Category: Breast Cancer

Imagine you are a young adult with your whole life ahead of you. Marriage, children, grandchildren, all of it. One day you find out that you have a history of breast cancer in your family, that doesn’t mean you’ll have it but there is a chance. You’re worried and stressed because you know nothing about this disease, so you look up and read about some basic information, and what you find might shock you. Are you prepared?

Cells in breast cancer become abnormal and multiply uncontrollably. Although more common in women, it can occur in men too. In both men and women, the most common form of breast cancer begins in cells lining the milk ducts, called ductal cancer. In women, the cancer can also develop in the milk glands (lobular tissue) causing lobular cancer. Men don’t have lobular tissue so this type is rare.

In breast cancer genetic changes are acquired during a lifetime and are present only in certain cells in the breast, these are known as somatic mutations and are not inherited. Less commonly, gene mutations present in all of the body’s cells increase the risk of developing breast cancer. These mutations as germline mutations which are inherited from parents. Cancers that cluster in families are associated with inherited mutations in certain genes like the BRCA1 and the BRCA2. The BRCA1 gene provides instructions for making a protein that acts as a tumor suppressor. The protein acts with several other proteins to mend DNA breaks. The BRCA2 genes have similar functions to the BRCA1 gene, but the BRCA2 gene proteins play a role in maintaining the stability of a cell’s genetic information. These genes are classified as “high penetrance” because they’re associated with a high risk of developing breast cancer and other types in women with mutations. Men who have these mutations also have an increased risk of developing different types of cancer, including breast ( US National, 2019).

Can include a lump in the breast, change in size or shape, dimpling or puckering of the skin on the breast, the nipple turned in toward the breast, scaly, red, or swollen skin on the breast, nipple, or areola, and discharge from the nipple (NIH, 2019).

Second most commonly diagnosed cancer in women. One in eight women in the US will develop invasive breast cancer in her life. Breast cancer in men represents less than 1% of all breast cancer diagnoses. In 2015 researchers estimated more than 230,000 new cases of invasive breast cancer will be diagnosed in US women and 2,300 new cases in US men. Gene mutations associated with breast cancer are more common among certain geographic or ethnic groups like people of Dutch ancestry and Ashkenazi Jewish heritage (US National, 2019).

Most cases aren’t caused by inherited genetic factors. The cancers are associated with somatic mutations in breast cells acquired during a lifetime and they don’t cluster in families. In hereditary breast cancer, the way risk is inherited depends on the gene involved. Mutations in the BRCA1 and BRCA2 genes are inherited in an autosomal dominant pattern, one copy of the altered gene in each cell is sufficient to increase a person’s chance of developing breast cancer. Though it is more common in women, the mutated gene can be inherited from either parent (US National, 2019).

Genetic testing is an option to diagnose (US National, 2019). Cancer screenings are also an option, mammograms, breast exams, and MRIs are options for screenings. Mammograms are the most common, it is an x-ray of the breast using a machine and they can find tumors too small to feel. Breast exams don’t work as well as mammograms to find cancer, the exam is a test to feel for lumps under the breast and underarms. Don’t rely on breast exams to screen for cancer. An MRI is only done for women with a high risk of breast cancer, it is radio waves and a powerful magnet ()

There are different types of treatments for patients. Some are standard, currently being used, and some are being tested in clinical trials. When clinical trials show that a new treatment is better than the standard, the new treatment might become the standard. Five types of standard treatment are used, surgery, radiation, chemotherapy, hormone therapy, and targeted therapy.

Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. This is the first in a group to receive lymphatic drainage from the primary tumor. A radioactive substance is injected near the tumor, the substance flows through the lymph ducts to the lymph nodes, The first lymph node to get the substance is removed. A pathologist looks at the tissue to look for cancer. If no cancer cells aren’t found it may not be necessary to remove more lymph nodes and if cancer cells are found, more lymph nodes will be removed from a different incision.

Radiation is a treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy, external and internal. External uses a machine to send radiation towards the cancer and internal uses a radioactive substance sealed in a needle, seeds, or catheters that are placed into or by the cancer

Chemo is a treatment that uses drugs to stop the growth of cells, either by killing them or stopping them from dividing.

Hormone therapy removes hormones or blocks the action and stops the cells from growing. Targeted therapy uses drugs to identify or attack specific cells without harming normal cells. People who do take part in clinical trials also help improve the ways cancer will be treated in the future (NCI, 2019).

Breast cancer can be traced to ancient Egypt. The earliest recorded case was in 1600 BC with Edwin Smith Papyrus. In the mid-20th century, scientists finally understood the cause of breast cancer. (Maurer Foundation, 2013).

Over 40 years treatment has improved due to lessons learned from clinical trials. The trials showed the benefits of hormone therapy and now that is part of standard treatments (NIH, 2018).

KISQALI is a national support group for people undergoing new treatments. Their features are, personal phone calls fitted to your schedule, educational information about your medication, financial assistance, support in understanding insurance coverage, and help identifying and determining pharmacies covered by your plan. (KISQALI Support Services)

Victory in the Valley is a Wichita, Kansas support group that encourages cancer families and patients on their journey by offering hope through emotional support while also providing practical services to improve their quality of life (Victory in the Valley).

Angelina Jolie tested positive for the BRCA1 mutation and had a double mastectomy even though she didn’t have cancer in either breast. Her family has a significant history of breast cancer (Celebrities: NBCF, 2018). The month of October is dedicated to Breast Cancer awareness and people wear pink to support the cause (Breast Cancer Awareness Month: NBCF).

Whether you are male or female, rich or poor, famous or unknown, young or old, cancer doesn’t care who or when it attacks. More and more people are given hope with the treatments available and the treatments becoming available. With support groups, people can be surrounded by people like them and by people who care.

Breast cancer has become a major public health issue worldwide and is the main cause of cancer-related deaths among women (1). South Africa accounts for one out of every four cancers diagnosed and one out of every five cancer deaths among women(2). The rate of breast cancer among the female South African population is rising by the day and is seen as one of the most common cancers among females in South Africa (3) (Appendix II Fig 2 and Table 2) (4). Therefore, education and awareness on breast cancer and cancer as a whole should be introduced to the public and communities (1).

Some of the latest statistics indicate that women with higher education, chronic conditions, and medical aid are more likely to get their mammograms done (5). And that woman living in rural areas are more likely not to receive their screening due to limited affordability, availability, and accessibility of breast cancer services (5).

It is therefore crucial that females of different communities are made aware of how important the early detection of breast cancer can be (3). It should be taught that regular self-breast examinations and regular mammograms are vital for the early detection of breast cancer (3). This will result in the early treatment of the patient which will contribute to a more effective and positive outcome, and will eventually lead to a major decrease in the loss of life (3).

Therefore, creating this mobile unit will help to build more awareness amongst rural communities that lack knowledge about breast cancer and the effect it can have on one’s life.

The mobile unit traveling through the rural communities of the Western Cape will help to promote early detection of breast cancer and improved adherence to treatment. The following steps are crucial for developing better breast cancer care in rural communities in the Western Cape by addressing the communities’ insights into breast cancer, structural barriers to intensive therapies, the patient’s needs and desires for treatment, and the burden of invasive treatments(6).

