Pink Ribbons of Strength: Uniting for Breast Cancer Awareness.
Key Facts:
- Devastating Toll: Breast Cancer accounted for 685,000 fatalities worldwide in 2020.
- Unpredictable Nature: Roughly 50% of breast cancer cases develop in women without identifiable risk factors, except for their sex and age.
- A Global Challenge: Breast Cancer manifests in every corner of the world.
- Breaking Stereotypes: Men face an approximate incidence rate of 0.5-1% in breast cancer cases.
Breast cancer is characterized by the uncontrolled growth of abnormal cells in the breast, leading to the formation of tumors. If left unchecked, these tumors have the potential to spread throughout the body and result in a life-threatening condition.
The origin of breast cancer cells can be traced back to either the milk ducts or the milk-producing lobules within the breast. The earliest stage, known as in situ, does not pose a direct threat to life. However, when cancer cells invade the surrounding breast tissue, they form tumors that manifest as lumps or areas of thickening.
Invasive breast cancers have the ability to spread to nearby lymph nodes or other organs, a process referred to as metastasis. Metastasis carries the risk of fatality, as cancer cells establish growth in distant parts of the body.
The treatment approach for breast cancer varies based on factors such as the individual, the specific type of cancer, and its extent of spread. Typically, treatment involves a combination of surgery, radiation therapy, and medications.
In the year 2020, breast cancer diagnoses affected 2.3 million women globally, resulting in 685,000 deaths. By the end of that same year, there were approximately 7.8 million women who had been previously diagnosed with breast cancer within the past five years, solidifying its status as the most prevalent cancer worldwide. Breast cancer can develop in women of any age following puberty, with rates tending to increase as individuals grow older.
Historically, breast cancer mortality rates remained relatively stable from the 1930s through the 1970s, during a time when surgical intervention alone, particularly radical mastectomy, was the primary treatment approach. However, significant advancements in survival rates emerged in the 1990s with the establishment of breast cancer early detection programs in various countries. These programs were complemented by comprehensive treatment strategies incorporating highly effective medical therapies.
The female gender remains the most significant risk factor for breast cancer, with approximately 0.5-1% of cases occurring in men. The treatment approach for breast cancer in men follows the same principles applied to women.
Several factors contribute to an increased risk of breast cancer, including advancing age, obesity, excessive alcohol consumption, a family history of breast cancer, prior exposure to radiation, reproductive history (such as the age of first menstruation and age at first pregnancy), tobacco use, and postmenopausal hormone therapy. Remarkably, around half of breast cancer cases develop in women who do not possess any discernible risk factors other than being female and over the age of 40.
While a family history of breast cancer heightens the risk, it is important to note that most women diagnosed with breast cancer have no known family history of the disease. Therefore, the absence of a known family history does not necessarily imply reduced risk.
Certain inherited gene mutations with high penetrance significantly elevate the risk of breast cancer, particularly mutations in the BRCA1, BRCA2, and PALB-2 genes. Women identified as carriers of these major gene mutations may consider risk reduction strategies, such as prophylactic bilateral mastectomy (surgical removal of both breasts).
What to look out for?
Breast cancer can exhibit various combinations of symptoms, particularly in advanced stages, while many individuals may not experience any symptoms during the early stages of the disease.
Symptoms associated with breast cancer may encompass the following:
- Presence of a painless lump or thickening in the breast
- Changes in the size, shape, or appearance of the breast
- Skin changes, including dimpling, redness, pitting, or other alterations
- Changes in the nipple’s appearance or the surrounding skin (areola)
- Abnormal or bloody fluid discharge from the nipple
Individuals who detect an abnormal lump in the breast, regardless of whether it causes pain or not, should seek medical attention.
It is important to note that the majority of breast lumps are noncancerous. However, cancerous breast lumps have a higher chance of successful treatment when they are small and have not spread to nearby lymph nodes.
Breast cancer can spread to other parts of the body, giving rise to additional symptoms. Typically, the most common initial site of spread is the lymph nodes located under the arm, although cancerous lymph nodes may not be palpable.
As time progresses, cancer cells can metastasize to other organs, such as the lungs, liver, brain, and bones. When cancer reaches these sites, new symptoms related to the spread of cancer, such as bone pain or headaches, may emerge.
Possible course of treatment: Depends on your Healthcare Provider/Practitioner.
