Table of Contents
Abstract
Breast cancer starts from the very minute cells of the breast. These cells begin its growth that are capable of invading other surrounding breast tissues.
In some patients, it is asymptomatic. It is usually discovered during routine physical examinations, most commonly as a lump or thickening in the breast tissue or during a routine screening mammography. In advanced cases, the patient may present with breast deformity, abnormal nipple discharge or ulceration. A biopsy of the affected breast is confirmatory for the diagnosis. As the breast cancer is the considered the second leading cause of death in the United States. According to the National Cancer Institute, among Hispanic women, breast cancer is the leading cause of death.
Breast cancer also occurs in males but accounts for only about one percent of the total cases. In men, the manifestations, diagnosis and management are the same as in females. However, men tend to present the disease later in life. The American Cancer Society reported that there is about 268,600 new cases of invasive breast cancer while the reported number of deaths is 41,760 in 2019. Likewise, about 62,930 new cases of in-situ breast cancer are expected in the same year.
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There are several factors that out a person at risk for breast cancer. The strongest risk factor is age, in which the condition may occur in women over 50 years old. The family history of having a 1st degree relative (e.q. mother, sister or daughter) with breast cancer doubles or triples the risk of developing the same condition. The presence of a mutation in one of the 2 known breast cancer genes namely BRCA1 and BRCA2 may require a closer surveillance or preventive measures such as tamoxifen or undergoing mastectomy.
Women who had a previous in-situ or invasive breast cancer are with higher risk of developing cancer in the contralateral breast after mastectomy in about 0.5 to 1% per year of follow-up. In addition, early menarche for women, late menopause or late pregnancy are considered as risk factors for developing malignancy of the breast. Having a first child at an older age (after 30 years old) or never been pregnant are also considered as risk factors. Lifestyle modifications including oral contraceptive use and smoking, also contribute to a higher risk.
In treating breast cancer, staging is important as this will direct to the course of management and includes surgical excision of the breast mass or tissue, in some cases with added radiation therapy or an added adjuvant therapy or hormonal therapy or both is done.
Pathophysiology
All types of cancer occur due to this disturbed growth of cells leading to the formation of tumors or abnormal masses. The development is in a gradual course as how the growth of cells in the body is likely to be not within a controlled manner. In addition, cancer cells possess some properties making it difficult for them to be destroyed or removed from the body, as well as having longer life spans. The cells normally must undergo what is called apoptosis or programmed self-death, but this is being escaped by the abnormal cancer cells so they continue to grow. Unlike normal cells, they have the ability to invade other tissues or also called as metastasis. These cells grow into tumors that are supplied by a new network of blood vessels, a process called angiogenesis.
There are the most common sites of invasion of the cancer cells, and they can spread through any of the following namely the lymph nodes, bloodstream, or both for advanced stages. The most common organ that is first affected by advanced stage of breast cancer are the lungs. Metastatic breast cancer may affect any organ in the body, most commonly the lung. Other organs that may be involved are the liver, bone, brain and skin including the scalp. In some cases that breast cancer can affect the integumentary system as the skin affected is where the site of the breast cancer is. Skin metastasis will not occur immediately after the initial diagnosis, but it will take several years for the gradual onset of appearance and development.
Breast cancer cells may carry both estrogen and progesterone receptors. They are nuclear hormone receptors that support DNA formation and cell division. Tumors with these receptors may benefit from medicines that can block these receptors. Approximately 2/3 of breast cancer patients in their postmenopausal period carry an estrogen receptor positive (ER+) tumor. There tends to be a lower incidence of (ER+) tumors among postmenopausal women.
The human epidermal growth factor receptor 2 (HER2 which is also known as HER2/neu or ErbB2) is another cellular receptor which may be found present in breast cancer patients. When identified in patients, they suggest a poorer prognosis at any given stage of cancer.
It may be helpful to state at this point that the major risk factors for the development of breast cancer are either genetic or hereditary and hormonal.
Approximately 12% of breast cancers is caused by the inheritance of a susceptibility gene or genes. Majority of cancers attributed to single mutations are those occurring in the BRCA1 and BRCA2. Breast cancers bearing BRCA1 do not have hormone receptors and are usually poorly differentiated.
The hormones that increases during pubertal stages, as well as during menstruation, ovulation and pregnancy act as nutrients for the cancer cells. These hormones stimulate and increase the growth of the breast tissue. In addition, these hormones such as estrogen and progesterone hormones pose the risk for damaging the cell’s DNA and further causing disorganized proliferation abnormal cell. As premalignant and malignant cells start to form, hormones can also begin to stimulate their growth. The normal epithelial and stromal cells may likewise grow to help in the tumor development. Estrogen may play a more direct role in carcinogenesis, with its end products causing harmful mutations or create DNA-damaging free radicals found in animal model systems.
Conclusion
Underdeveloped and even developing countries are confronted with financial constraints that hinder in achieving their goal of improving the outcomes for breast cancer management and treatment. This is with regards to giving correct information through health education, thereby increasing awareness on the importance of early diagnosis and management.
According to the American Cancer Society back in 2017, the significant decrease in breast cancer mortality in the United States is attributed to continuous improvement in both screening mammography and treatment. According to the World Health Organization, improving breast cancer outcome and survival thru early detection remain to be the cornerstone of breast cancer control.
References
- Breastcancer.org. (2019, February 13). U.S Breast Cancer Statistics. Retrieved from https://www.breastcancer.org
- National Cancer Institute. (2018). BRCA Mutations: Cancer Risk and Genetic Testing. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#what-are- brca1-and-brca2
- Kumar, V., Abbas, A., Fausto, N., & Aster, J. (2009). Robbins and Cotran Pathologic Basis of Disease Eighth Edition. Philadelphia: Elsevier/Saunders.