By increasing awareness of breast cancer and increasing early diagnosis of breast cancer, we hope to reduce mortality and morbidity associated with breast cancer (7). And to serve and to improve the overall breast care service (7).

The main objective of having a mobile truck is to ensure that South Africans have access to breast units, which provide essential breast services (7). The purpose of this unit is to include early breast cancer recognition, workup, and treatment and ensure improved agile services through the healthcare system by shortening waiting times, and efficiently minimizing morbidity and mortality due to cancer progression (7).

The plan is to improve the early detection of breast cancer by promoting community awareness and educating healthcare workers and communities on breast cancer management and breast healthcare (7). Patients with health fears will be given a streamlined referral process and an ideal breast cancer policy will be developed, setting standards for the ideal treatment of breast conditions (7).

Mobile mammography units (MMUs), which were originally introduced to increase geographical accessibility but also to reach deprived women, are now used in several breast cancer screening programs (8). Although few studies have compared mammography screening adherence between MMUs and stationary sites, there are likely to be more in the future (8). According to research, there was also a higher participation rate in the MMU subgroup of women with low household incomes (8). Most women who obtain their mammography in MMU are most likely to have a lower socioeconomic status, which is also less in contact with healthcare services, live in rural areas, and adhere to mammography screening guidelines less than those who receive it in fixed sites (8).

By providing mobile mammography (MM) services, we can improve adherence to mammography screening guidelines and reduce geographic and social disparities in participation in breast cancer screening (8).

The following aspects are essential to achieve high-quality mammography: appropriate positioning and technical factors for exposure; equipment that is in proper working order; appropriate image viewing conditions; well-skilled and qualified personnel such as the radiologist, mammographer, medical physicist); and a modern well-designed equipment (STIPUB1482 (iaea.org)

A mobile mammography program is proposed to demonstrate its cost-effectiveness (9). Women in medically underserved areas can benefit from mobile mammography programs as they can eliminate many barriers to breast cancer screening (9). To establish a cost-effective mobile mammography program, you must find and maintain resources, have appropriate equipment and infrastructure, and have a dedicated team with an efficient workflow (9).

Invasive ductal carcinoma is the most common type of breast cancer, it begins in the cells that line the milk duct in the breast, then the cancer penetrates the channel wall and grows into nearby breast tissue, at this stage it can spread to other parts of the body through the lymphatic system and the bloodstream. Given in this case, the patient has invasive ductal carcinoma through the biopsy taken, and since the solid mass is immobile with a diameter of 2-3 cm, 5 cm from the nipple, is felt in the upper outer quadrant of the right breast, the lymph node in the armpit is imperceptible, and there is no spread In the body, according to the TNM staging system, the system that describes the amount and spread of cancer in a patient’s body. T describes the size of the tumor and any spread of cancer into nearby tissue; N describes the spread of cancer to nearby lymph nodes; and M describes metastasis. Accordingly, the patient in this case is in Stage 2A: T2, N0, M0.

In this case, we will start with a topical treatment.

Stage 2 cancers are treated with either breast preservation surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. Proximal lymph nodes will also be examined, either by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Women with BCS are treated with radiotherapy after surgery as radiation is discussed as a treatment option after surgery. In this case, we will start with a lumpectomy and then dissect the axillary lymph node.

The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy followed by radiation therapy is as effective in preventing a recurrence of breast cancer as the removal of the entire breast (mastectomy) for early-stage breast cancer. here we recommend lumpectomy because the biopsy has shown that the cancer is believed to be small and early stage. A lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.

we do not recommend lumpectomy for breast cancer if you: Have a history of scleroderma, have a history of systemic lupus erythematosus, have two or more tumors in different quadrants of your breast that cannot be removed with a single incision, which could affect the appearance of your breast, have previously had radiation treatment to the breast region, have cancer that has spread throughout your breast and overlying skin since lumpectomy would be unlikely to remove cancer completely, have a large tumor and small breasts, which may cause a poor cosmetic result, and don’t have access to radiation therapy. But in this case, all of these barriers are not present, so a lumpectomy is a correct and proper option.

The goal of axillary lymph node which is a surgical procedure that incises the axilla to identify, examine, or remove lymph nodes. Axillary dissection has been the standard technique used in the staging and treatment of the axilla in breast cancer. Patients presenting with symptomatic early breast cancer have a 30-40% chance of having positive axillary nodes and a 20-25% chance if presenting through a screening program. Staging of the axilla is an important step in the treatment of breast carcinoma. Axillary lymph node status is a significant prognostic pathologic variable in patients with operable primary breast cancer, and it remains the most powerful predictor of recurrence and survival.

starting with a Lumpectomy to remove cancerous breast tissue along with a rim of normal tissue surrounding it called a surgical margin. The procedure preserves the rest of the breast as well as the sensation in the breast. If you have invasive breast cancer and are younger than 70 years of age, a lumpectomy is always followed by radiation treatments to the breast the patient is 42 years old so we will start with radiation therapy, External beam radiation therapy is offered after breast-conserving surgery for stage 2 breast cancer. All of the breast and the lymph nodes under the arm and near the collarbone are treated. Radiation after lumpectomy is to kill any cancer cells that might remain. Adding radiation after a lumpectomy reduces the risk that cancer will return to the affected breast. Lumpectomy combined with radiation therapy is often referred to as breast conservation therapy. This type of treatment is as effective as having all the breast tissue removed (mastectomy). In special situations where the risk of recurrence is very low.

After lumpectomy, radiation treatment options might include:

Radiation to the entire breast. One of the most common types of radiation therapy after a lumpectomy is external beam radiation of the whole breast (whole-breast irradiation).

Radiation to part of the breast. Radiation therapy to part of the breast (partial-breast irradiation) may be an option for some early-stage breast cancers. This technique directs internal or external radiation to the area around where the cancer was removed.

Complementary and Alternative Medicine (CAM) is becoming increasingly popular among cancer patients, in particular those with breast cancer. It represents one of the fastest-growing treatment modalities in the United States. CAM encompasses a wide range of modalities including special diet and nutrition, mind-body approaches, and traditional Chinese medicine.

• CAM treatment 1: Special diet

A healthy diet is an important part of cancer treatment. However, some people with breast cancer may start on a special diet in place of taking anticancer drugs. You should avoid foods that are:high-fat, salt-cured, smoked, or pickled. You should also double up on fruits, vegetables, and plant-based foods.

• CAM treatment 2: Antioxidant supplements

Antioxidants lower your risk of cancer by helping protect your body from damage caused by free radicals. Certain grains, fruits, and vegetables are rich in dietary antioxidants, including:

beta carotene, lycopene, vitamin A, vitamin C, vitamin E. These antioxidants may be found in the following foods: goji berries, wild blueberries, dark chocolate, pecans, and kidney beans. They’re also available through dietary supplements. However, research is mixed on whether antioxidant supplements are safe to use during cancer treatment.

• CAM treatment 3: Mind, body, and soul therapies

Mind-body practices are meant to improve your mind’s positive impact on the rest of your body. Each therapy targets your mind, body, and soul using meditative techniques and creative activities that help enhance your quality of life.

