Understanding Breast Cancer
Breast cancer is the abnormal growth of cells in the breast – lobules, milk ducts, or connective tissue. Breast cancer is now more common than lung cancer. Here are a few statistical figures about breast cancer:
- More than 297,000 women in the United States of America were diagnosed with invasive breast cancer in 2023.
- More than 55,000 women in the United States of America were diagnosed with non-invasive breast cancer in 2023.
- More than 2,700 men in the United States of America were diagnosed with invasive breast cancer in 2023.
- The five-year survival rate for American women with non-invasive breast cancer is 91%.
- The ten-year survival rate for American women with non-invasive breast cancer is 85%.
With evolving medical trends, the chances of survival have increased. Today, each line of treatment, be it radiation therapy, chemotherapy, hormone therapy, targeted therapy, immunotherapy, or clinical trials for breast cancer, is far more advanced than in the 2000s or before. As a result, there are more than 4 million breast cancer survivors in the United States of America today.
So, what kept them going? What made it possible for them to beat the cancer? Let us explore.
Also know about: Financial Planning for Life After Breast Cancer Diagnosis
Every patient with breast cancer is affected differently and uniquely. Depending on their age, genomic tests, menopausal status, preferences, nodal status, presence of BRCA 1 or BRCA 2 (known mutations in inherited breast cancer genes), type of cancer, sex, stage, grade, size, and sensitivity to hormones, doctors choose the line of treatment for a breast cancer patient.
Most doctors recommend breast cancer patients undergo surgery to prevent the spread of cancer. They also receive additional treamtent in chemotherapy, hormone therapy, or radiation therapy. When breast cancer gets attacked through both lines of treatment, it does not usually return.
Let’s find out which are the best options available for breast cancer treatment:
Breast Cancer Surgery
There are four types of breast cancer surgery:
- A lumpectomy is where the lump or breast cancer gets removed.
- A mastectomy is where the affected breast gets removed.
- Sentinel node biopsy, where a dye is injected at the affected breast site and spreads to sentinel nodes. After the sentinel nodes become visible, they get removed.
- Axillary lymph node dissection, where if the doctor finds cancer in the sentinel node, then the doctor advises you to remove the additional lymph nodes in the armpit.
- Double mastectomy is where both the breasts get removed.
In this therapy, high-power X-rays destroy the cancer cells.
In this therapy, high-dose and powerful drugs destroy cancer cells and keep them from growing, multiplying, and dividing.
Some breast tumors test positive for hormones like estrogen or progesterone (ER positive or PR positive). These tumors use hormones to grow. So, in hormonal or endocrinal therapy, anti-hormone therapy or blockage of hormones is administered. They prevent the growth of cancer cells and death from happening due to cancer and avoid cancer recurrence.
Targeted therapy is a revolutionary approach to treating cancer that seeks to destroy cancer cells using a precision-guided approach. By targeting specific genes, proteins, and tissue environment, this groundbreaking therapy can help eliminate cancer cells without damaging healthy cells. With fewer side effects and a higher success rate, targeted therapy is a powerful weapon in the fight against cancer.
Immunotherapy or biological therapy strengthens the immune system, helps it fight cancer cells, or controls the side effects of cancer treatments.
In this treatment, a breast cancer patient volunteers in clinical research by helping doctors and researchers understand the disease and look for ways to treat it better.
Surgery for Breast Cancer
Most breast cancer treatments begin with this line of treatment. Let us find out about the different kinds of surgeries in depth.
The other name for this surgery is lumpectomy. Your doctor recommends it when your breast cancer is small compared to the size of your breast, lies in a suitable position in your breast, and covers only a single area of the breast. The surgeon removes the lump or breast cancer and the surrounding breast tissue. The surgeon leaves behind the maximum healthy cells of the breast. The surgery leaves a scar on the breast. But it is not visible through a bra or swimming costume. It usually fades away with time.
Your doctor recommends the removal of your breast when there is a large lump in your small-sized breast, the tumor lies in the middle of your breast, there is more than one area of cancer, large areas of milk ducts have cancer, and if you have had radiotherapy to the breast before. The choice of reconstruction depends on you. Reconstruction of the breast usually involves a new breast shape using tissue from your body, an implant, or both together.
There are two types of reconstruction:
- Immediate reconstruction is where the new breast tissue is implanted immediately after the mastectomy.
- Delayed reconstruction is where the implantation of new breast tissue occurs after a few months.
Removal of Lymph Node Surgery
The spread of breast cancer occurs through lymph nodes. Lymph nodes in the armpit are the first ones to get affected. The doctors check the lymph nodes before removing them. They verify the spread of cancer, and it helps them determine the cancer stage.
Through an ultrasound, doctors check the lymph nodes in the armpit closely. If they look abnormal, then a biopsy is conducted. If the biopsy is positive for the spread of cancer cells, surgery gets conducted to remove all lymph nodes.
The surgery takes place during the breast surgery itself. The surgery makes a small cut in the armpit and removes 10 to 15 lymph nodes. The number varies from patient to patient. Some patients are ordered radiotherapy for the lymph nodes instead of surgery.
The first line of management for breast cancer is surgery. The second line of treatment for breast cancer is radiation therapy. Radiation helps eliminate the remnant cancer cells in the body. Radiation therapy uses high-power X-rays, protons, and other particles to destroy cancer cells. Fast-growing cancer cells are more susceptible to radiation compared to healthy cells. The X-rays are painless and not visible to the naked eye. A cancer patient does not become a radioactive carrier after exposure to the X-rays. They are safe to be around children.
There are three types of radiation therapy:
- External radiation therapy: A machine transmits radiation to the breast. The machine is outside the body.
