Future Directions in Breast Cancer Research

Running Head: BREAST CANCER 1 

Breast Cancer 

Background/Introduction 

Breast cancer is a disease that involves the division of cells in the breast without a normal control. Breast cancer affects more women than any other form of cancer. Additionally, approximately 2,600 men are estimated to have been diagnosed with the same disease in 2016. Globally, it is estimated that 40,890 people will lose their lives to the invasive breast cancer by the end 2016 ( American Cancer Society, 2016) . Therefore, the disease is deadly and requires quick intervention. As a result, the focus of this discussion is to analyze breast cancer through detailing the pathophysiology of the illness, Physical Assessment, early detection, possible treatment as well as a future research direction. 

Pathophysiology of the Disease 

The human body consist of an uncountable number of cells which undergo several cell-controlled cycles that include growth, maturity, and death. Cell division is rapid during childhood to allow an individual to grow and once they reach adulthood, cell division takes place to supplant worn-out cells as well as to repair injured ones. DNA or cellular blueprint and genes found in the nucleus of the cell regulate all these processes of cell division and growth. 

On the other hand, breast cancer is a malignant tumor that starts to develop in an individual’s breast. The disease is found mostly in women with few cases being reported among men. Breast Cancer begins when the growth of cells in the breast get out of control. Any disturbance in the cell growth that results in the development of lesions and tumor triggers breast cancer. The cells grow into a tumor that is felt from outside by the individual as a lump. Such tumors are malignant, and the cells may grow into other tissues spreading out in the body. However, not all cancers will cause a lump in one’s breast. Most of the cancer cells begin from the ducts that are responsible for carrying milk to the nipple. Such cancer cells are referred to as ductal cancer while others that start from the lobules where the milk production takes place are known as lobular cancer. When the cancer cells are developed in the breast, they slowly spread through the lymphatic system. The cells enter the lymphatic vessels into the lymph nodes and begin to grow by spreading into other parts of the body. 

Figure 1 normal breast tissues, Source: American Cancer Organization 2016 

Breast cells can be cancerous due to many factors. Any disturbance that damages the cell’s DNA can cause cancer. This is because every cycle of the cell is regulated by the DNA, hence, any damage caused on it affects the cells. Unlike most normal cells, any damaged DNA in the cancer cells are left unrepaired, leading to new abnormal cells that are produced by the malfunctioning cells. Through mutation, relatives or parents with cancer cells can pass this damaged DNA to their future generations. This implies that people whose families have had a history of breast cancer stand high chances of getting the disease. In other cases, the persons who have inherited DNA defects like BRCA1, BRCA2 and P53 are also prone to breast cancer. The human immune system would usually seek out the cancer cells and destroy them. Moreover, the immune system destroys the cells with damaged DNA. In some cases, signaling system of growth factors, as well as other mediators may be interacting with stromal and epithelial cells experiencing disruptions consequently leading to breast cancer. Some behavioral factors like cigarette smoking, alcohol consumption and exposure to some toxins may also result in the damaging of the DNA causing breast cancer. 

Physical Assessment 

Humphrey, Chan, Bougatsos, Naik, Tyne, and Nelson (2009) explains that the physical assessment of breast cancer can be performed either by the individual in person or by a trained clinician. However, individuals are encouraged to self-examine their breasts for any suspicious sign. When any suspicion is felt, then one could help from a medical facility. The first step in physical assessment involves a visual check of the skin and tissues. The healthcare provider visually checks the appearances of the breasts. During the examination, an individual is often asked to strip and let lose their breasts. This will enable the breast to hang firmly enabling the health care professional to assess the differences in sizes as well as the shapes of the breasts. Next, the health care provider observes for any rushes on the breasts or any other abnormal signs. One’s nipples can also be slightly squeezed to see if any fluids are expressed. 

The second assessment involves the manual check for any unusual lumps or suspicious texture. The health care professional checks an individual’s breasts, under arms or around the collarbone for any suspicious lumps or abnormalities. During this examination, the health care provider will be looking for a suspicious lump usually about the size of a pea around the breast tissues. Also, the health care provider will check the lymph nodes around the breast area to ascertain any possible enlargement. 