• CAM treatment 4: Massage therapy

Massage therapy is known to boost immunity and ease anxiety, pain, and fatigue. One 2003 study by Trusted Source found that in women who had breast cancer, massage therapy helped reduce not only anxiety and pain but also the need for pain medication. Another study Trusted Source released around that time found that massage therapy and progressive muscle relaxation helped increase protective white blood cells in women with stage 1 and stage 2 breast cancer.

• CAM treatment 5: Acupuncture

Acupuncture is a central part of traditional Chinese medicine that may help relieve symptoms of breast cancer and the side effects of treatment. Acupuncture requires a practitioner to place sterile, hair-thin needles into acupuncture points — specific points on your skin — and then gently move them to stimulate your nervous system.

Research Trusted Source has shown that acupuncture can help: relieve fatigue, control hot flashes, reduce vomiting, reduce pain, and help decrease nausea.

Fighting cancer typically involves more than one treatment. Most of the time, the disease requires a multidisciplinary approach or a combination of therapies. Treatment plans often involve a primary therapy—generally surgery or radiation therapy—in addition to an adjuvant or neoadjuvant therapy. In a nutshell, these are therapies, like chemotherapy or hormone therapy, delivered before or after the primary treatment, to help increase the treatment’s chance of success and decrease the risk of recurrence.

Neoadjuvant and adjuvant therapies are often used to treat breast, colon, and lung cancers, and may include chemotherapy, hormone therapy, radiation therapy, immunotherapy, and targeted therapy. The two therapies differ largely in when they are given and why. Neoadjuvant therapies are delivered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread. Adjuvant therapies are delivered after the primary treatment, to destroy remaining cancer cells.

Most often, neoadjuvant and adjuvant therapies are recommended when a patient with early-stage cancer undergoes surgery or radiation therapy and we believe that in this condition she may benefit from additional systemic treatments, In this condition we have localized breast cancer, and the first-line treatment in this case is surgery, but to improve the chances that the surgery works as well as it can, we give chemotherapy three or four months before surgery, or three to four months after surgery, then there is a significant improvement in prognosis and a decreased risk of recurrence with doing either an adjuvant or neoadjuvant approach.”

Neoadjuvant and adjuvant therapies benefit many, but not all, cancer patients. The type and stage of a patient’s cancer often dictate whether she is a candidate for additional treatment. Neoadjuvant therapy may also serve as a tool for determining the patient’s response to treatment. If the tumor responds to chemotherapy before surgery, you know that the patient is more than likely to do well.”

It’s important to know, though, that neoadjuvant and adjuvant therapies may cause side effects, such as the nausea and fatigue that often accompany chemotherapy. That’s why they’re commonly recommended for otherwise healthy cancer patients when the expected benefits outweigh the potential risks.

What types of adjuvant therapies are used for breast cancer?

Most adjuvant therapies are systemic: they use substances that travel through the bloodstream, reaching and affecting cancer cells all over the body. Adjuvant therapy for breast cancer can include chemotherapy, hormonal therapy, the targeted drug trastuzumab (Herceptin), radiation therapy, or a combination of treatments.

• Adjuvant chemotherapy uses drugs to kill cancer cells. Research has shown that adjuvant chemotherapy for early-stage breast cancer helps to prevent the cancer from returning.

• Hormonal therapy deprives breast cancer cells of the hormone estrogen, which many breast tumors need to grow. A commonly used hormonal treatment is the drug tamoxifen, which blocks estrogen’s activity in the body. Studies have shown that tamoxifen helps prevent the original cancer from returning and also helps to prevent the development of new cancers in the other breast.

• Trastuzumab is a monoclonal antibody that targets cancer cells that make too much of, or overexpress, a protein called HER2. When cancer cells overexpress HER2 protein, they are said to be HER2-positive. Approximately 20 percent of all breast cancers are HER2 positive. Clinical trials have shown that targeted therapy with trastuzumab in addition to chemotherapy decreases the risk of relapse for women with HER2-positive tumors.

• Radiation therapy is usually given after breast-conserving surgery and may be given after a mastectomy. For women at high risk of recurrence, doctors may use radiation therapy after mastectomy to kill cancer cells that may be left in tissues next to the breast, such as the chest wall or nearby lymph nodes.

What types of Neoadjuvant therapies are used for breast cancer?

• Neoadjuvant chemotherapy. If your treatment plan includes chemotherapy, neoadjuvant chemotherapy may be an option as a first treatment. However, for some women, neoadjuvant chemotherapy may change their surgical options. Neoadjuvant chemotherapy may be able to shrink a larger tumor enough so lumpectomy plus radiation therapy becomes an option instead of mastectomy like in this case.

• Neoadjuvant hormone therapy, may change a woman’s surgical options. It may be able to shrink a large tumor enough so lumpectomy plus radiation therapy becomes an option instead of mastectomy like in this case. Neoadjuvant hormone therapy is only used to treat hormone receptor-positive (ER-positive and or PR-positive) breast cancers. Some women with low-grade tumors or invasive lobular breast cancer may be offered neoadjuvant hormone therapy instead of chemotherapy. Survival is the same whether you start taking hormone therapy before surgery or after surgery.

The BRCA gene test is offered to those who are likely to have an inherited mutation based on a personal or family history of breast cancer or ovarian cancer. The BRCA gene test isn’t routinely performed on people at average risk of breast and ovarian cancers.

While BRCA1 and BRCA2 gene mutations may increase your odds of developing breast cancer, your odds of having either mutation are pretty small. An estimated 0.25% of the general population carries a mutated BRCA gene or about one out of every 400 people.

For some people, though, the chances of having a BRCA gene mutation are much higher. Genes are inherited, which is why knowing your family history is important when determining breast cancer risks. If one of your parents has a BRCA mutation, you have a 50% chance of inheriting the mutated gene. Odds can also vary depending on a person’s ethnicity. For example, people of Ashkenazi Jewish descent have a 2.5% chance of inheriting a BRCA mutation, or about 10 times the rate of the general population.

Genetic counseling is recommended for tested breast cancer gene mutations. So we determine whether genetic testing would make sense based on family history and risk factors. Since many genetic tests only look for one specific gene mutation. The genetic test itself simply involves taking a small sample of blood or saliva, which is sent to a lab for analysis. Results can take several weeks or months.

Ideally, in a family that might carry a gene mutation, a family member who has breast or ovarian cancer will have the BRCA gene test first. If this individual agrees to genetic testing and doesn’t carry the BRCA gene mutation, then other family members may not benefit from genetic testing. However, there might be other genetic tests to consider. In this case, based on the information given, the patient does not have a family history of breast cancer, so genetic tests are not very useful in this case. Nevertheless Genetic testing results are not always clear-cut:

A test result can be positive, meaning that the patient does carry the gene mutation.

A negative test result indicates that they do not have that particular known gene mutation. It does not, however, rule out the possibility of having mutations in other genes. It also does not rule out the possibility of developing breast cancer. Most breast cancer cases are not hereditary, so everyone should still have an early detection plan.

Genetic test results can also be uncertain or ambiguous. An ambiguous test result means that a mutation has been found in the gene, but it is not yet known whether that particular mutation has any effect on the chances of developing breast cancer.

Genetic testing can be scary. The results also can impact other family members such as siblings and offspring; when someone tests positive for a gene mutation, their siblings and offspring will have a 50% risk of also testing positive.