- Internal radiation therapy: After your breast cancer surgery, your doctor inserts a radioactive source-containing device or tiny radioactive seed close to the area of your breast cancer. The device gives off radiation for several minutes before your doctor removes it. Another name for this type of radiation therapy is brachytherapy.
- Intraoperative radiation therapy: The radiation happens during the surgery of your breast cancer. Your surgeon removes the tumor, and before it is time to close the surgical site, your surgeon delivers a high-power radiation dose to the tumor area.
Anti-cancer drugs are administered intravenously in chemotherapy. It targets and destroys the cancer cells. The administration of the drugs may also be oral. If the cancer spreads through spinal fluid, anti-cancer drugs can be administered directly into the spinal cord (intrathecal administration). Chemotherapy can increase the chances of survival, reduce the risk of return, ameliorate the symptoms of cancer, and facilitate cancer patients to live a quality life.
Chemotherapy is beneficial during the following circumstances:
- Before surgery
Chemotherapy can shrink the size of the tumor. Chemotherapy before the surgery, the surgery becomes less extensive for the doctors.
- After surgery
If the surgery cannot remove all the cancer cells from the tumor site, chemotherapy will remove the remnant ones.
- For metastatic cancer
When the cancer spreads to different body parts like the liver and lungs, chemotherapy becomes the main line of treatment. For metastatic cancers, chemotherapy can be given after the diagnosis or after the first few treatments.
- To treat different types of breast cancer
As the first line of treatment, chemotherapy can work wonders for patients with inflammatory breast cancer, triple-negative breast cancer, and HER2+ breast cancer.
Chemotherapy Drugs for Before and After Surgery Administration are as follows:
- Anthracyclines like doxorubicin and epirubicin
- Carboplatin like paraplatin
- 5-fluorouracil like 5-FU or Capecitabine like Xeloda
- Taxanes like paclitaxel and docetaxel
- Cyclophosphamide like Cytoxan
Chemotherapy Drugs for Metastatic Breast Cancer are as follows:
- Ixabepilone like Ixempra
- Eribulin like Halaven
- Vinorelbine like Navelbine
- Gemcitabine like Gemzar
- Taxanes like paclitaxel and docetaxel
- Capecitabine like Xeloda
- Anthracyclines like doxorubicin, liposomal doxorubicin, and epirubicin
- Antibody-drug conjugates like ado-trastuzumab emtansine, sacituzumab govitecan
- Platinum agents like carboplatin
The Side Effects of Chemotherapy are as follows:
- Chemotherapy-induced brain fog or confusion
- Loss of hair
- Hair color changes after the treatment
- Loss of appetite
- Nails become brittle
- Skin becomes dry and itchy
- Tingling numbness in lower limbs
Hormone treatment slows down or stops the growth of breast tumors that use hormones to grow or spread. Hormone therapy blocks the body’s ability to produce hormones. It does not have any effect on cancers that are hormone-insensitive.
Types of hormone therapy are as follows:
Hormones blocking ovarian function: Various surgeries like ovarian ablation or oophorectomy reduce the function of ovaries. And it ultimately targets the production of estrogen.
Hormones blocking estrogen production: Two types of drugs block the formation of estrogen:
- SERMs (Selective estrogen receptor modulators)
Drugs like Tamoxifen block the effects of estrogen in the cancerous breast tissue but work like estrogen for the uterus and bones.
- Other anti-estrogen drugs
Drugs like Fulvestrant block the effects of estrogen in the cancerous breast tissue but do not work like estrogen for the uterus and bones.
The Side Effects of Hormonal Therapy are as follows:
- Joint pain
- Mood swings
- Risk of blood clot formation in lungs and legs
- Breathing problems
- Loss of appetite
In immunotherapy, the doctors administer drugs to the patients to enhance their immune systems and help them fight the cancer cells.
Here are the Different Drugs Used in Immunotherapy:
- Trastuzumab deruxtecan
- Trastuzumab emtansine
When can Immunotherapy be Given to Cancer Patients?
- Recurring breast cancer
- Metastatic breast cancer
- Triple-negative breast cancer
Two Types of Immunotherapy:
- Active: Doctors focus on strengthening the immune system by targeting the antigens present in the cancer cells.
- Passive: Laboratory-made drugs improve the immune system of a cancer patient in passive immunotherapy.
Clinical Trials and Future Treatments
With advancements in almost every other field, the healthcare sector has seen fresh developments in breast cancer treatment in clinical trials.
Clinical trials involve administering breast cancer drugs to breast cancer patients in either of the two forms – new medicine or old medicine. The new medicine is a drug that can potentially treat breast cancer. However, it needs extensive research analysis to prove its worth. The old one is the standard treatment for breast cancer.
Before beginning the clinical trial, a patient gets judiciously informed about the procedures, purposes, risks, and differences between new and old medicines. The patient signs an informed consent.
Future of Breast Cancer
- There is no cure for metastatic breast cancer, but Pertuzumab is the drug of choice for treating metastatic HER2-positive breast cancer.
- Immunotherapy has evolved- approved for treating the advanced stage of triple-negative breast cancer.
- By 2040, there will be more than 3 million breast cancer cases.
- By 2040, deaths due to breast cancer would be more than 1 million.
- A wearable ultrasound device discovered by MIT researchers detects breast cancer in its early stages.
Even though there are many treatment options for breast cancer, like radiation therapy, chemotherapy, surgery, and hormone therapy, it does not go away completely. Recurrence is a common trend even after many years of treatment. The treatment option can be less extensive if the cancer gets detected in its early stage. For this reason, regular mammograms, self-examination, and dietary management are essential.