The third step involves an assessment of any suspicious area. In case the health care provider discover any lump; they will note the shape size and texture. The health care provider will also check to see any signs of movement by the lump. Benign lumps have a different texture from the cancerous lumps. Lumps that are shapely, smooth and easily movable may just be benign tumors or some cyst. However, those that are firmly attached and oddly shaped around the breast is a possible indicator of cancer. The clinical physical examination is a predominant part in early detection. Suspicious lumps found may be tested using further diagnostic measures (Nelson, et al., 2009). 

Figure 2 source, American Cancer Organization: Cancerous vs. Normal breast 

Statistics 

According to American Cancer Society (2016), there will be roughly 246,660 new invasive breast cancer diagnosed by the end of 2016. Additionally, 40,450 men will lose their lives to breast cancer. American Cancer Society (2016) adds that breast cancer in the US showed an upward trend over the past decades till 2,000. However, after 2002, the statistics showed a 7% decline in 2003. The decline was thought to be as a result of reduced use of hormone therapy by women after menopause. A study was published that linked hormone therapy to cancer and hence the low uptake. Among women in the US, breast cancer is ranked second as a major cause of deaths after lung cancer. Roughly, cancer kills 1 in every 36 women. However women of age 50 and below have witnessed a sharp decline in cancer-related deaths since 1989. Today, about 2.8 million breast cancer survivors exist in the US. About 5%-10% cases of cancer are associated to be hereditary factors while less than 15% of women with breast cancer have a family history of a member with the same disease. About 12% of women in the US will most likely develop cancer every year. In 2016, 30% of newly diagnosed cancer cases will be breast cancer among women. However, among the under 45 women, breast cancer is more likely to affect the African American ethnicity. (American Cancer Society, 2016) 

Possible Treatment 

The treatment of cancer usually involves a multidisciplinary team. The type of breast cancer that an individual suffers determines the treatment plan adopted. Other factors also include the stage of cancer, the subtype of the tumor, individual’s age, menopausal status and the presence of known mutants. 

Khatcheressian, Hurley, Bantug, Esserman, Grunfeld, Halberg, and Vogel, (2013) explains: for the early stage invasive and DCIS cancer, doctors tends to recommend surgery as an option to ensure the tumor is removed. During the operation, all the cancer cells that may exist around the breasts are removed. For larger tumors or those that grow very fast, doctors would recommend a systemic treatment. Often chemotherapy and hormonal therapy are used before surgery. After the surgery, the doctors offer adjuvant therapy management to prevent recurrence of cancer. The adjuvant treatment therapy includes radiotherapy, chemotherapy and hormonal therapy. Although the adjuvant treatments are done to prevent cancer recurrence in a patient it does not mean the cancer completely never occur in the patient again. 

Chemotherapy involves the use of medicine to weaken and destroy the cancer cells. The treatment affects the entire body since the chemicals go through the blood stream. It is used to get rid of any possible cancer after surgery so that the risk of recurrence is reduced. Also, it may be used to treat advanced stage breast cancer to ensure the cancer cells all get damaged. It may also be administered before surgery to shrink the cancer cells (Khatcheressian, et al., 2013). 

During surgery, the tumor and surrounding tissues are removed from the breast. The lymph nodes and underarms are also assessed during the surgery. The surgery may include the following: lumpectomy which involves the removal of the lump or tumor as well as some small margin of cancer-free healthy tissues around the tumor. The second is mastectomy which comprises of the removal of the entire breast affected by cancer (Khatcheressian, et al., 2013). 

Also, there is the lymph nodes removal in surgery. Lymph nodes removal involves a process referred to as sentinel lymph nodes biopsy which allows the surgeon to remove a few lymph nodes in an auxiliary lymph nodes dissection. The pathologist then examines the lymph nodes for cancer cells. The second process of lymph nodes removal is auxiliary lymph nodes dissection that involves the removal of various lymph nodes from the underarm to be examined by the pathologist for cancer cells (Khatcheressian, et al., 2013). 