Preoperative testing before the lumpectomy, In the weeks or days before surgery, we need to take tests to make sure the body can handle the anesthesia and the operation.

A chest X-ray and electrocardiogram (EKG) will show whether your lungs and heart are working properly. Blood tests will check your blood counts, your liver and kidney function, and your risk of bleeding or infection. A urine test can find out about your kidney function and look for infections.

Sometimes other tests, such as CAT scans, are given to check for tumor location and size. A CAT scan can also determine whether a tumor is involved with other parts of the body. Also, we ask about having diabetes, high blood pressure, heart disease, or other conditions that could affect surgery.

Breast Cancer, as defined by Majure, breast cancer is an ‘uncontrolled growth of abnormal breast cells’ (Majure: 110). In other words, Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to other parts of the body (American Cancer Society, 2016.)

Breast cancer is a disease that causes abnormal changes in the genes, which regulate the growth of cells and keep them healthy. Breast cancer can begin in the cells of the lobules, these are the milk-producing glands, or can begin in the ducts, these are the passages that drain the milk from the lobules to the nipple (Breastcancer.org, 2016).

Breast Cancer is the most frequent malignancy in women worldwide and is curable in around 70-80% of early-stage, non-metastatic disease patients.

According to Coleman et al.,2008 that in developing countries almost 50% of all breast cancer patients and nearly 60% of deaths were occurring from 1.38 million new breast cancer cases which were diagnosed in 2008. There is a huge difference in breast cancer survival rates worldwide, with an estimated 5-year survival of 80% in developed countries to below 40% in developing countries.

This essay will draw on the role of breast cancer as a key agent in the rehabilitation of patients who suffered from this disease and help women to understand how to prevent and treat breast cancer at a young age. It will also help them to get information on different existing treatment options.

To acknowledge the function of breast cancer, it is necessary to first understand how breast cancer impacts the individual. According to the cancer society, breast cancer has several important parameters of tumor development: its size, its distribution to the surrounding tissue, whether it has spread to the lymph nodes in the breast or around it, whether it has spread to other parts of the body, such as the bones, liver or lung as well as also stimulated by the hormones. The survival rate during 5 years at four stages is on average 22percent (ACS, 2016).

Somehow, the main symptoms of breast cancer collected from Cancer Research (2014) and ACS (2016) may be:

• Presence in one or both breasts of one or more’ hard masses’ lumps of any size, shape, texture, with smooth or non-smooth edges.
• Inflammation (redness, swelling, increase of temperature).
• Skin of the breast change: noticeable depressions, redness, or thickening.
• Prolonged pain in one or both breasts, the cause of which is not clear (in many cases, breast cancer develops painlessly).
• Nipple retraction (if before the nipple was another form).
• Skin Redness, peeling, the appearance of sores on the nipple.
• Bleeding or transparent fluid from the nipple, without a known reason.

For a long time, maybe swollen lymph nodes under or above the clavicle or in the armpit.

Meanwhile, there are partially or completely several different treatments that prevent the development of breast cancer. So, there are special drugs that remove the parts that develop ‘pre-cancerous changes’ and the complete removal of the breast (NCI, 2013). However, such kind of preventive treatment is recommended mainly for women with a high risk of developing breast cancer, but the conventional risk of developing treatment is avoided. After a certain age, they are only recommended to undergo regular special preventive screening – mammograms, ultrasound, MRI scan, and biopsy.

Therefore, mammography can detect breast cancer in its early stages when it may still have no symptoms but can be perfectly treated. Women who do regular mammograms have a chance of successful treatment and full recovery. In other words, regular mammogram screening can prevent the development of advanced cancer, for which recovery prognosis is much worse than in the beginning. ( La¸berg et al, 2015).

Currently, it is the main screening method for breast cancer, this survey is simple, safe, cheap, and affordable for all women. This test is taken from several X-ray images of mammary glands(breast). It was performed in a specially equipped room with a mammography machine. It is a form of an x-ray machine. Before mammography, it is needed to undress from the waist up breast are done separately. The process takes 20 minutes. (NCI, 2014).

Women who undergo screening mammography do not examine any change or those which detect breast cancer in such case doctor recommend an additional examination ultrasound and biopsy. Only with non-hazardous mammography, these changes cannot be distinguished from ‘cancer.’ For obvious reasons, to find any changes that may be a ‘tumor’ it is recommended to do the further examination on biopsies or even surgical removal of the formation to finally make sure that it is not dangerous.

Although, the exact cause of breast cancer is not known. Breast cancer disease plays a significant role in aging, genetic predisposition, female sex, and hormones however still it does not clear exactly how all these factors contribute to the growth of the tumor (Hashemi et al 20114).

The development of breast cancer r has nothing to do with the size of the breast, wearing a bra, using deodorants (antiperspirants), or abortion. Injuries of the breast (punches) also may slightly increase the likelihood of developing cancer due to scarring. Receiving oral contraceptives slightly increases the risk of breast cancer, but the risk is returning to the average level after a woman stops taking the medication. Smoking may contribute to the development of mammary gland cancer in women with long experience of heavy smoking. (Hashemi et al 2014).

Besides age, another factor that increases the likelihood of developing breast cancer is a woman’s genetic predisposition to the disease. During the research, it was found that the probability of occurrence of breast cancer among women with a genetic predisposition to the development of the disease may be more than 20% and, in some cases, increases up to 80%.

The specialized doctors improve the survival and quality of life of their patients through different treatments like surgery, radiotherapy, and systematic therapy. Such treatments kill the cancer cell or tissue which is present. After completing treatment for breast cancer, the patient may experience some long-term side effects, depending on the treatment you have received – for example, radiotherapy can increase the risk of heart disease and lung cancer and chemotherapy can cause peripheral neuropathy. These long-term effects can be managed so patients must tell their doctor or specialist nurse about any persistent or new symptoms. After such treatment of breast cancer, the doctor advised the patient should take some exercise and maintain body weight in a healthy range may also reduce the risk of recurrence (Cardoso et al. 2018 [in press]). It should be noted that they eat healthy, fit, good mood, and exercise with differing based on the patient and their condition.

To sum up, everything that has been stated so far, the main goal of scientists is to give advance, is to an understanding of the needs of patients with advanced breast cancer and intense lobbying for their rights is crucial. In this regard, the ABC Global Alliance was created and is actively fighting for, among others, better survival and quality of life, accurate information, access to multidisciplinary and high-quality care, early access to supportive and palliative measures, financial support, and the ability to maintain or return to work. The ABC Charter, which is a comprehensive needs assessment of the field of advanced breast cancer, clearly highlights that much work is still needed and that intense collaboration between all stakeholders involved is crucial to improve the length and quality of life of all patients and perhaps one day be able to reach a cure for advanced breast cancer.

