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An estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed among women in the US during 2015; about 2,350 new cases are expected in men. Exclud­ing cancers of the skin, breast cancer is the most frequently diagnosed cancer in women. The breast cancer incidence rate decreased almost 7% among white women from 2002 to 2003. This dramatic decrease has been attributed to reductions in the use of menopausal hormone therapy (MHT), previously known as hormone replacement therapy, after it was reported in 2002 that the use of combined estrogen plus progestin MHT was asso­ciated with an increased risk of breast cancer and coronary heart disease. From 2007 to 2011, the most recent 5 years for which data are available, breast cancer incidence rates were stable in white women and increased slightly (by 0.3% per year) in black women.

Treatment: Taking into account tumor characteristics, includ­ing size and extent of spread, as well as patient preference, treatment usually involves either breast-conserving surgery (surgical removal of the tumor and surrounding tissue) or mas­tectomy (surgical removal of the breast). Numerous studies have shown that for early breast cancer (without spread to the skin, chest wall, or distant organs), long-term survival is similar for women treated with breast-conserving surgery plus radiation therapy and those treated with mastectomy. Women undergo­ing mastectomy who elect breast reconstruction have several options, including the tissue or materials used to restore the breast shape and the timing of the procedure.

Underarm lymph nodes are usually removed and evaluated dur­ing surgery to determine whether the tumor has spread beyond the breast. For early stage disease, sentinel lymph node biopsy, a procedure in which only the first lymph nodes to which cancer is likely to spread are removed, has a lower risk of long-term side effects (e.g., lymphedema, or arm swelling caused by the accu­mulation of lymph fluid) and is as effective as a full axillary node dissection, in which many nodes are removed.

Treatment may also involve radiation therapy, chemotherapy (before or after surgery), hormone therapy (e.g., selective estro­gen receptor modifiers, aromatase inhibitors, ovarian ablation), and/or targeted therapy. Women with early stage breast cancer that tests positive for hormone receptors benefit from treatment with hormonal therapy for at least 5 years. For postmenopausal women, treatment with an aromatase inhibitor (e.g., letrozole, anastrozole, or exemestane) is preferred in addition to, or instead of, tamoxifen. For women whose cancer overexpresses the growth-promoting protein HER2, several targeted therapies are available.