Breast Pathology and Cancer Diagnosis

The sooner breast cancer gets diagnosed, the better your odds of getting successful treatment.

That's why it’s important to get mammograms as recommended, to be familiar with how your breasts usually look, and to report any changes to your doctor ASAP. Why?

• Breast cancer risk is on the rise: The lifetime risk of a woman getting breast cancer in the U.S. was around 5%, or 1 in 20, in 1940. Now it’s 12% or more than 1 in 8.
• Finding breast cancer earlier boosts your survival odds: Women who have breast cancer screening mammograms are much less likely to die from the disease. This depends on:

• The quality of the test
• Getting screened as often as you need to
• Doing what your doctor says afterward

Clinical breast exams and mammography are screening tests. At higher risk breast MRI can also be used for some women. Powerful magnetic field and radio waves are used during Magnetic Resonance Imaging (MRI), which produces detailed images of structures within the breast. If breast cancer is detected either by screening tests or from symptoms diagnostic tests precautionary measures are given to the woman who is suspected of having breast cancer. Diagnostic tests include Mammogram (X-ray of the breast), Breast ultrasound (uses sound waves to produce pictures of structures), Removing a sample of breast cells for testing (biopsy), Breast Magnetic Resonance Imaging (MRI). These diagnostic tests confirm the presence or absence of breast cancer and give more information about breast cancer like whether it has traveled outside the breast or not. Many tests are used to monitor how well therapies are working after the diagnosis of breast cancer. These tests after diagnosis are also used to check any signs of recurrence. These tests include mammography and medical history, physical examination. The patient should visit the doctor every 3 to 6 months for the 3 years after the treatment.

To reduce the chances of developing breast cancer for women at higher risk, healthcare providers may recommend therapy along with one of several medications based upon careful risk assessment. Selective Estrogen Receptor Modulators (SERM) is another name for these medications, these include tamoxifen and raloxifene. Aromatase inhibitors are a group of medications; they are effective for breast cancer prevention. These medications prevent tumor which is known to be responsive to female hormones. The treatment plan to achieve good outcomes is affected by the biology of breast cancer. Breast Therapy includes Mastectomy, breast-sparing surgery and radiation therapy, Chemotherapy, Stereotactic Radiosurgery, Hormone Therapy, and Targeted Therapy.

The most common treatment for breast cancer is Surgery; with the removal of as much of the tumors as possible is the main purpose. Different types of surgeries are available. Some type of surgery is a part treatment for most women with breast cancer. Two main types of surgery to remove breast cancer are Breast-Conserving Surgery (BCS) and Mastectomy. During the breast-conserving surgery, most of the breast part containing tumor cells are removed and some part of surrounding tissues is also removed. Mastectomy includes the removal of the entire breast; double mastectomy is also done in some cases in which both the breasts are removed. At the early stages of breast cancer, many women choose between breast-conserving surgery and mastectomy. Women undergoing BCS have the advantage of keeping most of her breast but she will also need radiation. Women opting for mastectomy at earlier stages are less likely to for radiation. Because of the type of breast cancer mastectomy may be the better option for some women.

Furnishing the proper treatment to the right person at the right time is the primary goal of personalized medicine. Precision medicine is another term used for personalized medicine; it is a medical procedure in which patients are segregated into different groups. Based upon their predicted response or risk to disease after medical decisions, practices, interventions or products given to individual patients. Personal genetic or protein profiles are integrated for personalized medicine so that healthcare can be strengthened at a more personalized level. A positive effect on patient’s disease is the main target of personalized medicine so that effective treatment for a particular disease can be achieved. Knowledge of patients’ genetic profiles is required for proper medication or therapy. For the development of personalized medicine for breast cancer, knowledge of genetic profile is taken into consideration.

Clinical trials are research studies, with the help of which doctors identify the best treatments with minimal side effects. For clinical trials, people agree on new therapies. The overall standard of care can be improved with the help of these studies. Side effects are there for all treatment procedures for breast cancer and for some diagnosis tests as well. Clinical trials or research trials are done to figure out the side effects of treatment as well as the success rate of the new treatment procedure. Clinical trials are done after the preclinical trials. Preclinical trials are done on mice, as they suggest whether it will be safe for people to exposure a new treatment or not. Security and advantages of new medications can be tested with the help of clinical trials.

The most common tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

Tumor (T): How large is the primary tumor? Where is it located?

Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

Metastasis (M): Has cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages: stage 0 (zero), which is non-invasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer. The stage provides a common way of describing cancer, so doctors can work together to plan the best treatments.

Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations, mammograms, ultrasound, and MRI scans. Pathologic staging is based on what is found during surgery to remove breast tissue and lymph nodes. The results are usually available several days after surgery. In general, pathological staging provides the most information to determine a patient’s prognosis.

Lifestyle changes are shown to be important in the prevention of breast cancer. Diet, physical activity, smoking, alcohol use, and vitamin and mineral use are key factors influencing the risk of breast cancer among women. Because these factors are related to each other, it is difficult to assess their individual roles in breast cancer. Some of these factors are alterable, meaning that women can decrease their risk of breast cancer by changing their behaviour. Breast cancer is associated with a high rate of mortality and morbidity among women. Therefore, it is logical to try to find ways to decrease the risk of developing breast cancer. Lifestyle changes seem to be an easy, effective, and economical way to help prevent breast cancer. In women with a confirmed breast cancer diagnosis who are under radiotherapy treatment after undergoing a mastectomy, lifestyle changes are still very important. Some factors, such as smoking cessation and prevention of weight gain, may improve the long-term survival chances of these patients. Therefore, ways to increase women’s knowledge about the role of lifestyle changes in the prevention of breast cancer and in the survival of patients with diagnosed breast cancer should be considered and studied.