References:

1. Breastcancer.org, (2016) Breast cancer facts and Statistics Available at: https:www.breastcancer.orgfacts-statistics (1332022)
2. Breast cancer (2019) Available at: https:www.researchgate.netpublication335984408_Breast_cancer Accessed at (13032022)
3. Awareness and current knowledge of breast Cancer by Akram et al. Biol Res (2017) 50:33 Available at: https:biolres.biomedcentral.comtrackpdf10.1186s40659-017-0140-9.pdf Access at (13032022)
4. Benefits and harms of mammography screening Available at: https:breast-cancer-research.biomedcentral.comarticles10.1186s13058-015-0525-z accessed at (130302022)
5. National cancer institution (2014) available at: https:www.cancer.govtypesbreastmammograms-fact-sheet Access at (13032022)
6. Lifestyle changes for prevention of breast cancer by Seyed Hesam Bani Hashemi access on(03212022) available at: https:www.ncbi.nlm.nih.govpmcarticlesPMC4324293
7. Lifestyle changes for prevention of breast cancer (2014) by Seyed Hesam Bani Hashemi
8. Available at: https:www.researchgate.netpublication273466739_Lifestyle_changes_for_prevention_of_breast_cancer.[ Accessed:13 March 2022]
9. Primary breast cancer (2015) by S. Zackrisson, F. Cardoso. Available at: https:www.annalsofoncology.orgarticleS0923-7534(19)47181-0fulltext [ Accessed:13 march, 2022]

“As of January 2019, there are more than 3.1 million women with a history of breast cancer in the U.S.”(breastcancer.org). Breast cancer is not a rare disease. It is affecting a large population of women where the cells in the bosom develop wild. There are various types of bosom malignant growth. The sort of bosom malignancy relies upon which cells in the bosom transform into disease (cdc.gov). Although the majority of females come in contact with this disease, breast cancer affects males as well. Breast cancer has no favoritism when it comes to age or even gender. It can affect a young person or an older person. It all depends on the function within that person’s body, but those with a certain genetic mutation and ancestry of breast cancer are prone to get the disease. During this research paper, we will learn about the effectiveness of a drug called Tamoxifen used on high-risk women. It is expected that overall it is beneficial and the world’s best medication against breast cancer. However, there are weighing side effects that come with this medicine.

Discovery

Tamoxifen is a drug used to treat cancer from growing inside the breast. It is additionally used to lessen the odds in high-chance patients. This medicine can hinder the development of the disease. It works by meddling with the impacts of estrogen in the tissue inside the breast. Tamoxifen was, truth be told, a fairly unplanned disclosure. It was first made in 1966 by researchers working for Imperial Chemical Industries Pharmaceutical. An individual from the group, V. Craig Jordan, saw the capability of tamoxifen to treat breast cancer. Jordan happened to be the first to bring worries about the tamoxifen-expanding endometrial disease. Around the 1970s, at Christie Hospital in Manchester, the first clinical preliminary testing was done. Tamoxifen had been revived from the cinders and was en route to a worldwide achievement (The International Journal of Developmental Biology). According to www.cancer.gov, The Food and Drug Administration (FDA) supports tamoxifen, an antiestrogen sedate initially created as an anti-conception medication treatment, for the treatment of bosom malignant growth. Tamoxifen is the first of a class of medications known as specific estrogen receptor modulators, or SERMs, to be endorsed for malignant growth treatment (cancer.gov).

Structure and Mode of Action

First, we must understand how tamoxifen works. This medication squares estrogen receptors on breast cells. It prevents estrogen from associating with the malignancy cells and guiding them to develop and partition. While tamoxifen acts like an enemy of estrogen in breast cells, it acts like an estrogen in different tissues, similar to the uterus and the bones. Along these lines, it is known as a specific estrogen receptor modulator (SERM). It tends to be utilized to treat ladies with breast cancer who have or have not experienced menopause. Below are images and a formula of the molecule given by Pubchem:

Formula: C26H29NO

2D Structure

3D Structure

High Risk Groups

Family History

Genetics plays a huge role in one’s life story. The vast majority of us realize that we can decrease our danger of ailments by having a healthy life. In any case, did you realize that your family ancestry may be perhaps the most grounded effect on your danger of creating coronary illness, stroke, diabetes, or disease? Women who share the breast cancer risk in their family are at higher risk of getting breast cancer. There were approximately 13-16 percent of the ladies analyzed had a first-degree female family member (mother, sister, or little girl) with breast cancer (Susan G. Komen). A female’s life is endangered twice as much if they have a first-degree female relative determined to have the disease (breastcancer.org). However, using the data from the International Breast Cancer Intervention Study, the team demonstrates the reduction of Tamoxifen causes in women who have a family history of breast cancer. The IBIS- I intended to explore the utilization of tamoxifen in forestalling breast cancer growth in ladies with a higher danger of building up the sickness. The team recruited 7154 women in total. As a result, it reduced one-third in higher-risk women but with some serious side effects. Even if family history plays a dramatic role in a female’s life, tamoxifen can change that with the right amount of dosage.

Mutation

Women with a certain mutation will also determine the risk of them getting breast cancer or contralateral cancer. A clinical trial by the Hereditary breast cancer clinical study group demonstrates women with BRCA1 or BRCA2 as their mutation have a high risk of developing the disease. According to https://www.ncbi.nlm.nih.gov/pubmed/11130383, “Tamoxifen protected against contralateral breast cancer for carriers of BRCA1 mutations (odds ratio 0.38, 95% CI 0.19-0.74) and for those with BRCA2 mutations (0.63, 0.20-1.50)” In women who used tamoxifen for 2-4 years, the risk of contralateral breast cancer was reduced by 75%. Tamoxifen has a decent mediocrity profile and has shown benefits for breast cancer patients in dragging out generally speaking and ailment-free endurance and decreasing the rate of contralateral breast disease. These known advantages of tamoxifen far exceed the danger of endometrial disease in tamoxifen-treated patients with breast cancer.

Risk of Use

Tamoxifen diminishes breast malignancy repeat, mortality, and breast disease chance in high-hazard ladies. Despite these demonstrated advantages, tamoxifen use is regularly questioned because of its symptoms. The risk of contralateral breast cancer associated with tamoxifen use was estimated with the use of Cox regression. All statistical tests were two-sided. 89 tamoxifen users and 100 nonusers of tamoxifen were diagnosed with contralateral breast cancer (academic.oup.com).

Conclusion

Overall, tamoxifen is one of the most effective medications used on high-risk females. Of course, there will be side effects just like any other medication used. It may have a more severe effect, but fighting breast cancer or cancer in general takes a toll on a person. The issue identified with tamoxifen use becomes checking the focal points versus the hazards. On the positive side, tamoxifen affects the bone and lipids which is related to the reduction in contralateral chest ailment. This will change over into lives spared. On the negative side, tamoxifen has a relationship with an improvement in the affirmation of endometrial danger. If we consolidate the most clinically basic focal point of tamoxifen, which is its capacity to draw out infirmity-free constancy and to diminish chest sickness mortality, then it winds up being certain that the upsides of tamoxifen treatment far outperform the dangers. Tamoxifen is recorded best in the world. Nobody, female or male with breast cancer should shut tamoxifen out from attesting worry for potential gynecologic issues.

