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Clinical Summary

Female breast cancer is the leading cause of cancer-related mortality of women in the world. Patients seek care at all stages of disease from early (painless immobile breast lump, bloody nipple discharge, and mammography abnormality) to late (axillary lymphadenopathy, thickening of the breast skin [peau d’orange appearance], necrotic mass, and metastases to bone, liver, or lungs).

Management and Disposition

ED management of a breast mass suspicious for cancer depends on patient stability, level of function, severity of pain, and social and medical resources. Patients with suspected or obvious advanced disease who are reluctant to seek care should be hospitalized to determine disease staging. Stable patients with painless mass or abnormal mammography and medical resources should be referred to breast surgeon for biopsy.

FIGURE 7.91

Breast Mass. Necrotic breast mass in patient with suspected advanced breast cancer. (Photo contributor: Kevin Barlotta, MD.)

Pearls

  1. Approximately 250,000 cases of breast cancer are diagnosed annually in the United States with an associated 40,000 deaths.

  2. Mortality rates have decreased over the past 50 years in part due to improved breast cancer screening, patient awareness, and adjuvant therapy.

  3. Denial delays time-sensitive treatment.

FIGURE 7.92

Breast Mass. Peau d’orange appearance of the breast suggesting underlying breast cancer. (Photo contributor: Michael G. Clark.)

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