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Breast cancer

Breast cancer is highly prevalent in women. Globally, it is the prominent cause of cancer deaths in women. Clinicians and scientists are persistently seeking better ways to improve prognosis of the patients. The term breast cancer coalesces a group of mammalian tumor subtypes, each with a unique molecular and cellular source as well as clinical traits. The prognosis of the disease is worse for particular subtypes and in poorly developed countries where the diagnosis is done late. This paper will focus on the epidemiology, etiology, pathophysiology, treatment, and prognosis of breast cancer. The paper will give new insight into the management of the condition.

For a long time, breast cancer used to have a high mortality rate in cancer patients, but now it has been surpassed by lung cancer. In the US, it accounts for approximately 30% of all cancers among women. Most of the early cases are often asymptomatic. The US predicts that there will about 276,480 cases diagnosed in women in 2020 and 2620 cases in men. The number of cases in the US soared in the 1980s because of a widespread increase in screening (Siegel, Kimberly & Ahmed). Breast cancer cases surged outside the US, with the highest incidence reported in Westernized countries due to the increased awareness and screening. Women in these countries have altered reproductive patterns, which may explain the reason for the increased cases. A mammogram diagnosis is a confirmatory diagnosis for breast cancer. Guidelines recommend the use of a triple approach to diagnose the condition. It consists of clinical examination, needle biopsy, and breast imaging. Due to constant public awareness, more screening and early diagnosis are made in developed countries worldwide.

Breast cancer presents with the following signs and symptoms: axillary lump, skin changes, nipple abnormalities, increase or decrease in breast size, or a change in its shape. Cancer develops when there is a change in molecular and cellular structures of the mammalian epithelial cells that causes uncontrolled cell growth and dysfunctional apoptosis. Research into the genetic profiles of the cancers has shown there are several discrete subtypes of this cancer. The subtypes are grouped based on the presence or absence of ER, PR, and HER2. The intrinsic subtypes of breast cancer are luminal A, basal-like, HER2-positive, and luminal B. Each of these subtypes has its distinct features that guide its clinical management. The basal-like subtype shares many features with ovarian cancers (Tomczak et al.).

The etiology of breast cancer is founded on epidemiological studies. There are several risk factors for the disease. Firstly, age and gender. Sporadic cases are few in women aged below 40 years. However, the number increases immensely above that age. Breast cancer occurs at conspicuously greater numbers in women than men. One could easily say that it is a condition for women, just like the way prostate cancer is for men. Secondly, a positive family history exacerbates the risk of getting breast cancer. Family is one of the most intensely researched factors. A person has a 4-time lifetime risk if a mother and sister get the condition. The risk increases to 5 times when there are two or more first-degree relatives diagnosed with breast cancer (DeSantis). Thirdly, reproductive, and steroid hormone factors. For example, a late age to first pregnancy, nulliparity, late onset of menopause increases the person’s susceptibility to the condition. Clinical trial data have demonstrated the benefits of the use of SERMs agents such as tamoxifen and raloxifene. Oral contraceptives and hormonal replacement therapy are common in women of childbearing age, which significantly predisposes them to breast cancer. Fourth, lifestyle risk factors. Diet rich in fruits, vegetables, and grains, monounsaturated fatty acids, low alcohol intake provides a protective effect on women. Other factors include obesity and environmental factors such as smoking, alcohol use, and carcinogens (Tao).

In the clinical setting, management of breast cancer is done through surgery, radiation, or chemotherapy. The three approaches are frequently combined to achieve better results. There are two types of surgery mainly done namely, lumpectomy and total mastectomy. To reduce residue disease, radiation therapy is done after surgery. Pharmacotherapy is utilized regularly and can be either hormonal or chemotherapeutic. Some of these include methotrexate, cyclophosphamide, carboplatin, docetaxel, and trastuzumab. HER2 positive cancers may be treated with HER2-targeted therapy in combination with angiogenesis inhibitors. The SERM agents are used in the prophylaxis of breast cancer. Some women with a high risk of getting breast cancer opt for prophylactic mastectomy (Waks & Eric).

HER2 subtype is accompanied by a poorer prognosis. As a result, adjuvant therapy with trastuzumab, pertuzumab, and lapatinib is recommended to avoid worse outcomes. Anthracycline-based agents like doxorubicin also improve prognosis in this group of patients. There are two types of DCIS cancers: comedo and non-comedo. The worst prognosis occurs with comedo DCIS. 10-20% of LCIS women develop invasive metastatic breast cancer in about 15 years. Metastatic breast cancer leads to death within 3-5 years (DeSantis).

One of the goals of therapy is to avoid metastasis since it has a poor outcome. Early breast examination and imaging can help to ensure early diagnosis as it has been shown to have the best outcomes. Consequently, each country should put in measures to sensitize the public on the necessity of regular screening. Going forward, there is a need to encourage the world population to adopt a healthy lifestyle. In addition, to mitigating cancers, an appropriate lifestyle prevents a myriad of diseases.

Works cited

DeSantis, Carol E., et al. “Breast cancer statistics, 2019.” CA: a cancer journal for clinicians 69.6 (2019): 438-451.

Siegel, Rebecca L., Kimberly D. Miller, and Ahmedin Jemal. “Cancer statistics, 2019.” CA: a cancer journal for clinicians 69.1 (2019): 7-34.

Tao, ZiQi, et al. “Breast cancer: epidemiology and etiology.” Cell biochemistry and biophysics 72.2 (2015): 333-338.

Tomczak, Katarzyna, Patrycja Czerwińska, and Maciej Wiznerowicz. “The Cancer Genome Atlas (TCGA): an immeasurable source of knowledge.” Contemporary oncology 19.1A (2015): A68.

Waks, Adrienne G., and Eric P. Winer. “Breast cancer treatment: a review.” Jama 321.3 (2019): 288-300.