BREAST CANCER
Breast cancer is one of the most common cancers. Each year around 48,000 new cases are diagnosed. Of these, 80% are over 50 years old, but younger women and, in rare cases, men, can also get breast cancer. Breast cancer is the leading cause of death for women ages 34 to 54.
Treatment of breast cancer can be very effective, especially when the disease is identified early. Treatment of breast cancer often consists of a combination of surgical removal, radiation therapy, and medication to treat microscopic cancer that has spread from the breast tumor through the blood. This treatment, which can prevent the growth and spread of cancer, saves lives.
In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths worldwide. At the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the most prevalent cancer in the world. Breast cancer mortality changed little from the 1930s to the 1970s. Survival improvements began in the 1980s in countries with early detection programs combined with different modes of treatment to eradicate invasive diseases.
Who is at risk?
Breast cancer is not a communicable or infectious disease. Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, there are no known viral or bacterial infections associated with the development of breast cancer.
About half of breast cancers develop in women who have no identifiable risk factors for breast cancer other than gender (female) and age (older than 40 years). 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 at the start of menstrual periods and age of first pregnancy), tobacco use, and postmenopausal hormone therapy.
Normal chest
A woman's breasts are made up of fatty, supportive tissue and tissues with glands called lobules. These lobules are mammary glands where breast milk is produced. These are connected to the nipple by a network of milk ducts.
Both breasts can be slightly different from each other. They change throughout a woman's life and often feel different at different times of the month due to hormonal changes. Just before periods they may feel bulky and may feel softer, smaller, and looser as a woman ages.
Beneath the skin, an area of breast tissue extends to the armpit. This is called the chest tail. The armpits also contain a collection of lymph nodes that are part of the lymphatic system. These drain the breast tissues and are affected in breast diseases and inflammatory conditions.
What is cancer?
The body is made up of billions of tiny cells. Normally, cells grow and multiply in a strictly regulated manner. New cells are only made when and where they are needed. When cancer occurs, the growth cycle of cells goes haywire and multiplies uncontrollably. Cells turn into cancer cells due to DNA damage. This leads to the formation of a lump that can be benign or non-cancerous or aggressive in its growth, called malignant or cancerous.
What is breast cancer?
Breast cancer is a malignant tumor that begins in the cells of the breast. A malignant tumor is able to invade surrounding tissues or spread or metastasize to distant areas of the body. The disease occurs almost entirely in women, but men can get it too.
Signs and symptoms
Breast cancer most commonly presents as a painless lump or thickening in the breast. It is important for women who find an abnormal breast lump to see a doctor without a delay of more than 1 to 2 months, even when there is no pain associated with it. Seeking medical attention at the first sign of a potential symptom allows for more successful treatment.
Generally, the symptoms of breast cancer include:
• A lump or thickening of the breasts.
• Alteration in the size, shape or appearance of a breast.
• Dimples, redness, pitting, or other skin changes.
• Change in the appearance of the nipple or alteration in the skin that surrounds it.
• Abnormal discharge from the nipple.
There are many reasons why breast lumps develop, most of which are not cancer. Up to 90% of breast masses are not cancerous. Non-cancerous breast abnormalities include benign masses such as fibroadenomas and cysts, as well as infections.
This cancer can present in a wide variety of forms, so a complete medical exam is important. Women with persistent abnormalities (usually lasting more than a month) should undergo tests that include imaging of the breast and, in some cases, tissue samples (biopsy) to determine whether a mass is malignant (cancerous) or benign.
Advanced cancers can erode the skin and cause open sores (ulceration), but they are not necessarily painful. Women with non-healing breast wounds should have a biopsy.
Breast cancers can spread to other areas of the body and trigger other symptoms. Often the most common first detectable site of spread is the lymph nodes under the arm, although it is possible to have cancer-bearing lymph nodes that cannot be felt.
Over time, cancer cells can spread to other organs, including the lungs, liver, brain, and bones. Once they reach these sites, new cancer-related symptoms may appear, such as bone pain or headaches.
Treatment
Breast cancer treatment can be very effective, achieving a 90% or greater chance of survival, especially when the disease is identified early. Treatment generally consists of surgery and radiation therapy to control disease in the breast, lymph nodes, and surrounding areas, and systemic therapy to treat and / or reduce the risk of spreading the cancer. Anticancer drugs include endocrine (hormone) therapy, chemotherapy, and, in some cases, targeted biological therapy (antibodies).
In the past, all breast cancers were treated surgically by mastectomy (complete removal of the breast). When cancers are large, a mastectomy may be required. Today, most breast cancers can be treated with a smaller procedure called a "lumpectomy" or partial mastectomy, in which only the tumor is removed from the breast. In these cases, radiation therapy to the breast is generally required to minimize the chances of recurrence in the breast.
Lymph nodes are removed at the time of cancer surgery for invasive cancers. In the past, it was thought that complete removal of the lymph node bed under the arm was necessary to prevent the spread of cancer. A smaller lymph node procedure called a “sentinel node biopsy” is now preferred as it has fewer complications. It uses a dye and / or radioactive tracer to find the first lymph nodes to which cancer could spread from the breast.
Medical treatments for breast cancers, which can be given before or after surgery, are based on the biological subtype of the cancers. Cancer expressing the estrogen receptor (ER) and / or progesterone receptor (PR) is likely to respond to endocrine (hormonal) therapies such as tamoxifen or aromatase inhibitors. These drugs are taken by mouth for 5 to 10 years and reduce the chance of recurrence of these "hormone positive" cancers by almost half. Endocrine therapies can cause menopausal symptoms, but they are generally well tolerated.