Introduction

The World Health Organization (WHO) defined genomics as ‘the study of genes and their functions, and related techniques (WHO, n .d.). The completion of the Human Genome Project (HGP) in 2003 marked a new era of the genome in medicine and health. Although our knowledge of human genomes is far from complete, genomics is making a huge impact on health and disease. The advances in genome sequencing technology and analysis are opening up a new window on cancer progression, informing new approaches to diagnosis and treatment across the disease pathway (Hill, 2018). In this paper, the author takes breast cancer patient treatment management as an example to refute the statement that ‘genomics adds nothing new to what we have already known’. From the application of breast cancer preventative screening programs, and molecular stratification of breast cancer, to the precision medicine of the right drug and right dose for the right patient based on the genomic profile, the potential benefits of genomics to breast cancer care are enormous.

Genomics applied to breast cancer prevention

There are about 20-30% of breast cancer patients have a family history and only 5-10% of these patients have gene mutations (Caso et al.,2017), but the identification of these mutations plays a significant role in guiding patients in risk-reducing interventions and surveillance protocols. Genomic testing provides a unique opportunity for individualized cancer risk prediction. Early detection and intervention potentially decrease the morbidity and mortality of breast cancer.

Breast cancer (BRCA) gene screening and risk prediction tools

According to the World Cancer Research Fund (WCRF) (2017), breast cancer is the most common cancer in women worldwide. Although mammography screening programs have been established worldwide. However, as age is the only risk to be considered for women to have mammograms, the ‘one size fits all’ screening recommendation may not be effective and beneficial for all. Louro et al. (2019) conducted a systematic review and assessed the quality of individualized breast cancer risk prediction tools used in the studies up to February 2018, they identified four models to predict breast cancer risk, namely the Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Surveillance Consortium (BCSC), the Rosner and Colditz model, and the International Breast Cancer Intervention Study (IBIS). Even though it is hard to recommend any of the models as the standard tool for predicting individual risk, from the first publication of the BCRAT model in 1989 till the time of the study, genetic variation was updated in all of the models to improve the quality and accuracy of the tool. Although the BRCA genes were discovered in the 1990s, they didn’t attract much attention from the public until Angelina Jolie revealed herself to be the carrier of a BRCA1 gene mutation on 14 May 2013 (Troiano et al., 2017). She underwent a prophylactic mastectomy and laparoscopic bilateral salpingo-oophorectomy as her estimated risk of developing cancer was 87%. Angelina Jolie’s disclosure of BRCA status led to a big increase in BRCA tests with a peak of +80%. Narod’s 2010 study (as cited in Troiano et al., 2017) revealed that the vast majority of inherited breast cancers are due to mutations of the genes BRCA1 and BRCA2. Women who carry these highly penetrant genes have a lifetime risk of breast cancer of 50%-85% compared to 5%-10% in males (Shiovitz & Korde, 2015). The information about BRCA mutation assists the patients and family members in taking preventive measures. These measures include risk-reduction surgeries such as mastectomy and salpingo-oophorectomy, chemoprevention medicine tamoxifen and raloxifene, and intensive screening (Tyler, 2019). Bilateral mastectomies have shown a remarkable decrease in mortality for women who carry inherited genes of BRCA1 and BRCA2 with early-stage cancer (Caso et al., 2017).

BRCA genes test in Australia

Cancer Australia (n. d.) recommended the genetic testing of BRCA1 and BRCA2 gene mutations for women diagnosed with breast or ovarian cancer, regardless of their age and family history. On 12 October 2017, Australia Broadcast Corporation (ABC) announced the breaking news of the BRCA gene test free for patients at high risk of breast and ovarian cancer (Scott, 2017). The free gene testing has been claimed as ‘a huge milestone’ while one in eight women will develop breast cancer before the age of 80 in Australia. Breast Cancer Network Australia (BCNA) also welcomed the news of Medicare rebates for genetic testing (BCNA, 2017), the rebates not only improve women’s access to genetic testing but the timely information will help them to make the right intervention decision. As BRCA genes are familial, the genetic test is also funded for relevant family members in Australia. This funding policy has reduced the financial burden on the patients and their families. The genetic testing result also assists the family members in seeking a further medical diagnosis of breast cancer, and the early recognition of hereditary breast cancer is crucial in clinical management.

Genomic testing in cancer stratification and prognosis

Traditionally, breast cancer was classified simply by its histological appearance and its origination (Makki, 2015). The non-invasive breast cancers are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS), which are confined to the ducts and lobules and potentially malignant. Whereas, invasive breast cancers including invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and metastatic breast cancer have invaded the stroma. Such morphological categorizations are inadequate for precision medicine in individualized patient treatment.

Molecular subtypes of breast cancer and their roles

The whole-genome analysis by using a genome-wide association study (GWAS) and next-generation sequencing (NGS) advanced cancer genome profiling study (Low et al., 2017). To provide information on breast cancer prognosis and treatment planning, the identification of molecular subtypes of breast cancer through the genomic technology of immunohistochemistry and gene expression profiling becomes a critical component (Fragomeni et al., 2018). The four molecular subtypes of breast cancer include luminal A, luminal B, and human epidermal growth factor receptor2 (HER2)-positive and basal-like. Luminal A is estrogen receptor (ER)/ progesterone receptor (PR) positive and HER2 negative and accounts for 50% of invasive breast cancers (Makki, 2015). Patients in this group benefit from endocrine therapy such as tamoxifen and aromatase inhibitors with good prognosis (Fragomeni et al., 2018). In the subtype of luminal B, the ER/PR is positive and HER2 is variable. The prognosis is poorer compared with luminal A as the response to endocrine therapy and chemotherapy is variable (Makki, 2015). From the definition of HER2 positive, the ER/PR is usually negative and HER2 is strongly positive in this group. The patients in this group showed the highest sensitivity to HER2-targeting drugs such as trastuzumab and pertuzumab (Makki, 2015). Basal-like is a morphologically, genetically, and clinically heterogeneous category of breast cancer and is associated with unfavorable prognosis (Fragomeni et al., 2018). As ER, PR, and HER2 are all negative in the subgroup of basal-like, it is also called triple-negative breast cancer (TNBC). Tumors with the BRCA1 mutation fall into this subtype and show a high histologic grade.

The role of genomics in breast cancer etiology and pathogenesis

Cancer is the most common genetic disease that results from the accumulation of genetic alterations (Low et al., 2017). Germline alterations can be inherited as they are found in germ cells whereas somatic are cellular alterations. Somatic alterations are acquired during a person’s lifetime and are accounted for by most breast cancers. The BRCA1, BRCA2, CYP2D6, and fibroblast growth factor receptor2 (FGFR2) are examples of germline mutations identified by using the technology of GWAS, NGS, and genetic linkage analysis. PIK3CA, TP53, GATA3, and PTEN are the somatic mutations that were uncovered in luminal breast cancer through the genomic technology of targeted re-sequencing, whole-exome sequencing (WES), or whole-genome sequencing (WGS). The identification of patients who are predisposed to the high risk of breast cancer by investigating germline mutations and the exploration of molecular portraits of breast cancer by analyzing somatic mutations potentially aid in individualized patient care.

Genomic Applied to Breast cancer treatment and Precision Medicine

Precision medicine also called personalized medicine, is defined by the National Institute of Health (NIH) as ‘an approach to patient care that allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease’ (NIH, 2017). The eradication of tumors from the breast and regional lymph nodes and preventing metastatic recurrence for non-metastatic breast cancer as well as prolonging life and symptom palliation for metastatic breast cancer are the two principles of therapy for breast cancer patients (Waks & Winer, 2019). The decision-making for individualized patient care is also based on several factors including tumor morphology, grade classification, presence of lymph node metastases, and genomic expression of ER, PR, and HER2 (Fragomeni et al., 2017). Furthermore, the individualized treatment plan relies on the understanding of prognostic and predictive biomarkers.

