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Complete excision of all invasive and in situ disease is essential. 6) times more likely if margins are involved. Wider margins (beyond 1 mm) do not reduce local recurrence further but do adversely affect cosmetic outcomes. Neither atypical ductal hyperplasia nor lobular carcinoma at the margins increases local recurrence and re-excision based on their presence at a resection margin is not necessary. The risk of local recurrence falls with increasing age: young patients (Ͻ35) are two to three times more likely to develop local recurrence than older patients.

Ionising radiation also increases risk later in life but by considerably less. 3 Diethylstilbestrol 2 Cumulative risk of cancer (%) Certain mutations occur at high frequency in defined populations. For instance, some 2% of Ashkenazim Jewish women carry BRCA1 185 del AG (deletion of two base pairs in position 185), BRCA1 5382 ins C (insertion of an extra base pair at position 5382), or BRCA 6174 del T (deletion of a single base pair at position 6174), while BRCA2 999 del 5 (deletion of five base pairs at position 999) accounts for about half of all familial breast cancer in Iceland.

London: Saunders, 2000. ● Dixon JM, Bundred NJ. Management of disorders of the ductal system. In: Harris JR, Lippman ME, Morrow M, Hellman S, eds. Diseases of the breast. Philadelphia: Lippincott Williams and Wilkins, 2004:47–56. ● Taylor GB, Paviour SD, Musaad S, Jones WO, Holland DJ. A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology 2003;35:109–19. ● 23 5 Breast cancer—epidemiology, risk factors, and genetics K McPherson, CM Steel, JM Dixon With over a million new cases in the world each year, breast cancer is the most common malignancy in women and comprises 18% of all female cancers.

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