Navigating Breast Cancer: Awareness, Prevention, and Modern Treatment Approaches
By: Zainab Al-Attwani, Gissou Jafari Torreie, Luca LeClair, Raymond Zeng
Introduction
Breast cancer is one of the most common cancers affecting women worldwide, and understanding its risk factors, prevention, and treatment options is crucial for both patients and healthcare providers. This disease can develop due to a complex interplay of genetic, environmental, and lifestyle factors. While some risk factors, like age and inherited genetic mutations, are beyond our control, many lifestyle choices such as maintaining a healthy weight, limiting alcohol consumption, and regular self-examinations, can play a significant role in reducing the risk.
At its core, breast cancer arises when cells in the breast begin to grow uncontrollably, forming a tumor. When these cancerous cells spread to other parts of the body, the disease is classified as metastatic, which can significantly worsen outcomes. Early detection remains a vital strategy for improving survival rates. Thanks to advancements in screening methods like mammograms, we can now identify the disease at earlier stages, improving the chances of successful treatment. Additionally, understanding the hereditary role of gene mutations, like BRCA1 and BRCA2, can help high-risk individuals take preventative measures.
By taking a comprehensive approach that includes awareness of genetic risks, lifestyle modifications, and regular screenings, individuals can better navigate the complexities of breast cancer and take proactive steps toward maintaining their health.
Influencing Factors
Breast cancer is a complex disease influenced by a combination of genetic, lifestyle, and environmental factors. While some risk factors, like inherited gene mutations, are beyond our control, others, such as diet, weight, and alcohol consumption, can be managed to reduce the likelihood of developing the disease.
Genes
When it comes to breast cancer, genetics play a crucial role in determining one’s risk. Two key genes – BRCA1 and BRCA2 – are especially important because they help prevent cancer by producing proteins that keep tumor growth in check. However, if someone inherits a mutated form of these genes, their risk of developing breast cancer increases dramatically. In fact, mutations in BRCA1 and BRCA2 account for around 20–25% of hereditary breast cancer cases.
Another gene to consider is HER2. When this gene becomes overactive, it can accelerate the growth of breast cancer, making the disease more aggressive. This overactivity occurs in about 20% of all breast cancer cases.
EGFR is yet another gene linked to breast cancer, particularly more severe forms of breast cancer. EGFR overexpression leads to faster tumor growth and cancer spread. This is seen in more than half of triple-negative breast cancer cases, a type of breast cancer that lacks common treatment targets, making it particularly challenging to treat effectively (Sun et al., 2017).
Diet and weight
While genetics are one part of the picture, lifestyle factors such as diet and weight also play a significant role in breast cancer risk. Some studies suggest that a high-protein diet, especially from certain sources like red meat, might increase the likelihood of breast cancer by raising levels of a hormone called insulin-like growth factor-1 (IGF-1). However, the relationship between different types of protein and cancer risk remains unclear, as various types of protein may have different effects.
Body mass index (BMI) is another important factor. Research indicates that women with a BMI over 40 face a higher risk of death from breast cancer and are more likely to have larger and more aggressive tumors. This correlation holds true for both pre- and postmenopausal women. In one study, obese women were found to have more aggressive cancers that spread more readily throughout the body than their healthy-weight range counterparts (Rojas & Stuckey, 2016).
Alcohol
When it comes to alcohol consumption, even small amounts can increase breast cancer risk. Studies show that drinking alcohol is linked to a 10% increase in breast cancer risk. Experts recommend limiting alcohol intake to no more than one drink per day and suggest avoiding daily alcohol consumption to reduce the risk of breast cancer (Michaels et al., 2023).
Self Examination and Diagnosis
Early detection is key in the fight against breast cancer, as it can significantly improve outcomes and save lives. Understanding how to identify the signs of breast cancer, whether through self-examination or professional medical screenings, is an essential step in this journey.
Self-Exams
Many people first detect breast cancer through changes they notice in their own bodies. According to the National Breast Cancer Foundation, Inc., 40%of all new breast cancer diagnoses come after an individual first felt a lump themselves(Shockney, 2024b). Regular self-exams help individuals become familiar with their breasts so they can quickly notice any unusual changes. A monthly self-exam is recommended, ideally at the same time each month, such as a few days after a period, when breasts are less tender and swollen (American Cancer Society, 2023). These monthly self-exams can be conducted in front of a mirror, in the shower, or lying down (Shockney, 2024a). Some of the symptoms to be looked for when conducting a self examination include: lumps or thickening, changes in size or shape, skin changes, nipple changes (such as inverted nipple or discharge), and pain (5). Although a self-exam cannot directly diagnose breast cancer, it can alert individuals to see a doctor for further evaluation.
Professional Screening and Genetic Testing
While self-exams are important, they do not replace professional screenings like mammograms, which remain the gold standard for detecting breast cancer. Mammograms use low-dose x-rays to identify tumors that might be too small to feel. Starting at 40 yrs, women are generally advised to have mammograms every two years, although guidelines recommend beginning earlier for those at higher risk.