Genomics applied in the early stage breast cancer treatment

Traditionally, the early stage breast cancer treatment includes surgery and chemotherapy. As germline variants play an important role in the choice of treatment and the prediction of therapeutic effectiveness, the approach to breast cancer treatment has changed. In the study of Wockel et al. (2018), the treatment with denosumab in BRCA1 mutation showed promising results, the adjuvant use of tamoxifen in premenopausal women is also one of the effective treatments, and the treatment with aromatase inhibitors becomes the standard practice in postmenopausal patients with breast cancer. Hamdan et al. (2019) found that adjuvant chemotherapy has a significant reduction in the risk of metastatic relapse in patients with ER-positive, and HER2-negative without lymph node involvement. The discovery of the 21-gene expression assay served as a valuable prognostic and predictive biomarker for patients who received hormonal therapy (Wockel et al., 2018). To provide the right dose for the right patient, the discovery of variants on the enzyme CYP2D6, which activates tamoxifen by pharmacogenomics study has reduced the drug-induced adverse event (Low et al., 2017).

Genomics applied to the treatment of HER2-positive breast cancer

Apart from the surgery intervention, neoadjuvant and adjuvant chemotherapy regimens may be considered. To be able to make the right therapeutic decision, the detection of HER2 status in the primary tumor or metastatic samples has been suggested by Hamdan et al. (2019). The neoadjuvant therapy can be administered to patients if the postoperative chemotherapy is indicated (Wockel et al., 2018).

Genomics applied to the treatment of TNBC

The treatment of TNBC is very challenging owing to the lack of hormonal receptor expression and HER2 amplification, therefore, chemotherapy remains the first-line treatment choice (Low et al., 2017). Makki (2015) revealed that most of the high-grade invasive breast cancers belong to this molecular subtype and the prognosis is poor. However, studies demonstrated that breast cancer patients with BRCA1 mutations are very sensitive to chemotherapy with platinum agents such as cisplatin and carboplatin (Godet &Gilkes, 2017). According to Hammerl et al. (2017), this type of breast cancer may benefit from immunotherapy because TNBC bears the highest number of T cells.

Genomics applied to surgical treatment of breast cancer

The risk-reduction prophylactic mastectomy surgery has shown a 90% decrease in the lifetime risk of breast cancer (Caso et al., 2017). The blood-based biomarkers such as circulating tumor cells (CTC), and circulating tumor deoxyribonucleic acid (ctDNA) that are released from the primary tumor may indicate the metastases (Low et al., 2017). The test of these biomarkers can be used as an early indication of the presence or recurrence of breast cancer to guide surgical treatment.

Conclusion

The rapid evolution of genomic technology has reshaped the approach to breast cancer treatment. Genomics has had a notable influence on breast cancer prevention, cancer molecular subtype stratification, identification of gene mutations, and personalized treatment. Cancer care will be modified in the future while there are 40 rare disease and cancer flagship projects from Australia Genomics evaluating the clinical utilities of different sequencing modalities, including WGS, whole-exome sequencing (WES), ribonucleic acid(RNA) sequencing, and large capture panels in Australia (Stark et al., 2019). The contribution of genomics in breast cancer care is enormous and will magnify in the future. In conclusion, the statement that ‘genomics adds nothing new to what we have already known’ is incorrect.

“As of January 2019, there are more than 3.1 million women with a history of breast cancer in the U.S.”(breastcancer.org). Breast cancer is not a rare disease. It is affecting a large population of women where the cells in the bosom develop wild. There are various types of bosom malignant growth. The sort of bosom malignancy relies upon which cells in the bosom transform into disease (cdc.gov). Although the majority of females come in contact with this disease, breast cancer affects males as well. Breast cancer has no favoritism when it comes to age or even gender. It can affect a young person or an older person. It all depends on the function within that person’s body, but those with a certain genetic mutation and ancestry of breast cancer are prone to get the disease. During this research paper, we will learn about the effectiveness of a drug called Tamoxifen used on high-risk women. It is expected that overall it is beneficial and the world’s best medication against breast cancer. However, there are weighing side effects that come with this medicine.

Discovery

Tamoxifen is a drug used to treat cancer from growing inside the breast. It is additionally used to lessen the odds in high-chance patients. This medicine can hinder the development of the disease. It works by meddling with the impacts of estrogen in the tissue inside the breast. Tamoxifen was, truth be told, a fairly unplanned disclosure. It was first made in 1966 by researchers working for Imperial Chemical Industries Pharmaceutical. An individual from the group, V. Craig Jordan, saw the capability of tamoxifen to treat breast cancer. Jordan happened to be the first to bring worries about the tamoxifen-expanding endometrial disease. Around the 1970s, at Christie Hospital in Manchester, the first clinical preliminary testing was done. Tamoxifen had been revived from the cinders and was en route to a worldwide achievement (The International Journal of Developmental Biology). According to www.cancer.gov, The Food and Drug Administration (FDA) supports tamoxifen, an antiestrogen sedate initially created as an anti-conception medication treatment, for the treatment of bosom malignant growth. Tamoxifen is the first of a class of medications known as specific estrogen receptor modulators, or SERMs, to be endorsed for malignant growth treatment (cancer.gov).

Structure and Mode of Action

First, we must understand how tamoxifen works. This medication squares estrogen receptors on breast cells. It prevents estrogen from associating with the malignancy cells and guiding them to develop and partition. While tamoxifen acts like an enemy of estrogen in breast cells, it acts like an estrogen in different tissues, similar to the uterus and the bones. Along these lines, it is known as a specific estrogen receptor modulator (SERM). It tends to be utilized to treat ladies with breast cancer who have or have not experienced menopause. Below are images and a formula of the molecule given by Pubchem:

Formula: C26H29NO

2D Structure

3D Structure

High Risk Groups

Family History

Genetics plays a huge role in one’s life story. The vast majority of us realize that we can decrease our danger of ailments by having a healthy life. In any case, did you realize that your family ancestry may be perhaps the most grounded effect on your danger of creating coronary illness, stroke, diabetes, or disease? Women who share the breast cancer risk in their family are at higher risk of getting breast cancer. There were approximately 13-16 percent of the ladies analyzed had a first-degree female family member (mother, sister, or little girl) with breast cancer (Susan G. Komen). A female’s life is endangered twice as much if they have a first-degree female relative determined to have the disease (breastcancer.org). However, using the data from the International Breast Cancer Intervention Study, the team demonstrates the reduction of Tamoxifen causes in women who have a family history of breast cancer. The IBIS- I intended to explore the utilization of tamoxifen in forestalling breast cancer growth in ladies with a higher danger of building up the sickness. The team recruited 7154 women in total. As a result, it reduced one-third in higher-risk women but with some serious side effects. Even if family history plays a dramatic role in a female’s life, tamoxifen can change that with the right amount of dosage.