Finally, the adjuvant treatment processes would follow. One of them is radiation and involves external beam radiation therapy. The kind of radiation used inn treatment of breast cancer is referred to as ionization radiation. The radiation creates ions in the breast cells it passes through by removing electrons thus killing cells and stopping them from growing (Khatcheressian, et al., 2013). 

Two types of radiation exists, photon and particle radiation. Gamma and x rays are used in the photon radiation whereas particles such as beta and alpha as well as electrons, protons and carbon ions among others are used in the particle radiation. Particle radiation is mostly used for treating tumors and lymph nodes that are closer to the surface and not deep inside the body. It is because the rays are low energy and do not penetrate deep inside the body causing less harm to the tissues. Photon radiation on the other end comes from radioactive sources and is passed through the body to destroy the cancer cells along their path as they pass through exiting the body. Photon also differ from particle radiation since they get deep through the body and exit while particle radiation just slightly enter on the surface. Both radiation however use their energy to affect the cells they come across (Khatcheressian, et al., 2013). 

The radiation therapy is often given to a cancer patient after the chemotherapy. In most cases, for breast cancer treatment, radiation as a treatment for cancer that has extended from the breast to other areas. The external radiation is usually given for those who have undergone conservation surgery or mastectomy. The treatment is often given five a week and could last up to 6 weeks. The process is painless it might have a few side effects that include swelling of the breasts, peeling off of the skin around the treated area and tiredness (Khatcheressian, et al., 2013). 

Future Research Direction 

The first research that points towards future research direction on breast cancer is Palbociclib and Letrozole in Advanced Breast Cancer. In this research, the efficacy of the application of palbociclib plus letrozole was investigated by the use of Letrozole in the post-menopausal treatment of cancer. In the study comprising of 666 ER-positive papostmenopausal women, HER2-negative breast cancer without any prior treatment for advanced cancer were sampled and put on palbociclib plus letrozole. Following the study, the patients who had previously untreated ER-positive, HER2-negative breast cancer in the advanced stage the palbociclib combined with letrozole showed a longer progression-free survival unlike those who had been treated with letrozole alone (Finn, et al. 2016). 

Based on Cardoso, et al. (2016) analysis, the 70-gene signature test has a demonstrated ability to improve the prediction of the patient outcomes of women with early stage cancer. The research points towards the future utilization of the 70-gene signature test in selecting patients for adjuvant therapy. 6693 women, all suffering from early-stage breast cancer were enrolled in the program to determine their genomic risk through use of the 70-gene signature. The results of the study suggested the following: women who experience early stage breast cancer and at the same time having elevated clinical risk that is accompanied with a low genomic risk for relapse had a five-year rate endurance without receiving chemotherapy depending on their 70-gene signature. The study thus suggests that about 46 per cent of women suffering from breast cancer and whose clinical risks are high may not need chemotherapy as a way of treatment for their breast cancer. 

References 

American Cancer Society. (2016). Breast Cancer. Atlanta: American Cancer Society. 

American Society of Clinical Oncology. (2016, February). Breast Cancer: Statistics . Cancer.Net . Retrieved from http://www.cancer.net/cancer-types/breast-cancer/statistics. 

Fatima Cardoso, M. L.-Y. (2016). 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. The new england Journal of Medicine , 717-729. 

Richard S. Finn, M. M.-A. (2016). Palbociclib and Letrozole in Advanced Breast Cancer. Medicine, The new england Journal of Medicine , 1925 - 1936. 

Nelson, H. D., Tyne, K., Naik, A., Bougatsos, C., Chan, B. K., & Humphrey, L. (2009). Screening for breast cancer: an update for the US Preventive Services Task Force.   Annals of internal medicine ,   151 (10), 727-737. 

Khatcheressian, J. L., Hurley, P., Bantug, E., Esserman, L. J., Grunfeld, E., Halberg, F., ... & Vogel, V. G. (2013). Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update.   Journal of Clinical Oncology ,   31 (7), 961-965.