Summary: Screening, diagnosis & staging of breast cancer and multidisciplinary team working
- Frequent BC symptoms and signs include a palpable breast lump, skin or nipple retraction, bloody discharge from the nipple, changes in breast size or shape, skin rash, ulceration, erythema and eczema of the nipple–areola complex
- The gold standard for diagnosis is the triple diagnostic approach consisting of clinical examination, breast imaging and needle biopsy of suspicious lesions
- The diagnostic accuracy of CNB is superior when compared with FNAC. Moreover, hormone-receptor and HER2 statuses can be determined from CNB
- Breast MRI is beneficial when planning breast conservation in patients with invasive lobular cancer, when assessing response to neoadjuvant treatment and in surveillance of high-risk women with genetic predisposition for BC
- Axillary US with needle biopsy from suspicious nodes is an essential part of the diagnostic procedure
- SLNB is the gold standard in patients without evidence of axillary nodal metastases in the pre-treatment US examination of the axilla
- Staging by imaging to detect distant metastases is considered for high-risk patients
- The main goal of the multidisciplinary team meeting is to optimise the treatment for each patient. It is mandatory for all patients with BC
- Organised BC screening is strongly recommended for asymptomatic women aged 50–69, and conditionally recommended for women aged 45–49 or 70–74
- Screening reduces mortality from BC; the effect is best documented for postmenopausal women
Further Reading
- Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med 2019; 381:2091–2102.
- Biganzoli L, Marotti L, Hart CD, et al. Quality indicators in breast cancer care: an update from the EUSOMA working group. Eur J Cancer 2017; 86:59–81.
- Flemban AF. Overdiagnosis due to screening mammography for breast cancer among women aged 40 years and over: a systematic review and meta-analysis. J Pers Med 2023; 13:523.
- Giorgi Rossi P, Lebeau A, Canelo-Aybar C, et al; ECIBC Contributor Group. Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative. Br J Cancer 2021; 124:1503–1512.
- European Guidelines on Breast Cancer Screening and Diagnosis. https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breastcancer-guidelines (date last accessed, 10 October 2024).
- Kesson EM, Allardice GM, Geroge WD, et al. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 2012; 344:e2718.
- Krop I, Ismaila N, Andre F, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline focused update. J Clin Oncol 2017; 35:2838–2847.
- Loibl S, André F, Bachelot T, et al; ESMO Guidelines Committee. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159–182.
- Sessa C, Balmaña J, Bober SL, et al; ESMO Guidelines Committee. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:33–47.
- Wang M, He X, Chang Y, et al. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: a systematic review and meta-analysis. Breast 2017; 31:157–166.
