar Taha Abdullah Abdulaziz, MD, Xiao Qing Yu, MD, Le Zhang, MD, Xin Yue Jiang, MD, Dong Zhou, MD, PhD, and Jin Mei Li, MD, PhD. Paraneoplastic cerebellar degeneration associated with cerebellar hypermetabolism. Medicine. 2018 .
  61. Elizabeth A. Brett, Matthias M. Aitzetmüller, Matthias A. Sauter, Georg M. Huemer, Hans-Günther Machens, and Dominik Duscher. Breast cancer recurrence after reconstruction: know thine enemy. Oncotarget. 2018 .
  62. Philippe Rouanet, Pascal Roger, Emilie Rousseau, Severine Thibault, Gilles Romieu, Andre Mathieu, Jacques Cretin, Gilbert Barneon, Mireille Granier, Aurelie Maran-Gonzalez, Jean P Daures, Florence Boissiere, and Frederic Bibeau. HER2 overexpression a major risk factor for recurrence in pT1a-bN0M0 breast cancer: results from a French regional cohort. Cancer Medicine. 2014 .
  63. Statistics on breast cancer survival rates by stage. https://www.medicalnewstoday.com/articles/316867.php#5-year-survival-rates. Updated: August 19, 2019. Accessed: September 18, 2019.
  64. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N.. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.. The New England Journal of Medicine. 2002 .
  65. What is the role of tamoxifen and raloxifene for the reduction of breast cancer risk?. https://www.medscape.com/answers/1947145-155372/what-is-the-role-of-tamoxifen-and-raloxifene-for-the-reduction-of-breast-cancer-risk. Updated: May 21, 2019. Accessed: September 18, 2019.
  66. Raloxifene. https://www.drugbank.ca/drugs/DB00481. Updated: September 17, 2019. Accessed: September 18, 2019.
  67. Hitisha K., Patel Teeru Bihani. Selective estrogen receptor modulators (SERMs) and selective estrogen receptor degraders (SERDs) in cancer treatment. Pharmacology & Therapeutics. 2018 .
  68. American College of Obstetricians-Gynecologists. Practice bulletin no. 122: Breast cancer screening.. Obstetrics & Gynecology. 2011 .
  69. Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.. Annals of Internal Medicine. 2016 .
  70. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender; American Cancer Society.. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.. The Journal of the American Medical Association. 2015 .
  71. Michael S Sabel, MD, Laura C Collins, MD. Atypia and lobular carcinoma in situ: High-risk lesions of the breast. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/atypia-and-lobular-carcinoma-in-situ-high-risk-lesions-of-the-breast.Last updated: November 29, 2017. Accessed: September 21, 2019.