Breast Cancer: Risk Factors, Diagnosis or Detection, and Treatment Options

Introduction to Breast Cancer (BC)

Cancer is a cellular malignancy whose unique trait is loss of normal controls which results in unregulated growth, lack of differentiation and ability to invade local tissues and metastasize. The estimated number of new cases each year is expected to rise from 10 million in 2002 to 15 million by 2025, with 60% of those cases occuring in developing countries.
Breast cancer is the most common form of cancer in women. A cancerous growth in any parts of the breast is possible. BC is often described as abnormal division of
the cells of the ducts or lobules of the breast. It occurs mainly in females and very rare in males (<1%) as testosterone
suppresses breast lobular growth at puberty.

Types of Breast Cancer

Breast Cancer is divided into two main types:

1. Non-invasive BC

• Ductal carcinoma in situ: This is associated with increased risk of
  Invasive BC

2. Invasive BC

• Invasive ductal carcinoma (80% of BC)
• Invasive lobular carcinoma
• Others: Paget’s disease of the nipples,
  secondary BC, locally advanced BC.

Origin and Spread of Breast Cancer

BC can originate from two parts of the
breasts:

1. Ducts (80% of cancers)
2. Lobules

From the origin, the cancer spreads through
the blood and lymphatic vessels. The lymph nodes are the first point of BC spread from its origin.
In relation to BC, the affected lymph nodes
are:

• Axillary lymph nodes (first point to be
  affected)
• Supraclavicular lymph nodes
• Infraclavicular lymph nodes
• Internal mammary lymph nodes.

Presence of the cancer in the nodes is an
indicator of a possible spread to other parts
of the body. It is not all metastasized Breast Cancer that appears in the lymph nodes and not all breast cancer in the lymph nodes have metastasized.

Pathophysiology of Breast Cancer

• Mutations in DNA of breast cause abnormal growth
•  BC could be acquired or inherited: most breast cancer cases are due to acquired mutations; while 5-10 % of it are inherited.
• Mutated DNA leads to mutant genes

– Proto-oncogenes: supposed to help normal cell division; mutation leads to cancers

– Tumour suppression genes: supposed to slow cell division and repair errors; abnormality leads to cancer

• BRCA1 and BRCA2 are inherited tumour suppression genes that dramatically increase the risk for breast cancer.

Risk Factors to Breast Cancer Include

1. Endocrine Factors

• Early Menarch.
• Late Menopause.
• Age of first pregnancy (over 30).
• Fewer pregnancies.
• Oral contraceptives.
• Hormone Replacement Therapy.

2. Genetic Factors

• Family History.
• BRCA-1 and BRCA-2 genes.

Expression of these genes increases the risk of breast cancer by 85%.

3. Environmental Factors÷

• High fats and high calorie diets.

• Heavy alcohol use.

• Cigarette smoking.

• High radiation exposure.

Detection and Diagnosis of Breast Cancer

Early detection of Breast Cancer improves the outcome of therapy. A woman’s breasts go through many normal changes throughout her lifetime. The breasts are affected by hormonal changes during the menstrual cycle, pregnancy, breast-feeding, the menopause and weight loss or weight gain.
However, there are changes that would require thorough Medical attention and they include:

• A lump in either breast or armpit.
• A lumpy area or thickening anywhere in the breast.
• Enlarged glands under either armpit.
• Blood-stained nipple discharge.
• Any marked changed of appearance in a nipple such as nipple pulling.
• A change in the size or shape of one breast.
• Swelling, thickening or persistent pain in either breast that feels different from premenstrual tenderness.
• Swelling of the upper arm.

Breast Self-examination, Medical Examination and Mammography are the three complimentary screening techniques used. Others include:

• Breast Ultrasound (Breast Sonography).
• Fine Needle Aspiration (FNA).
• Needle Core Biopsy.
• Surgical Biopsy.
• Frozen Section Biopsy.
• Magnetic Resonance Imaging (MRI).

Symptoms of Breast Cancer

• New mass, lumpiness/thickening which is often painless, but may be tender and soft. More attention should be paid to this especially if it is in one breast.
• Changes to the size or shape/contour of the breasts.
• Changes to the skin of the breast: dimpling, irritation, indentation, rash, scaling.
• Changes to the nipples: shape, sores, redness, retraction, discharge (not breast milk).
• Swollen and/or painful lymph nodes

Staging and Grading of Breast Cancer

Staging

Stage I

•  < 2 cm, no axillary lymph node
  involvement

Stage IIA

• < 2 cm, with axillary lymph node involvement
  OR
• 2 – 5 cm, no axillary lymph nodes
  involvement

Stage IIB:

• 2 – 5 cm, with axillary lymph nodes
  involvement

Stage III

• Locally advanced Breast Cancer

Stage IV

• advanced Breast Cancer

Grading

Grade 1

• Also called low grade Breast Cancer
• Slight difference with normal cells, slow growing

Grade 2

• Also called intermediate grade Breast Cancer
• Unlike normal cells, grow faster than Grade 1 but slower than Grade 2

Grade 3

• Grade 3 is also called high grade
• It is completely different from normal cells and it is fast growing

Prognosis: Expected outcome of the ailment

• Breast Cancer is the second cause of deaths in women with cancers after lung cancers
• Exact course of disease difficult to map
• Early detection, standard diagnosis, and appropriate treatment options improves survival rate

Therapeutic of Breast Cancer 

Prevention

1. Chemo prevention
2. Vaccination
3. Reduction of exposure to modifiable risks

Treatment

1. Surgical therapy
2. Chemotherapy
3. Radiotherapy

Palliation

1. Surgery: (Lumpectomy and Mastectomy).
2. Chemotherapy.
3. Hormone Therapy.
4. Radiation Therapy.

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1. Breast Cancer Risk and Prevention. American Cancer Society website. Accessed August 12, 2021
2. Drugs Approved for Breast Cancer. National Cancer Institute. Accessed August 12, 2022
3. Tracy-Ann Moo, MD, Rachel Sanford, MD et al. Overview of Breast Cancer Therapy. NCBI. Accessed August 12, 2021
4. Breast Cancer. CDC. Accessed August 12, 2021
5. Abdulmuminu Isah, M.Pharm. Therapeutics of Breast Cancer.[/toggle]