Consultant 0

Breast Cancer

Breast Cancer

  • Definition and Prevalence
    • Breast cancer arises from the breast tissue, most frequently from the cells lining the milk ducts or lobules.
    • It is one of the most commonly diagnosed cancers in women worldwide, although men can also develop breast cancer (albeit at much lower rates).
  • Risk Factors
    • Gender and Age: Being female and older age are the most significant risk factors.
    • Family History and Genetics: Mutations in genes such as BRCA1 and BRCA2, and a strong family history of breast or ovarian cancer, increase risk.
    • Hormonal Factors: Early menarche (first period), late menopause, older age at first full-term pregnancy or having no pregnancies.
    • Lifestyle Factors: Obesity, sedentary lifestyle, high alcohol consumption, and long-term use of hormone replacement therapy.
    • Other Factors: Previous chest radiation, certain benign breast conditions.
  • Symptoms
    • A lump or thickening in the breast or underarm area.
    • Changes in breast size, shape, or appearance.
    • Dimpling or puckering of the skin.
    • Redness or scaling around the nipple or breast skin.
    • Nipple retraction or unusual discharge.

Disease Progression

  • Early-Stage Disease
    • May present as a small, localized tumor confined to the breast.
    • Often asymptomatic and may be detected via mammography.
  • Local Spread
    • Tumor can grow, invade surrounding breast tissue, and involve nearby lymph nodes (commonly in the axilla/underarm).
  • Regional and Distant Metastases
    • Cancer cells may travel to lymph nodes beyond the axillary area, or spread to other organs such as bone, liver, lungs, or brain.
    • Advanced metastatic disease is more challenging to treat curatively, and treatment often focuses on prolonging life and managing symptoms.

Screening*

  • Mammography
    • Gold Standard for breast cancer screening.
    • Recommended annually or biennially for women starting at age 40 or 50 (depending on specific national guidelines), continuing until at least age 74 or beyond based on individual risk and health status.
    • Can detect tumors before they are palpable, improving early diagnosis.
  • Breast MRI
    • Used for high-risk individuals (e.g., BRCA mutation carriers, strong family history) in combination with mammography.
    • More sensitive than mammography but has a higher rate of false positives.
  • Clinical Breast Exam
    • Performed by a healthcare provider to detect abnormalities.
    • Often part of annual check-ups, but utility for screening is less definitive compared to mammography.
  • Breast Self-Exam
    • Encouraged for women to become familiar with how their breasts normally feel so they can detect changes.
    • Not a substitute for mammography but can help patients notice any unusual lumps or changes.

Treatment Approaches

Treatment depends on the stage of breast cancer, the biological features of the tumor (hormone receptor status, HER2 status), and the patient’s overall health and preferences.

  • Surgery
    • Breast-Conserving Surgery (Lumpectomy): Removal of the tumor and a margin of surrounding tissue; often followed by radiation.
    • Mastectomy: Removal of the entire breast; may be followed by reconstruction.
    • Lymph Node Evaluation: Sentinel lymph node biopsy or axillary lymph node dissection to assess spread.
  • Radiation Therapy
    • Often used after lumpectomy (breast-conserving approach) to reduce recurrence risk.
    • May also be used post-mastectomy for large tumors or lymph node involvement.
  • Systemic Therapy
    • Chemotherapy: Used before surgery (neoadjuvant) to shrink the tumor or after surgery (adjuvant) to eliminate microscopic disease.
    • Hormonal Therapy: Indicated if the tumor is estrogen receptor (ER) and/or progesterone receptor (PR) positive. Common drugs include:
      • Tamoxifen (primarily in premenopausal women)
      • Aromatase Inhibitors (e.g., letrozole, anastrozole) in postmenopausal women
    • Targeted Therapy:
      • Anti-HER2 Agents (e.g., trastuzumab, pertuzumab) for HER2-positive tumors.
      • CDK4/6 Inhibitors (e.g., palbociclib) for ER-positive/HER2-negative metastatic disease.
      • PARP Inhibitors (e.g., olaparib) in patients with BRCA mutations.
    • Immunotherapy:
      • Agents like pembrolizumab are approved for certain advanced breast cancers (particularly triple-negative with high PD-L1 expression or high tumor mutational burden).
  • Neoadjuvant and Adjuvant Approaches
    • Neoadjuvant: Chemotherapy, targeted therapy, or hormonal therapy given before surgery to shrink tumors for breast-conserving approaches.
    • Adjuvant: Post-surgical therapy to reduce the risk of recurrence, tailored to tumor characteristics and stage.
  • Palliative and Supportive Care
    • Advanced or metastatic disease often requires treatments aimed at symptom control (e.g., pain management, bone-strengthening agents like bisphosphonates or denosumab).
    • Palliative care teams can help maintain quality of life alongside oncologic treatment.

Summary

Breast cancer remains one of the most common and treatable malignancies when detected early. Screening, particularly through mammography, is key to identifying tumors at an early stage. Treatment plans are highly individualized and often involve a combination of surgery, radiation, systemic therapy (chemotherapy, hormonal therapy, targeted therapy, immunotherapy), and supportive care. Prognosis varies widely based on stage, biological subtype, and patient factors; however, continuous advances in treatment strategies have led to ongoing improvements in survival rates and quality of life for breast cancer patients.

 

* Please note that screening programs may vary among different countries.