Other screening tools, such as ultrasounds and MRIs, may be used in combination with mammograms for women with dense breast tissue or those at a higher risk of breast cancer. For individuals with a family history of breast cancer or known genetic mutations like BRCA1 and BRCA2, genetic testing can assess their risk level and guide more frequent screenings or preventative measures. According to the World Health Organization, early diagnosis and targeted screenings can significantly improve survival rates and reduce complications (Krans, 2024).
Current Treatment
There are several ways to develop treatment plans for breast cancer, often involving a combination of multiple therapies. When determining the appropriate treatment options, various factors must be considered, such as the extent of the cancer (grade and stage), the presence of specific biomarkers in your blood, your overall health, and personal preferences.
One treatment method is surgery, which includes lumpectomy and mastectomy. Lumpectomy, or breast-conserving surgery, is a procedure that is conducted when the surgeon can safely remove the breast tumour along with a surrounding margin of tissue while maintaining the breast’s natural appearance (John Hopkins Medicine, 2024). In most cases, radiation therapy follows this surgery. After the procedure, a sample of the removed breast tissue is examined by a pathologist to ensure the tumour was successfully removed. If cancer cells are still found at the edge of the tissue, additional surgery may be required. The other surgical option, mastectomy, involves removing the entire breast. This is often necessary when the tumour is larger or affects multiple areas of the breast (American Cancer Society, 2024).
Another common treatment for breast cancer is radiation therapy. This involves directing radiation through the skin to target and destroy cancer cells in the tumour (Hieken et al., 2016). As mentioned, radiation is often used after surgery to eliminate any remaining cancer cells but can also be applied before surgery to shrink a tumour. A specialised form of this treatment, known as brachytherapy, involves placing a small sealed container of radioactive material directly into the tumour to kill the cancer cells from within (Cozzi et al., 2022).
Chemotherapy uses drugs to destroy cancer cells by targeting rapidly dividing cells, a characteristic of cancer (Canadian Cancer Society, 2024). Unfortunately, this also affects healthy cells that divide quickly, leading to side effects such as hair loss (Hauner et al., 2017). Chemotherapy is considered a systemic therapy because the drugs circulate through the bloodstream, targeting cancer cells throughout the body, including those that may have spread from the primary tumour (Canadian Cancer Society, 2024). Similar to radiation, chemotherapy can be administered before surgery to shrink the tumour, or afterward to reduce the risk of recurrence.
Breast cancer tissues can also be tested to determine whether they have hormone receptors. When cancer cells have these receptors, certain hormones can attach to them and promote the cancer’s growth (Breastcancer.org, 2024). Hormone therapy involves the manipulation of hormone levels to block, add, or remove hormones, preventing them from attaching to these receptors and preventing the cancer’s growth. Hormone levels can be adjusted through medications, surgery, or radiation therapy. While hormone therapy is often combined with other treatments, it can also be used as a stand-alone approach.
Current Research and Future Direction
Current and future research are targeting many aspects across the landscape of breast cancer, including the development of improved diagnostics and the use of targeted treatments and therapies.
One of the most widely used methods of diagnosing breast cancer is mammography. X-ray is used to produce an image of the breasts, of which is traditionally in 2D. A newer form of mammography, known as 3D mammography or breast tomosynthesis, is becoming more widely available in clinics and hospitals (National Cancer Institute, 2023). It overlays images from different angles to produce a more complete image of the breasts. One of the main concerns with diagnosis is overdiagnosing. This can be a significant problem when a patient’s case is determined to be life threatening, when in reality it is not (National Cancer Institute, 2023). Research is currently examining whether this technology is actually more accurate and effective at early detection (National Cancer Institute, 2023).
Other methodologies have focused on shifting away from a “one size fits all” approach. In the context of mammography, this would mean that only some patients are recommended mammograms while others are provided with their own individualized screening pathways (Kuhl, 2023). For example, there has been a move towards MRIs dedicated to breast cancer screening. New data has shown that not only are MRIs more comfortable and radiation-free, they may provide a more accurate diagnosis than mammograms (Kuhl, 2023). Having a variety of screening procedures that better fit a patient’s needs can allow for the use of more localized treatments.
