Breast cancer today

Breast cancer is the most common cancer in the UK. Although it mainly affects women, it can also be developed by men. According to the World Health Organization, over half a million women died due to breast cancer in 2012 (Global Health Estimates, WHO 2013).

Although the number of deaths remain high, due to successful prevention programs and early detection in developed countries, survival rates in the last decades have greatly improved. Today, early detection of breast cancer, increases the chances of successful management and cure of the disease. Approximately 90% of deaths due to breast cancer are linked to a late stage diagnosis, stages III and IV,  and the spreading  of the disease  to other vital organs of the body (metastasis), which is why current efforts in the scientific community are directed towards preventing this step occurring. The articles highlighted below cover the latest lab-research aiming to improve personalized patient treatment, to the most recent improvements in the clinical practice of advanced breast cancer.

Towards personalized medicine

Although we generally refer to breast cancer as one disease, there are multiple sub-types of breast cancer that require different treatments. During the past decade it has become increasingly clear that in each patient, tumors evolve in a distinctive, unique way, which has led to the conclusion that individualized or personalized therapies are key in the treatment of the advanced stage of the disease.

New technique facilitates therapy personalization

Personalizing a therapy consists of studying the unique cellular and molecular composition of a patient’s tumor and then subsequently designing an optimal treatment for this person accordingly. The only problem with these therapies is that they are difficult to implement in practice because they are time consuming and very expensive for health care systems. Therefore, it’s important to find new techniques that will allow testing of multiple drugs in patient’s tumors. In an article published in BMC Cancer this year, the authors describe a new method for testing different drug combinations in the tumor of a patient after surgical removal. The researchers developed a way to maintain a living section of the patient’s breast tumor in a petri dish, which can then be tested with various treatments to find the optimal therapy for each patient. This method is particularly relevant as it can avoid treating patients with drugs that will not work for them, saving them time and the discomfort of unpleasant side effects.

Improving clinical practice

After exploring new advances coming from the laboratory that promise a better future for breast cancer patients, now we will focus on how clinical practice is changing to offer improved breast cancer prevention and diagnosis.

Prevention: body weight remains a top risk factor in breast cancer

Prevention remains the most promising strategy for reducing breast cancer incidence and mortality. Research has identified the main risk factors associated with breast cancer occurrence, and the good news is that it is estimated that one third of the most common cancer types could be prevented by changes to the foods we eat and the amount of physical activity we do (World Cancer Research Fund – Continuous Update Project).

A new report published last month in BMC Cancer, corroborates evidence that being overweight and weight gain in general during adulthood is linked to an increased risk of breast cancer after menopause. The researchers conducted a large population study, including 739 cases of breast cancer compared to 815 healthy women. Weight variations were analyzed, including weight a year before diagnosis, in women of 20, 40 and 50 years of age. The data obtained indicated that postmenopausal cancer is associated with significant weight gain after the age of 40.

This study adds to the building evidence highlighting the importance of prevention in breast cancer incidence, and endorses more control over weight gain in middle age women.

Diagnosis: choosing the right imaging technique to achieve early diagnosis

Early diagnosis is the most effective way to reduce breast cancer mortality. Surgical removal of tumors complemented with adequate treatments has achieved a significant improvement in survival of early diagnosed breast cancer. The initial assessment of a potential breast cancer case is done using non-invasive imaging techniques that allow clinicians to see the inner tissue and find the tumor mass. There are currently multiple imaging techniques available, and the latest comparative analysis published in BMC Cancer aids clinicians when choosing the appropriate technique to increase diagnostic accuracy. Mammography is the gold standard technique for breast cancer diagnosis, being harmless and providing good results in most women. However, in women with denser and smaller-sized breasts the technique is not able to produce clear images for diagnosis. With this problem in mind, Yu and colleagues examined women diagnosed with breast cancer using gamma imaging, mammography, ultrasound and magnetic resonance before surgery. The analysis concluded that high resolution specific gamma imaging provides the sensitivity and specificity needed to diagnose women with dense or small breasts.

Although prevention can achieve a decrease in the incidence of breast cancer, these strategies cannot eradicate the majority of breast cancers that develop in low- and middle-income countries where breast cancer is diagnosed in very late stages. Therefore, early detection to improve breast cancer outcome and survival remains the keystone of breast cancer control, particularly in women with dense breasts where detection is more challenging, and in men, where a lack of public awareness remains.

Male breast cancer awareness

The first question that might come to mind is: is this a thing? Indeed, male breast cancer is very rare. Compared to the 50,000 women diagnosed with breast cancer every year in the UK, only 350 men are affected, and therefore the condition is generally overlooked. To change this, in 2009 the male breast cancer advocacy groups Out of the Shadow of Pink, A Man’s Pink, and the Brandon Greening Foundation for Breast Cancer in Men joined together to globally establish the third week of October as “Male Breast Cancer Awareness Week”.

But males don’t have breasts, how can they develop breast cancer? Well, males do actually have a small amount of breast tissue under the nipples. Generally, due to the low levels of ‘female hormones’ this tissue remains inactive, however, a hormone imbalance at any point in life can cause the breast tissue to grow, and on occasion, uncontrolled growth can lead to breast cancer.

Given the low incidence of male breast cancer, it’s difficult to conduct research with a large number of patients to achieve conclusive evidence, and therefore treatment is generally adopted from female breast cancer guidelines. Recognizing the lack of public and clinical awareness about male cancer, we wanted to highlight one of the studies published in BMC Cancer adding further evidence to the current knowledge of breast cancer in men. The authors analyzed patient’s data including age, weight, risk factors, family history, tumor characteristics, treatment received and long term survival in all breast cancer patients attending their hospital over 15 years. In line with previous findings, the analysis revealed that those men having BRCA1/2 mutations, the most common mutation in hereditary breast cancers, display significant reduced survival. Among the risk factors, obesity and family history of breast cancer were associated with 21 % and 30 % of the cases respectively. Yet, a general positive message was conveyed, the study showed a high long-term survival rate in patients with male breast cancer compared with previous analyses. Given the low number of male breast cancer cases, reports like this one analyzing available patients’ data play a crucial role in shedding light into this rare condition.

A bright future ahead

Thanks to the advances achieved over the last decades in healthcare, today we live longer. With an increasingly ageing population worldwide, the incidence of Breast Cancer may also rise. As covered in this blog, evidence demonstrates that prevention and early diagnosis could help to eradicate this still deadly disease. Nevertheless, to achieve a world free of Breast Cancer deaths, public awareness about prevention programs and further research into the late stage of the disease is needed.

We hope that through exploring some of our recently published Breast Cancer Research, we have increased your awareness for breast cancer research and furthered your enthusiasm to support this cause.

Questions? Call +254 733 994 368 or E-mail: wecare@pathwayintl.co.ke

PATHWAY INTERNATIONAL: providing Global Healthcare Solutions.

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Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. In some instances, patients may be able to visit survivor-ship clinics that specialize in the post-treatment needs of people diagnosed with breast cancer.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return, and will help you make decisions about your treatment.

Breast cancer can come back in the breast or other areas of the body. Generally, a recurrence is found when a person has symptoms or an abnormal finding during a physical examination. The symptoms depend on where the cancer has recurred and may include:

• A lump under the arm or along the chest wall
• Pain that is constant, worsening, and not relieved by over-the-counter medication
• Bone, back, neck, or joint pain, fractures, or swelling, a possible sign of bone metastases
• Headaches, seizures, dizziness, confusion, personality changes, loss of balance, changes in vision, possible signs of brain metastases
• Chronic coughing, shortness of breath, or trouble breathing, possible symptoms of lung metastases
• Abdominal pain, itchy skin or rash, or yellow skin and eyes from a condition called jaundice, which may be associated with liver metastases
• Changes in energy levels, such as feeling ill or extremely tired
• Having a low appetite and/or weight loss
• Nausea or vomiting

It is important that your surgeon explain what your breast will feel like after surgery and, when used, radiation therapy. Over time, the breast will soften and change. But knowing what your breast will feel like can help you understand what is “normal” and what is not. If you have any questions or concerns about a symptom, you should talk with your doctor.

Your doctor will ask specific questions about your health. Regular follow-up care recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.”

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

• Long-term effects of surgery. After a mastectomy or lumpectomy to treat early-stage or locally advanced breast cancer, the breast may be scarred and may have a different shape or size than before surgery. Or, the area around the surgical site may become hardened. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema may occur, even many years after treatment. This is a life-long risk for survivors.
• Long-term effects of radiation therapy. Some patients experience breathlessness, a dry cough, and/or chest pain 2 to 3 months after finishing radiation therapy. That is because the treatment can cause swelling and a hardening or thickening of the lungs called fibrosis. These symptoms may seem similar to the symptoms of pneumonia but do not go away with antibiotics. The symptoms can be treated with medications called steroids. Most patients fully recover with treatment. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.
• Long-term effects of trastuzumab and/or chemotherapy. Patients who received trastuzumab or certain types of chemotherapy called anthracyclines may be at risk of heart problems. Talk with your doctor about the best ways to check for heart problems.
• Long-term effects of hormonal therapy. Women taking tamoxifen should have yearly pelvic exams, because this drug can slightly increase the risk of uterine cancer. Tell your doctor or nurse if you notice any abnormal vaginal bleeding or other new symptoms. Women who are taking an AI, such as anastrozole, exemestane, or letrozole, should have a bone density test periodically during treatment, as these drugs may cause some bone weakness or bone loss.

In addition, women recovering from early-stage or locally advanced breast cancer have other side effects that may continue after treatment. However, these can often be managed with medications or other options. Women recovering from early-stage or locally advanced breast cancer may also experience the following long-term effects:

• Neuropathy
• Menopausal symptoms
• Joint pain
• Fatigue
• Mood changes

Vaginal dryness and a lowered sex drive are also common side effects during or after treatment for early-stage and locally advanced breast cancer. Treatment is individualized for the patient and the type of cancer and may be best managed by a gynecologist working with your oncologist.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

Questions? Call +254 718 994 368 / 733 994 368 or E-mail: wecare@pathwayintl.co.ke

PATHWAY INTERNATIONAL: providing Global Healthcare Solutions.

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