These are generalized course only, not a medical advise.
The treatment approach for breast cancer relies on the specific subtype of cancer and its extent of spread, either to the lymph nodes (stages II or III) or to distant parts of the body (stage IV).
Medical professionals employ a combination of treatments to minimize the risk of cancer recurrence. These encompass:
- Surgical intervention to remove the breast tumor.
- Radiation therapy aimed at reducing the likelihood of cancer recurrence in the breast and surrounding tissues.
- Administration of medications designed to eradicate cancer cells and impede their spread, such as hormonal therapies, chemotherapy, or targeted biological therapies.
Initiating treatment for breast cancer early and completing the full course of treatment significantly enhances effectiveness and tolerance.
Surgery options may involve the removal of solely the cancerous tissue (known as lumpectomy) or the entire breast (mastectomy). Additionally, surgery may include the removal of lymph nodes to assess the cancer’s potential for spreading.
Radiation therapy is employed to treat residual microscopic cancers in the breast tissue and/or lymph nodes, thus minimizing the chances of cancer recurrence on the chest wall.
In advanced cases, breast cancer may erode the skin, resulting in the formation of open sores (ulceration), which may or may not be accompanied by pain. Women experiencing non-healing breast wounds should seek medical attention for a biopsy.
The selection of medicines for treating breast cancer is based on the biological characteristics of the cancer determined through specialized tests, including tumor marker analysis. The majority of drugs used for breast cancer treatment are already included in the World Health Organization (WHO) Essential Medicines List (EML).
Lymph nodes are typically removed during surgery for invasive breast cancers. Previously, complete removal of the lymph node bed under the arm (known as complete axillary dissection) was believed to be necessary to prevent cancer spread. However, a less extensive procedure called “sentinel node biopsy” is now preferred as it poses fewer complications.
The medical treatments administered for breast cancer, either before (neoadjuvant) or after (adjuvant) surgery, are determined by the specific biological subtypes of the cancer.
Cancers expressing the estrogen receptor (ER) and/or progesterone receptor (PR) tend to respond well to endocrine (hormone) therapies like tamoxifen or aromatase inhibitors. These medications are taken orally for 5-10 years and significantly reduce the risk of recurrence in “hormone-positive” cancers by nearly half. Although endocrine therapies can induce menopause-like symptoms, they are generally well-tolerated.
For cancers lacking expression of ER or PR, known as “hormone receptor negative” cancers, chemotherapy is necessary unless the cancer is small in size. Modern chemotherapy regimens are highly effective in reducing the chances of cancer spread or recurrence and are typically administered on an outpatient basis. In the absence of complications, hospital admission is generally not required for chemotherapy treatment in breast cancer cases.
Some breast cancers independently exhibit overexpression of a molecule called the HER-2/neu oncogene. These “HER-2 positive” cancers can be effectively treated with targeted biological agents such as trastuzumab. However, these biological therapies tend to be expensive due to being antibody-based rather than chemical-based. When targeted biological therapies are used, they are typically combined with chemotherapy to maximize their effectiveness in eradicating cancer cells.
Radiotherapy plays a crucial role in breast cancer treatment. In early-stage breast cancers, radiation therapy can help avoid the need for a mastectomy. In later stages, it significantly reduces the risk of cancer recurrence, even after a mastectomy has been performed. In certain cases of advanced breast cancer, radiation therapy may also contribute to a reduced likelihood of succumbing to the disease.
The effectiveness of breast cancer therapies is highly dependent on completing the full course of treatment. Incomplete treatment is less likely to yield positive outcomes.
In high-income countries, the age-standardized mortality rate for breast cancer witnessed a significant decline of 40% between the 1980s and 2020. The countries that have successfully reduced breast cancer mortality rates achieved an annual reduction of 2-4% per year.
Improving outcomes for breast cancer and other diseases relies on strengthening fundamental healthcare systems to deliver established effective treatments. These strategies are also crucial for managing other types of cancer and non-malignant noncommunicable diseases (NCDs). For instance, establishing reliable referral pathways that connect primary care facilities to district hospitals and dedicated cancer centers.
The establishment of these referral pathways serves as a universal approach for managing various types of cancer, including cervical cancer, lung cancer, colorectal cancer, and prostate cancer. Breast cancer acts as an “index” disease, allowing the creation of pathways that can be followed for the effective management of other diseases.