In the therapeutic context, researchers are constantly working to develop new and improved drug treatments to manage the progression of breast cancer. Many ongoing clinical trials are testing these relationships. In a previous trial, trastuzumab, an FDA approved drug, was administered with chemotherapy in advanced HER2 breast cancer patients. It was found that the combination of the two treatments yielded increased patient survival and response rates (Hudis, 2003). With that data, trastuzumab and another FDA approved drug, pertuzumab, are now being used together with chemotherapy in early stage HER2 breast cancer patients (National Cancer Institute, 2023). Similar to the trastuzumab and chemotherapy trial, the current trial is aiming to determine whether the combination of three therapies would yield greater positive effects than any single therapy alone. In another example, the ovarian function suppression plus endocrine therapy (OFSET) clinical trial is aiming to determine whether the combination of chemotherapy and usual treatment for premenopausal estrogen receptor positive breast cancer is more effective than the usual treatment on its own (National Cancer Institute, 2023). The clinical trial is in phase III and is actively recruiting patients at various sites across the U.S. (Uscher, 2024). Other important research areas include: testing drug combinations for breast cancer that has spread to the brain, testing the effectiveness of different radiation therapies (e.g. proton beam radiation) and how that compares to traditional radiation therapy, whether chemotherapy should be used to treat all HER2 breast cancer cases, and the use of vaccines to mitigate disease relapse or progression (American Cancer Society, 2024).
Although there is much evidence pointing to the need to understand the complexity that underlies breast cancer complications, the current direction of treatment suggests there may be many promising care options in the near future. Refined screening methods and more potent drug therapies are some of the avenues that are continuously being improved.
References
American Cancer Society. (2023) Breast cancer early detection and diagnosis: How to detect breast cancer. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection.html
American Cancer Society. (2024). What is a mastectomy? https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html
American Cancer Society. (2024). What’s new in Breast Cancer Research? https://www.cancer.org/cancer/types/breast-cancer/about/whats-new-in-breast-cancer-research.html
Breastcancer.org. (2024). Hormonal therapy for breast cancer. https://www.breastcancer.org/treatment/hormonal-therapy
Cozzi, S., Augugliaro, M., Ciammella, P., Botti, A., Trojani, V., Najafi, M., Blandino, G., Ruggieri, M. P., Giaccherini, L., Alì, E., Iori, F., Sardaro, A., Ghersi, S. F., Deantonio, L., Gutierrez Miguelez, C., Iotti, C., & Bardoscia, L. (2022). The role of interstitial brachytherapy for breast cancer treatment: An overview of indications, applications, and technical notes. Cancers, 14(10), 2564. https://doi.org/10.3390/cancers14102564
Hauner, K., Maisch, P., & Retz, M. (2017). Nebenwirkungen der Chemotherapie. Der Urologe, 56, 472–479. https://doi.org/10.1007/s00120-017-0338-z
Hieken, T. J., Mutter, R. W., Jakub, J. W., Boughey, J. C., Degnim, A. C., Sukov, W. R., Childs, S., Corbin, K. S., Furutani, K. M., Whitaker, T. J., & Park, S. S. (2016). A novel treatment schedule for rapid completion of surgery and radiation in early-stage breast cancer. Annals of Surgical Oncology, 23(10), 3297–3303. https://doi.org/10.1245/s10434-016-5321-1
Hudis, C. A. (2003). Current status and future directions in breast cancer therapy. Clinical Breast Cancer, 4. https://doi.org/10.3816/cbc.2003.s.018
Johns Hopkins Medicine. (2024). Breast-conserving surgery (lumpectomy). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/breast-conserving-surgery
Krans, B. (2024). Breast self-exam. Healthline. https://www.healthline.com/health/breast-lump-self-exam
Kuhl, C. K. (2023). What the future holds for the screening, diagnosis, and treatment of breast cancer. Radiology, 306(3). https://doi.org/10.1148/radiol.223338
Michaels, E., Worthington, R. O., & Rusiecki, J. (2023). Breast cancer. Medical Clinics of North America, 107(2), 271–284. https://doi.org/10.1016/j.mcna.2022.10.007
National Cancer Institute. (2023). Advances in breast cancer research. NCI. https://www.cancer.gov/types/breast/research
Rojas, K., & Stuckey, A. (2016). Breast Cancer Epidemiology and risk factors. Clinical Obstetrics & Gynecology, 59(4), 651–672. https://doi.org/10.1097/grf.0000000000000239
Shockney, L. (2024a). Breast cancer signs and symptoms. National Breast Cancer Foundation. https://www.nationalbreastcancer.org/breast-cancer-symptoms-and-signs/
Shockney, L. (2024b). Breast self-exam. National Breast Cancer Foundation. https://www.nationalbreastcancer.org/breast-self-exam/#:~:text=With%20the%20pads%2Fflats%20of,or%20any%20other%20breast%20changes is as
Sun, Y.-S., Zhao, Z., Yang, Z.-N., Xu, F., Lu, H.-J., Zhu, Z.-Y., Shi, W., Jiang, J., Yao, P.-P., & Zhu, H.-P. (2017). Risk factors and preventions of breast cancer. International Journal of Biological Sciences, 13(11), 1387–1397. https://doi.org/10.7150/ijbs.21635
Uscher, J. (2024, September 15). OFSET clinical trial for early-stage breast cancer. Breastcancer.org – Breast Cancer Information and Support. https://www.breastcancer.org/treatment/clinical-trials/early-stage-breast-cancer-ofset
World Health Organization. (2024). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer