Breast Cancer

Screening

Breast Cancer can be more effectively treated when it is caught early. That is, when it is small, and before it has the chance to spread locally or to other areas. Because of this, there has been found to be a significant benefit to breast cancer screening. Screening involves using tests (in this case often mammography and ultrasound) to look for cancer in asymptomatic individuals. In Alberta, women over the age of 45 are recommended to undergo breast cancer screening every 2 years, or more often if at higher risk. Women with a family history of breast cancer, or certain genetic predispositions to cancer are often screened at an even younger age. Additionally, women who have been diagnosed with breast cancer in their lifetime should undergo annual screening. Screening generally consists of a mammogram, but ultrasound can be used for certain individuals.

Symptoms and Diagnosis

The most common sign of breast cancer is a lump in the breast. Sometimes, a lump can also be felt in the armpit (or axilla) where several lymph nodes are located. Someone with breast cancer may also notice asymmetry of the breasts, or changes in the shape or size of the breast. Changes to the nipple area are also possible, including abnormal discharge from the nipple itself. If the cancer has spread to other body systems, symptoms can become much more general. Sometimes, this includes weight loss, bone pain, nausea, and poor energy, but the symptoms depend on where the cancer has spread.

When breast cancer is suspected it is important that it be diagnosed accurately and promptly. The diagnosis of breast cancer can include a history and physical examination, imaging, and biopsy of the breast or lymph nodes. Biopsy can be performed in different ways, but it is vital in that it collects a part of the cancer in order to accurately identify it. Diagnosis also includes testing the tumor for hormone sensitivity and HER2 status, which is a gene that can affect cancer growth and susceptibility to certain treatments. Diagnosis also involves checking to see if the cancer has spread to other locations. This is done using imaging such as bone scans and MRIs, as well as collection and examination of related lymph nodes during surgery. This is vital for cancer staging.

Treatment

As with many cancers, the management of breast cancer depends on the type and stage of the cancer. It also depends on the specific characteristics of the cancer, including its HER2 status and sensitivity to hormones. Characteristics of the patient, including their menopausal status, their age, and their overall health, are also important factors to consider.

Surgery

Surgery is one of the hallmark treatments for many types of local breast cancer. There are different types of surgery available, and the best choice depends on the size, location, and type of cancer, as well as the personal preferences of the patient. Surgery is generally separated into two categories: breast conserving surgery and total mastectomy. Breast conserving surgery involves removing the cancer while attempting to preserve the rest of the breast. It is generally the first line choice for smaller tumors that can be removed safely and in their entirety without affecting the overall look of the breast. Generally, it is followed by radiation in order to ensure that microscopic amounts of disease are not left behind. Mastectomy is offered when breast conserving surgery is not possible, or when it would be unsafe to do so (for example, due to risk of cancer being left behind). Mastectomy is a surgery that removes the entirety of the breast. It may also involve removal of some of the surrounding tissue and lymph nodes. In rare cases, parts of the muscle that forms the chest wall may also be removed.  Lymph node biopsies are often also performed to rule out spread of the cancer through the lymphatic system. More information on surgery for breast cancer can be found here.

Non-Surgical Treatments:

The non-surgical treatments available for breast cancers are diverse. They can be classified into several categories, including hormonal therapy, chemotherapy, radiotherapy, and immunotherapy. Not all of these categories are appropriate for all types of breast cancer, or all patients. Often, the best treatment is a combination of two or more of these options, sometimes at the same time, and sometimes spaced out.

Firstly, hormonal therapy is used in cancers that respond to estrogen or progesterone in the body. It generally works by blocking these hormones. Common hormonal-based therapies include tamoxifen and letrazole, which work by different means but to similar effect. Often, the right option depends on whether a person has gone through menopause, or not. Usually, these therapies are given alongside other treatments, but in some cases, they may be the primary therapy used.

Immunotherapy involves targeting specific proteins or receptors on the cancer cells. In other words, it harnesses the patient’s own immune system to slow cancer growth and destroy cells. A common example of an immunotherapy used in breast cancer is Herceptin, or Trastuzunab. This drug stops cells from dividing by binding to their HER-2 receptor found on some types of breast cancer cells. Of course, in order for it to be effective, the cancer cells must possess this marker. Other immunotherapies exist, targeting different markers.

Chemotherapy is probably what most people think of first when it comes to cancer treatment. In the case of breast cancer, chemotherapy may be used for several reasons. First, it can be used prior to surgery to shrink down the size of a local cancer so that it may be removed. It is also sometimes used after surgery to target microscopic or residual disease that may have been left behind by the procedure. It can also be used in cases where surgery isn’t an option, often because the cancer has already spread to other areas of the body. Chemotherapy can be very difficult on a person’s body, and the benefits of chemotherapy treatments must be weighed against their toxicities and side effects. Common chemotherapy drugs used in breast cancer are anthracycline (doxorubicin, epirubicin), taxane (paclitaxel, docetaxel) and platinum-based treatments.

Finally, breast cancer is sometimes treated with radiation. Radiation uses high energy waves or particles aimed at a cancer to destroy its cells. This can shrink a tumor or kill off residual cells that might not be seen on imaging or with the naked eye during surgery. Radiation can also be used in some cases to treat pain from cancer that has spread to other areas of the body, for example the bones. A radiation oncologist can determine whether radiation is an appropriate treatment.

Breast cancer is a complex disease. Screening, diagnosis, and treatment can often seem overwhelming and complicated. Partly, this is because there are so many treatment options available, thanks to the years of research and awareness surrounding the disease. If you have been diagnosed with breast cancer, remember that there will be a whole team of experts to walk you through the steps that will follow. They are there to answer your questions, address your concerns, and provide the best care possible.

References: 

1. https://cancer.ca/en/cancer-information/cancer-types/breast/treatment/radiation-therapy

2. https://teachmesurgery.com/breast/malignant-disease/non-surgical-treatments-for-breast-cancer/

3. https://cancer.ca/en/cancer-information/cancer-types/breast/what-is-breast-cancer

4. https://www.canada.ca/en/public-health/services/chronic-diseases/cancer/breast-cancer.html