With 2.3 million women diagnosed with breast cancer each year, it has long been a familiar term in cancer treatment. Due to its prevalence and drastic impact, it is not merely a disease but a medical condition which causes turmoil in patients’ lives.
Breast Cancer: An Overview
Breast cancer occurs when abnormal growth of cells is observed, often caused as a result of mutation.
The precise mechanisms underlying breast cancer development remain a subject of ongoing investigation. However, several risk factors have been studied that affects the pathways involved in cell growth, differentiation, and ultimately apoptosis (cell death).
Let’s disclose some of the risk factors of breast cancer.
- Genetic Factors- Mutations in genes such as BRCA1 and BRCA2, as well as alterations in hormonal signalling, can contribute to the transformation of normal breast cells into malignant ones. Also, approximately 5–10% of cases of breast cancer are associated with their family history as well.
- Environmental Factors- Exposure to high levels of estrogen or progesterone over a lifetime can act as a catalyst for breast cancer.
- Lifestyle Factors- Excess weight gain can increase estrogen levels as adipose tissue can contribute up to 100% of circulating estrogen in postmenopausal women.
However, It’s important to note that not all women with these risk factors will develop breast cancer, and some women with no known risk factors may be diagnosed as well. We need to understand that the development of breast cancer is a complex interplay of various factors, and the specific causes for developing breast cancer vary from individual to individual.
Understanding the Types of Breast Cancer
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As far as the complexity of breast cancer is concerned, we should know that breast cancer can be of various types based on the degree of invasiveness, genes involved in mutation, etc. Let’s discuss them below.
Invasive Breast Cancer
Invasive breast cancer occurs when cancerous cells penetrate beyond the basement membrane of the milk ducts or lobules, allowing them to invade surrounding breast tissue as well.
Once the cancer cells have broken through this natural barrier, they can also enter the lymphatic system or bloodstream. This leads to the potential spread known as metastasis to other parts of the body. There are several subtypes of invasive breast cancer, including:
- Invasive Ductal Carcinoma (IDC)
Accounting for more than 80% of all invasive breast cancer cases, the most common form of breast cancer, IDC, begins in the milk ducts. Then, the cancer cells invade further into the surrounding breast tissue. Sometimes, via metastasis, the cancer cells reach the bones, lungs, liver, and brain as well.
- Invasive Lobular Carcinoma (ILC)
This cancer develops in the lobules, which contain the glands responsible for milk production. However, unlike IDC, ILC leads to thickening of the breast tissue, making it harder to detect in physical examination and imaging.
- Triple-Negative Breast Cancer (TNBC)
As the name suggests, Triple-negative breast cancer does not express three major prognostic factors for breast carcinoma- estrogen receptors (ER), progesterone receptors (PR), or the HER2 (human epidermal growth factor receptor 2).
Since the patient lacks these targets, they do not respond to hormonal therapies or drugs that target these specific proteins. This makes TNBC more aggressive in breast cancer, with limited treatment options. Evidence has suggested that TNBC patients have a higher risk of recurrence.
- HER2-Positive Breast Cancer
HER2 is a protein that promotes cell growth. Normally, breast cells have small amounts of this protein on their surface. In HER2-positive breast cancer, the cancer cells have an excess of HER2 receptors due to a genetic mutation. This overexpression accelerates cell division and tumour growth.
Non-Invasive Breast Cancer
Also referred to as carcinoma in situ, non-invasive breast cancer refers to cancer cells that have not breached the basement membrane or spread to surrounding tissues in the breast area.
This type is often detected early, leading to a favourable prognosis, after which a proper treatment plan can be generated. Some common forms of non-invasive breast cancer include:
- Ductal Carcinoma in Situ (DCIS)
The earliest form of breast cancer, where the abnormal cells are confined within the milk ducts and have not invaded the surrounding breast tissue, is known as DCIS.
Although DCIS is non-invasive, it has the potential to become invasive if left untreated.
- Lobular Carcinoma in Situ (LCIS)
Unlike DCIS, LCIS is not considered a true cancer but rather a marker for elevated risk for breast cancer. In LCIS, abnormal cells are found in the lobules of the breast but have not spread beyond. While LCIS itself does not usually progress to invasive cancer, it also signals a risk for developing invasive breast cancer in either breast.
Diagnosis and Treatment of Breast Cancer
The fear of diagnosis, the uncertainty of treatment outcomes, and the potential for life-altering surgeries or therapies can be overwhelming. However, with the advancement in medical sciences, we have developed various diagnostic and treatment measures.
Early detection of breast cancer can drastically improve outcomes, which is why regular screening is so important.
Breast Self-Examination (BSE)
For many women, breast cancer is detected by themselves through self-examination. With various awareness programmes, women get educated on how to regularly check their breasts and immediately report to their doctor if they find any unusual lumps, feel sudden pain, or detect any change in the size and shape of the breast. It can alert you to early signs, after which clinical examination is necessary to confirm the diagnosis.
Clinical Breast Examination (CBE)
This basically involves an examination of breasts for abnormalities, including lumps or changes in texture, by a medical professional. If something suspicious is found, further diagnostic tests will be recommended to confirm the presence of breast cancer.
Mammogram
A mammogram is an X-ray of the breast area and is currently one of the most effective screening tools for detecting early-stage breast cancer. Women over the age of 30 or those with a family history of breast cancer are advised to undergo regular mammograms so that breast cancer can be detected at an early stage.
Ultrasound
If a lump or abnormality is detected in the breast, an ultrasound may be performed .It helps to determine whether the tumour is like a solid mass that could turn cancerous with time or like a fluid-filled cyst considered usually a benign form.
Biopsy
With this method, a small sample of breast tissue is removed and examined under a microscope. This is the definitive way to confirm if a lump detected is cancerous or not. Some common types of biopsies include fine-needle aspiration, core needle biopsy, surgical biopsy: etc.
Genetic Testing
Since breast cancer is caused as a result of a mutation in genes such as BRCA1 and BRCA2, hence, in the case when breast cancer runs in families, genetic testing for mutations in the BRCA1 and BRCA2 genes may be recommended. Genetic tests can assess your risk of developing breast cancer as well.
If the tests have confirmed the presence of cancer, staging of cancer is done based on the BI-RADS scale.
Stage 0: Cancer is non-invasive and confined to the ducts (ductal carcinoma in situ, or DCIS).
Stages I-III: The cancer is progressively invasive but localised to the breast or nearby lymph nodes only.
Stage IV: The cancer has already moved to other parts of the body, such as bones, liver, or lungs.
Before moving to the treatment approach, we need to understand that breast cancer treatment is highly personalised and depends on the stage, type, and specific characteristics of the tumour.
Surgery
Surgery is often the first line of treatment for breast cancer, where the oncosurgeons surgically remove the tumour and ensure that there is the least chance of relapse. The types of surgical treatment for breast cancer include:
- Lumpectomy
Also known as breast-conserving surgery, this procedure removes the tumour and a small margin of surrounding tissue while preserving most of the breast. The breast size is reduced after lumpectomy.
- Mastectomy
Here, one or both breasts are entirely removed to eliminate cancerous tissue. In partial mastectomy, a portion of the breast tissue is removed while preserving the overall shape of the breast. In cases where a high risk of recurrence is there, radial mastectomy is done where a wide margin of healthy tissue is removed around the tumour, creating a wedge-shaped incision.
Most of the patients further go for reconstruction surgery to restore the breast’s appearance after radical mastectomy.
Radiation Therapy
Radiation uses high-energy rays to target and destroy cancer cells. It is often recommended after surgery, particularly following a lumpectomy surgery. This combined treatment approach aims to reduce the risk of recurrence.
Chemotherapy
When drugs are used to destroy cancer cells, the approach is known as chemotherapy. Often employed as neoadjuvant therapy, it is used to shrink tumours prior to surgery. However, it has some common side effects, such as hair loss, fatigue, and nausea.
Hormonal (Endocrine) Therapy
Since breast cancer is associated with the overproduction of certain hormones, hormonal therapy can block or lower hormone levels to prevent the cancer from growing or recurring.
Immunotherapy
In certain cases, such as triple-negative breast cancer, immunotherapy drugs are used to help the body’s immune system to specifically recognise cancer cells and attack them.
One of the most effective strategies in modern oncology is combination of therapies. Often referred to as multimodal therapy, This approach involves using multiple types of treatments in combination to target the cancer from different angles. By doing so, it significantly increases the chances of successful outcomes and long-term survival for breast cancer patients.
Thus, the combination of approaches utilised affect the cost of breast cancer treatment in India and other countries such as Turkey, Thailand and Germany.
Conclusion
Breast cancer treatment has come a long way, thanks to medical advancements and personalised care. However, early diagnosis and understanding the warning signs specific to each type have been the emphasis of breast cancer treatment. Remember that breast cancer is treatable, and a healthy, cancer-free life is within reach.
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