Medicine that is used along with conventional medicine is known as complementary medicine. On the other hand, alternative medicine is the medicine that is used in place of conventional medicine. Optimization of combined treatment by using conventional medicine and complementary medicine is very important for better results. Use of Meditation, Massage, Acupuncture, and herbs come under the category of complementary medicine. Studies have shown that the intake of supplements like vitamins can increase the risk of breast cancer, as some supplements might be having anti-cancer properties. So, alternative, complementary medicine and intake of supplements can minimize the risk of breast cancer.

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

• Have genetic changes that make them less visible to the immune system.
• Have proteins on their surface that turn off immune cells.
• Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.

Having no signs of cancer after finishing treatment is what we say Survivorship or we can also say living with, through and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and are uncertain about coping with everyday life. Some people may even prefer to put the experience behind them and feel that their lives have not changed in a major way.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

• Understanding the challenge you are facing
• Thinking through solutions
• Asking for and allowing the support of others
• Feeling comfortable with the course of action you choose

Male breast cancer is rare cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a disease that affects women, breast cancer does occur in men.

Male breast cancer is most common in older men, though it can occur at any age.

Men diagnosed with male breast cancer at an early stage have a good chance for a cure. Treatment typically involves surgery to remove the breast tissue. Other treatments, such as chemotherapy and radiation therapy, may be recommended based on your particular situation.

Breast cancer is quite rare in very young women. It is a disease primarily of older women, with 75% of cases occurring in women over 50 years of age. Only 6.5% of cases occur in women under 40 years of age, and a mere 0.6% of cases in women under 30 years of age. Thus, in the U.S., only about 1,200 cases of breast cancer occur in women under 30 years of age each year. Similarly, any such studies, which prove deviation from the normal outline, have been considered under the case study.

Oncology nurses are such important components of our care. They interact directly with patients in a way that allows them to monitor what's going on at a granular level. Oncology nurses are great at making sure they are staying on the pulse of patient symptoms, not only when they're in the clinic, but when they call in with symptoms. More and more people are using telemedicine to report their symptoms.

Oncology nurses are trained to recognize the common side effects that we see, and even some of the less common ones. To intervene early is so important. Things like diarrhea and dehydration—we need to know about those and monitor them early. Things like complications of chemo that are also common with low white blood cell counts and infections or fevers, those need to be intervened right away. The oncology nurse can intervene in not only assessment but also in recommending the types of supportive care approaches that would be critical to keeping patients out of trouble.

Breast Cancer being prevalent among various types of cancer, the drug market has driven up. But there are factors, which can hinder the drug market like the risk of failure of cancer drugs and therapies, side effects of cancer therapies, high cost of drug development and cost of research in this area. Breast cancer is becoming the most common cause of death of women. The girls and young age women are at high risk of cancer-causing agents. Research in field of advanced cancer drugs and personalized medicine provides opportunities to the companies in developed and developing countries in the area of pharmaceuticals and biotechnology.

Discussion on the latest technologies and applications in breast cancer treatment is important to improve the treatment of breast cancer as well as for awareness against breast cancer. Breast cancer is the most affecting disease among women worldwide. Chances of survival from breast cancer are higher today than ever before. Latest technologies and outstanding clinical applications have helped the mortality to reduce. Latest technological advancements or advanced treatment methodologies can be shared during the workshop between the speakers and participants.

Pregnancy and breast cancer impact each other in many ways. Whether you are cancer-free, newly diagnosed or a long-term survivor, you may have questions about how having children and breast cancer may be related. Understanding how childbearing impacts your breast cancer risk, and for survivors, how it relates to the chances of survival after treatment is important. And, for newly diagnosed younger women, understanding how some therapies may affect your fertility may be helpful in exploring options for having a child after treatment ends.

Globally, breast cancer (BC) is one of the most frequently diagnosed cancers. More than 1.6 million new cases of BC are identified among women, according to the recent worldwide available data. In addition, the cumulative incidence of BC rose by more than a quarter between 1980 and 2010 among 187 countries. This raise has been succeeded thanks to BC awareness and early detection of breast malignancy.

Taking into consideration the progress in diagnosis and treatment, it is inevitable that some controversies will come up in daily clinical practice. The aim of this review is to illustrate some of these conflicting issues and make them less “ambiguous”. Especially, in the diagnosis field, the subjects which are discussed below are mammography, breast tomosynthesis, 3D ultrasound, shear wave elastography, magnetic resonance imaging, fine needle aspiration and core biopsy, computed tomography, positron emission tomography-computed tomography (PET-CT), axillary node dissection, sentinel lymph node biopsy, internal mammary node sampling and negative margin widths. As for the controversial issues based on treatment, these are partial breast radiotherapy, breast reconstruction, a sequence of radiotherapy and chemotherapy, hormone therapy and biphosphonates. However, the follow-up of BC survivors has not been overlooked.

Prevention, Detection, and cure of breast cancer depend upon a better understanding of the biology of breast cancer cells. Understanding of signal transduction and protein interactions at the molecular level helps in understanding the biology of breast cancer cells more clearly. Imaging techniques are there which help in early detection of Breast Cancer. Molecular Imaging helps in the detection of different changes that occur in the body due to the therapy used for treatment. The use of different therapeutic and gene-targeted cells for the treatment of breast cancer will affect mortality and modalities in the future. Molecular Imaging in Oncology, Gene therapy is the new emerging era in the field of breast cancer treatment. Challenges are there using molecular imaging for the treatment of breast cancer.