Cancers that do not express ER or PR are "hormone receptor negative" and should be treated with chemotherapy unless the cancer is very small. Currently available chemotherapy regimens are very effective in reducing the chances of cancer spreading or recurrence and are generally given as outpatient therapy. Chemotherapy for breast cancer generally does not require hospital admission in the absence of complications.
Radiation therapy also plays a very important role in the treatment of breast cancer. With early-stage breast cancers, radiation can prevent a woman from having a mastectomy. With advanced stage cancers, radiation therapy can reduce the risk of cancer recurrence even after a mastectomy has been performed. For advanced-stage breast cancer, radiation therapy can reduce the chance of dying from the disease in some circumstances.
The effectiveness of breast cancer therapies depends on the full course of treatment. Partial treatment is less likely to result in a positive result.
Chemotherapy drugs used for breast cancer
Chemotherapy can be given before surgery (neoadjuvant) or after surgery (adjuvant). In most cases, chemotherapy is most effective when combinations of drugs are used. Today, doctors use many different combinations, and it is not clear that one combination is clearly better than another.
Adjuvant and neoadjuvant drugs
• Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
• Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
• 5-fluorouracil (5-FU) or capecitabine
• Cyclophosphamide (Cytoxan)
• Carboplatin (Paraplatin)
• More often, combinations of two or three of these drugs are used.
Medicines for breast cancer that has spread
• Taxanes such as paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane)
• Anthracyclines (doxorubicin, pegylated liposomal doxorubicin, and epirubicin)
• Platinum-containing agents (cisplatin, carboplatin)
• Vinorelbina (Navelbine)
• Capecitabine (Xeloda)
• Gemcitabine (Gemzar)
• Ixabepilone (Ixempra)
• Eribulin (Halaven)
Although drug combinations are often used to treat early-stage breast cancer, this advanced-stage cancer is most often treated with individual drugs. Still, some combinations, such as paclitaxel and gemcitabine, are commonly used to treat advanced breast cancer.
Types of breast cancer
There are varieties of breast cancer. These can affect various parts of the breast. Breast cancer is often divided into invasive and non-invasive types.
Non-invasive breast cancer
Non-invasive breast cancer is also known as cancer or carcinoma in situ, or precancerous cells. This is seen in the ducts of the breast and does not have the ability to extend outside the breast. This form of cancer rarely shows up as a breast lump and is usually found on a routine checkup with a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS).
Invasive cancer
Invasive cancer is more aggressive and spreads outside of the breast. The most common form of breast cancer is invasive ductal breast cancer. This type develops around the ducts of the breast and accounts for about 80% of all breast cancer cases.
Package leaflet Letrozole Sun 2.5 mg film-coated tablets
What is Letrozole SUN and how does it work
Letrozole SUN contains an active substance called letrozole. It belongs to a group of medicines called aromatase inhibitors. It is a hormonal (or "endocrine") treatment for breast cancer. The growth of breast cancer is usually stimulated by estrogens, which are female sex hormones. Letrozole SUN reduces the amount of estrogen by blocking an enzyme ('aromatase') involved in the production of estrogens and thus can block the growth of breast cancers that need estrogens to grow. As a consequence, tumor cells grow slower or for growth and / or spread to other parts of the body.
Package leaflet Anastrozole Cinfa 1 mg film-coated tablets
Anastrozole Cinfa contains a substance called anastrozole and belongs to a group of medicines called 'aromatase inhibitors'. Anastrozole is used to treat breast cancer in women who are in menopause. Anastrozole works by reducing the amount of hormones called estrogens that are made by your body, by blocking a natural body substance (an enzyme) called "aromatase."
Research is being done around the world to find new and better treatments for breast cancer. They play a key role in the discovery of drugs that, to reach the market and be used by patients, have to pass several stages of testing. The search for new drugs always begins in the laboratory, if there their actions are promising, it is decided to test them on animals. If its safety and efficacy are determined, human clinical studies can be commenced. These represent the final stage of this long research process.
According to the American Cancer Society, of approximately 1,000 drugs that are tested, only one makes it to the clinical trial stage. On average, a new drug to treat breast cancer is studied for at least six years before a clinical trial can be done with it. Also, clinical trials can last from months to years.
Some of the latest advances in breast cancer procedures are focused on treating some special types of cancer, such as HER2 positive breast cancer and triple negative breast cancer.
HER2 positive breast cancer is characterized by the increased presence in breast tumor cells of a protein called HER2. This occurs in one in five breast cancers. For some years now, research has determined that drugs such as Trastuzumab, Pertuzumab, Trastuzumab emtansine and Lapatinib are effective for treating tumors that have increased amounts of this protein in their cells. These drugs are part of the so-called "targeted therapies", which specifically identify and attack cancer cells. This type of treatment may have fewer side effects than traditional ones.
Triple negative breast cancer is one that lacks receptors for the hormones estrogen and progesterone on the surface of the mammary tumor cells, and does not present increased amounts of the HER2 protein; all three negative results characterize this type of cancer. It occurs in approximately 10-20% of breast cancer cases.
This type of cancer does not respond to additional therapies in addition to conventional chemotherapy or radio treatments (such as hormone therapy with tamoxifen or HER2 receptor targeted therapies with Trastuzumab). But it is important to know that a series of clinical trials are currently underway to test new medications and treatment options for this type of tumor. Studies are being carried out to find out if a specific type of medicine, PARP inhibitors, could be used in this type of case.
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