Breast cancer is characterised by the uncontrolled growth of abnormal cells in the milk producing glands of the breast or in the passages (ducts) that deliver milk to the nipples.
ii. Types of breast cancer
The type of breast cancer is important in determining the most effective treatment approach. The most common way to classify breast tumours is according to the status
of three specific cell surface receptors. These are the oestrogen receptor (ER), the
The most common type of breast cancer is known as Hormone Receptor-Positive breast cancer; accounting for around 75% of all breast cancers.5 This type of
cancer grows in response to the hormones oestrogen and progesterone, and as such is likely to respond to therapies that aim to inhibit the growth effects of hormones.5
Another type of breast cancer classified by the system is ‘HER2-positive breast cancer’ which is typified by cells that make too much of a protein known as HER2/neu. It
represents 20–30% of Hormone Receptor- Positive breast cancers. Tumours that do not overexpress HER2/neu are described asHER2-negative. Breast Cancer Treatment India At Affordable Cost
Triple negative breast cancer (TNBC) is a rarer form of breast cancer which is a sub-type of HER2-negative disease. TNBC refers to tumour cells which lack oestrogen and progesterone receptors, and do not overexpress the HER2 protein. This cancer type accounts for around 15% of all breast cancers, and is usually more aggressive and difficult to treat as it does not tend to respond to standard therapies.5,7 Due to the aggressive nature of this disease it is important to treat patients early; however with few effective treatments available there
is a high unmet medical need.
iii. Causes and risk factors
There are a number of factors that have been shown to increase a woman’s risk of developing breast cancer: Age: The majority of breast cancer cases
occur in women over the age of 50.8 Family history: If a woman has a personal or family history of breast cancer she is at increased risk of developing breast cancer.1
Clinical history: Women who have previously suffered with benign breast cancer are at greater risk of developing Breast cancer Treatment in the future. Breast Cancer Treatment In Delhi
A late first pregnancy: Women who have a late first pregnancy (after the age of 35) are more likely to develop breast cancer
Prolonged hormonal exposure: A long menstrual life or possibly use of hormone replacement therapy after the menopause expose women to an increased risk of
developing breast cancer.
Lifestyle factors: For example, being overweight or obese after the menopause, physical inactivity, a high fat diet and high alcohol consumption can play an important
role in the development of breast cancer.1
iv. Symptoms and diagnosis
The symptoms of early stage breast cancer can often go undetected. There are 12 common signs of breast cancer, these are summarised below:
A hard lump developing in the breast or armpit – typically painless and occurring on one side only.
A change in the size or shape of the breast, including indentation, ‘growing’ (particularly prominent) veins or skin erosion.
Changes in the skin such as hardening, dimpling, bumps, redness/heat or an orange peel like appearance. Changes in the nipple such as retraction, the secretion of unusual discharge or a rash around the nipple area.
In simple terms the stage of a cancer describes the size of the tumour and determines whether it has spread and how far it has spread. The stage is important
because it helps cancer specialists to decide on the best treatment option. Adjacent is a simplified description of a staging system for breast cancer
Stage Classification
Stage I The tumour is no larger than two centimeters, and has not spread to the lymph nodes
Stage II The tumour is around five centimeters in size and may have spread to the lymph nodes under the arm
Stage III The tumour(s) may have spread to lymph nodes, be clumped together or sticking to other structures. The tumour(s) may have also spread to surrounding breast tissue
Stage IV Tumour(s) that have spread to other organs in the body e.g. lungs, liver or bone. This is sometimes referred to as ‘invasive cancer’
There are three main stages of breast cancer: Breast Cancer Treatment in Delhi
Early stage, which refers to cancer that is confined to the fatty tissue of the breast. Locally advanced, which has spread to
underlying tissue of the chest wall. Advanced or metastatic, where the tumour has spread to other parts of the body. Approximately one third of breast cancer cases are diagnosed after the cancer has spread beyond the primary tumour site (metastasised).
i. Incidence and mortality
Worldwide: Globally, over one million women are diagnosed with breast cancer every year.1 It is the most frequently
diagnosed cancer in women1 and the leading cause of cancer death in women. Every year more than 500,000 women die
from the disease. Europe: In Europe over 400,000 women are diagnosed with breast cancer every year and 120,000 women die from the disease. Breast cancer is the most frequently diagnosed cancer in Europe and the leading cause of cancer death in European women.10 It accounts for 17% of female cancer deaths in this region.10
Breast cancer treatment options vary
depending on the stage of the cancer – its size, position, whether it has spread to other parts of the body and the physical health of the patient. Current treatments for
breast cancer include surgery, Radiotherapy, Chemotherapy, hormonal and targeted therapies. These therapies may be used alone or in combination depending on the
stage of the disease.
i. Surgery
This is the main treatment option for patients whose breast cancer has not spread to other parts of the body and is
also an option for more advanced stages of the disease. The types of breast cancer surgery differ in the amount of tissue that is removed with the tumour; this depends on
the tumour’s characteristics, whether it has spread, and the patient’s personal feelings.14 Some of the most common types of surgery
include: Breast conserving therapy or ‘Lumpectomy’ which involves the removal of the cancerous area, the surrounding tissue and in some cases the lymph node, whist aiming to
maintain a normal breast appearance after surgery. ‘Partial Mastectomy’ or ‘Quadrantectomy’; this is where a larger
portion of tissue is removed (compared with Lumpectomy).
‘Oncocare’, which is performed in an attempt to further cancer prevention. This surgery involves the removal of the entire breast, without the removal of lymph nodes.12
Surgery can also be followed or preceded by radiotherapy and/or chemotherapy, either sequentially or in combination.
ii. Radiotherapy
Therapy with radiation is often used in addition to surgery and chemotherapy to reduce the chances of the cancer recurring.
Chemotherapy may be given prior to surgery (neo-adjuvant) with the aim of reducing tumour size and the need for extensive surgery, or after surgery (adjuvant) to reduce the chances of the cancer coming back. When the cancer has spread to other parts of the body (metastatic), chemotherapy may be used to reduce symptoms, improve quality of life and extend
survival. Chemotherapy drugs can be given intravenously (directly into the blood), or orally in a tablet. Chemotherapy is typically
associated with adverse side effects such as fatigue, nausea and diarrhea; this is because of its toxic nature and non-specific mode of action, which means that all cells are
attacked (even healthy cells).
iv. Hormonal therapy
Medicines that block or inhibit the actions of the hormones oestrogen and progesterone are often used in the treatment of patients with Hormone Receptor-Positive breast cancer.
v. Targeted therapy
Targeted therapies (also called biological therapies) are a relatively new approach to cancer treatment and target specific biological processes that are often essential
to tumour growth. Targeted therapy can include use of monoclonal antibodies, vaccines and gene therapies. Targeted therapies precisely target cancer-specific
processes, making them effective and less toxic to non-cancerous, healthy cells.15 Several types of targeted therapy exist for the treatment of advanced breast cancer. These are either given just after chemotherapy as maintenance or in conjunction with other therapies e.g. chemotherapies or hormonal therapies at various stages of advanced disease in accordance with their approved label.
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