Introduction
When aberrant breast cells proliferate uncontrollably and develop into tumors, it is known as breast cancer. The tumors have the potential to spread throughout the body and become lethal if untreated.
The milk ducts and/or the breast’s milk-producing lobules are where breast cancer cells start. The earliest type, known as in situ, is detectable in its early stages and poses no harm to life. Cancer cells have the ability to invade neighboring breast tissue. Tumors resulting from this induce thickening or lumps.
It is possible for invasive tumors to metastasis, or spread, to other organs or surrounding lymph nodes. Metastasis can be deadly and life-threatening.
The patient, the type of cancer, and its spread all influence the course of treatment. Radiation therapy, medicine, and surgery are all part of the treatment.
The extent of the issue
2.3 million women received a breast cancer diagnosis in 2022, and 670,000 people died from the disease worldwide. In any nation on earth, breast cancer can strike women at any age after puberty, though its incidence rises with age.
Global estimations show glaring disparities in the incidence of breast cancer based on human development. For example, 1 in 12 women may receive a breast cancer diagnosis over their lifetime and 1 in 71 will pass away from the disease in nations with extremely high Human Development Indexes (HDIs).
In comparison, 1 in 48 women will die from breast cancer in nations with a low HDI, even though only 1 in 27 women will receive a breast cancer diagnosis during their lifetime.
Who is in danger?
Female gender is the strongest breast cancer risk factor. Approximately 99% of breast cancers occur in women and 0.5–1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.
Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy. Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years).
Although the majority of women who are diagnosed with breast cancer do not have a known family history of the disease, having a family history of breast cancer increases the chance of developing breast cancer. A woman is not always at lower risk just because her family history is unknown.
The most common inherited high penetrance gene mutations that significantly raise the risk of breast cancer are those in the BRCA1, BRCA2, and PALB-2 genes. Women who have mutations in these key genes may think about risk-reduction measures like chemoprevention or surgically removing both breasts.
Symptoms and indicators
Early detection is crucial because the majority of people won’t exhibit any symptoms when the cancer is still in its early stages.
Combinations of symptoms are common in breast cancer, particularly in more advanced stages. Breast cancer symptoms can include:
- unnatural or crimson nipple fluid.
- alteration in the look of the nipple or the areola, the skin around it
- Redness, pitting, dimpling, or other skin abnormalities
- a breast thickening or lump, frequently painless
Even if an atypical breast lump doesn’t ache, people should still get medical attention.
Most bumps on the breast are not cancerous. Cancerous breast lumps that are tiny and have not migrated to neighboring lymph nodes have a better chance of being effectively treated.
Breast cancers can cause additional symptoms and spread to other parts of the body. Although it is possible to have cancer-bearing lymph nodes that are not palpable, the lymph nodes under the arm are frequently the most frequently found initial site of dissemination.
Cancerous cells have the potential to spread over time to other organs, such as the brain, liver, lungs, and bones. New cancer-related symptoms, such headaches or bone pain, may manifest once they reach these locations.
Treatment of breast cancer
The subtype of breast cancer and the extent to which it has spread to lymph nodes (stages II or III) or other regions of the body (stage IV) determine the course of treatment.
To reduce the likelihood that the cancer will return (recur), doctors combine different treatments. These consist of:
- drugs that destroy cancer cells and stop them from spreading, such as targeted biological therapies, hormone therapies, or chemotherapy.
- radiation treatment to lower the risk of breast and surrounding tissue recurrence
- surgery to remove the breast tumor
Breast cancer treatments that are initiated early and completed are more effective and more tolerated.
Surgery can remove the entire breast (mastectomy) or just the malignant tissue (lumpectomy). In order to determine whether the cancer has the potential to spread, surgery may also remove lymph nodes.
Radiation therapy reduces the likelihood of cancer reoccurring on the chest wall and treats microscopic malignancies that are still present in the breast tissue and/or lymph nodes.
Although they are not always unpleasant, advanced malignancies can erode through the skin to produce open sores, or ulcerations. Women who have non-healing breast sores should see a doctor so that a biopsy can be done.
The biological characteristics of breast cancer, as identified by specialized testing (tumor marker determination), are taken into consideration when choosing medications to treat the disease. The WHO Essential Medicines List (EML) already includes the vast majority of medications used to treat breast cancer.
For aggressive tumors, lymph nodes are removed during cancer surgery. In the past, it was believed that in order to stop cancer from spreading, the lymph node bed beneath the arm had to be completely removed (full axillary dissection). Due to its lower risk of problems, a smaller lymph node operation known as “sentinel node biopsy” is currently recommended.
Based on the biological subtyping of the malignancies, medical treatments for breast cancers can be administered either before (“neoadjuvant”) or after (“adjuvant”) surgery. Triple negative breast cancer, which does not express the estrogen receptor (ER), progesterone receptor (PR), or HER-2 receptor, is one of the more aggressive forms of the disease. Tamoxifen and aromatase inhibitors are examples of endocrine (hormone) therapy that are likely to be effective for cancers that express the estrogen receptor (ER) and/or progesterone receptor (PR). certain oral medications, which are taken for five to ten years, cut the risk of recurrence of certain “hormone-positive” tumors in half. Although they are usually well tolerated, endocrine medications might cause menopausal symptoms.
Chemotherapy is required for “hormone receptor negative” cancers, which do not express ER or PR, unless they are extremely tiny. Today’s chemotherapy regimens, which are typically administered as outpatient therapy, are quite effective in lowering the risk of cancer spread or recurrence. If there are no side effects, hospitalization is typically not necessary during chemotherapy for breast cancer.
Trastuzumab and other targeted biological treatments can be used to treat breast tumors that independently overexpress a protein known as the HER-2/neu oncogene (HER-2 positive). In order to effectively destroy cancer cells, tailored biological therapies are administered in conjunction with chemotherapy.
In the treatment of breast cancer, radiotherapy is crucial. Radiation can save a woman from needing a mastectomy when her breast cancer is in its early stages. Even after a mastectomy, radiation can lower the chance of cancer recurrence in later-stage malignancies. In certain cases, radiation therapy may lower the chance of dying from advanced stages of breast cancer.
The entire course of treatment determines how well breast cancer treatments work. Results from partial treatment are less likely to be favorable.
Worldwide influence
Between the 1980s and 2020, high-income nations saw a 40% decrease in age-standardized breast cancer mortality (1). Countries that have been successful in lowering the death rate from breast cancer have been able to do it at a rate of 2–4% year.
In order to provide the proven effective treatments, the plans for improving the outcomes of breast cancer rely on the fundamental strengthening of the health system. These are also crucial for managing non-malignant noncommunicable diseases (NCDs) and other cancers. For instance, establishing trustworthy routes for referrals from primary care offices to district hospitals and specialized cancer centers.
The management of cervical, lung, colorectal, and prostate cancers all need the creation of trustworthy referral channels from primary care offices to secondary hospitals and specialized cancer centers. In light of this, breast cancer is referred to as an indicator illness, creating management paths for other malignancies.
WHO response
The WHO Global Breast Cancer Initiative (GBCI) aims to prevent 2.5 million breast cancer deaths worldwide between 2020 and 2040 by reducing the global breast cancer mortality rate by 2.5 percent annually. A 2.5% annual reduction in the worldwide breast cancer mortality rate will prevent 25% of deaths from breast cancer among women under 70 by 2030 and 40% by 2040. Comprehensive breast cancer management, prompt diagnosis, and health promotion for early detection are the three pillars supporting the achievement of these goals.
More women would seek medical attention when breast cancer is suspected and before any existing cancer has progressed if public health education was made available to increase women’s knowledge of the disease’s symptoms and signs and to help them and their families recognize the value of early detection and treatment. Even without mammography screening, which is currently impracticable in many nations, this is achievable.