Mutation

Women with a certain mutation will also determine the risk of them getting breast cancer or contralateral cancer. A clinical trial by the Hereditary breast cancer clinical study group demonstrates women with BRCA1 or BRCA2 as their mutation have a high risk of developing the disease. According to https://www.ncbi.nlm.nih.gov/pubmed/11130383, “Tamoxifen protected against contralateral breast cancer for carriers of BRCA1 mutations (odds ratio 0.38, 95% CI 0.19-0.74) and for those with BRCA2 mutations (0.63, 0.20-1.50)” In women who used tamoxifen for 2-4 years, the risk of contralateral breast cancer was reduced by 75%. Tamoxifen has a decent mediocrity profile and has shown benefits for breast cancer patients in dragging out generally speaking and ailment-free endurance and decreasing the rate of contralateral breast disease. These known advantages of tamoxifen far exceed the danger of endometrial disease in tamoxifen-treated patients with breast cancer.

Risk of Use

Tamoxifen diminishes breast malignancy repeat, mortality, and breast disease chance in high-hazard ladies. Despite these demonstrated advantages, tamoxifen use is regularly questioned because of its symptoms. The risk of contralateral breast cancer associated with tamoxifen use was estimated with the use of Cox regression. All statistical tests were two-sided. 89 tamoxifen users and 100 nonusers of tamoxifen were diagnosed with contralateral breast cancer (academic.oup.com).

Conclusion

Overall, tamoxifen is one of the most effective medications used on high-risk females. Of course, there will be side effects just like any other medication used. It may have a more severe effect, but fighting breast cancer or cancer in general takes a toll on a person. The issue identified with tamoxifen use becomes checking the focal points versus the hazards. On the positive side, tamoxifen affects the bone and lipids which is related to the reduction in contralateral chest ailment. This will change over into lives spared. On the negative side, tamoxifen has a relationship with an improvement in the affirmation of endometrial danger. If we consolidate the most clinically basic focal point of tamoxifen, which is its capacity to draw out infirmity-free constancy and to diminish chest sickness mortality, then it winds up being certain that the upsides of tamoxifen treatment far outperform the dangers. Tamoxifen is recorded best in the world. Nobody, female or male with breast cancer should shut tamoxifen out from attesting worry for potential gynecologic issues.

Introduction

The World Health Organization (WHO) defined genomics as ‘the study of genes and their functions, and related techniques (WHO, n .d.). The completion of the Human Genome Project (HGP) in 2003 marked a new era of the genome in medicine and health. Although our knowledge of human genomes is far from complete, genomics is making a huge impact on health and disease. The advances in genome sequencing technology and analysis are opening up a new window on cancer progression, informing new approaches to diagnosis and treatment across the disease pathway (Hill, 2018). In this paper, the author takes breast cancer patient treatment management as an example to refute the statement that ‘genomics adds nothing new to what we have already known’. From the application of breast cancer preventative screening programs, and molecular stratification of breast cancer, to the precision medicine of the right drug and right dose for the right patient based on the genomic profile, the potential benefits of genomics to breast cancer care are enormous.

Genomics applied to breast cancer prevention

There are about 20-30% of breast cancer patients have a family history and only 5-10% of these patients have gene mutations (Caso et al.,2017), but the identification of these mutations plays a significant role in guiding patients in risk-reducing interventions and surveillance protocols. Genomic testing provides a unique opportunity for individualized cancer risk prediction. Early detection and intervention potentially decrease the morbidity and mortality of breast cancer.

Breast cancer (BRCA) gene screening and risk prediction tools

According to the World Cancer Research Fund (WCRF) (2017), breast cancer is the most common cancer in women worldwide. Although mammography screening programs have been established worldwide. However, as age is the only risk to be considered for women to have mammograms, the ‘one size fits all’ screening recommendation may not be effective and beneficial for all. Louro et al. (2019) conducted a systematic review and assessed the quality of individualized breast cancer risk prediction tools used in the studies up to February 2018, they identified four models to predict breast cancer risk, namely the Breast Cancer Risk Assessment Tool (BCRAT), the Breast Cancer Surveillance Consortium (BCSC), the Rosner and Colditz model, and the International Breast Cancer Intervention Study (IBIS). Even though it is hard to recommend any of the models as the standard tool for predicting individual risk, from the first publication of the BCRAT model in 1989 till the time of the study, genetic variation was updated in all of the models to improve the quality and accuracy of the tool. Although the BRCA genes were discovered in the 1990s, they didn’t attract much attention from the public until Angelina Jolie revealed herself to be the carrier of a BRCA1 gene mutation on 14 May 2013 (Troiano et al., 2017). She underwent a prophylactic mastectomy and laparoscopic bilateral salpingo-oophorectomy as her estimated risk of developing cancer was 87%. Angelina Jolie’s disclosure of BRCA status led to a big increase in BRCA tests with a peak of +80%. Narod’s 2010 study (as cited in Troiano et al., 2017) revealed that the vast majority of inherited breast cancers are due to mutations of the genes BRCA1 and BRCA2. Women who carry these highly penetrant genes have a lifetime risk of breast cancer of 50%-85% compared to 5%-10% in males (Shiovitz & Korde, 2015). The information about BRCA mutation assists the patients and family members in taking preventive measures. These measures include risk-reduction surgeries such as mastectomy and salpingo-oophorectomy, chemoprevention medicine tamoxifen and raloxifene, and intensive screening (Tyler, 2019). Bilateral mastectomies have shown a remarkable decrease in mortality for women who carry inherited genes of BRCA1 and BRCA2 with early-stage cancer (Caso et al., 2017).

BRCA genes test in Australia

Cancer Australia (n. d.) recommended the genetic testing of BRCA1 and BRCA2 gene mutations for women diagnosed with breast or ovarian cancer, regardless of their age and family history. On 12 October 2017, Australia Broadcast Corporation (ABC) announced the breaking news of the BRCA gene test free for patients at high risk of breast and ovarian cancer (Scott, 2017). The free gene testing has been claimed as ‘a huge milestone’ while one in eight women will develop breast cancer before the age of 80 in Australia. Breast Cancer Network Australia (BCNA) also welcomed the news of Medicare rebates for genetic testing (BCNA, 2017), the rebates not only improve women’s access to genetic testing but the timely information will help them to make the right intervention decision. As BRCA genes are familial, the genetic test is also funded for relevant family members in Australia. This funding policy has reduced the financial burden on the patients and their families. The genetic testing result also assists the family members in seeking a further medical diagnosis of breast cancer, and the early recognition of hereditary breast cancer is crucial in clinical management.

Genomic testing in cancer stratification and prognosis

Traditionally, breast cancer was classified simply by its histological appearance and its origination (Makki, 2015). The non-invasive breast cancers are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS), which are confined to the ducts and lobules and potentially malignant. Whereas, invasive breast cancers including invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and metastatic breast cancer have invaded the stroma. Such morphological categorizations are inadequate for precision medicine in individualized patient treatment.

Molecular subtypes of breast cancer and their roles

The whole-genome analysis by using a genome-wide association study (GWAS) and next-generation sequencing (NGS) advanced cancer genome profiling study (Low et al., 2017). To provide information on breast cancer prognosis and treatment planning, the identification of molecular subtypes of breast cancer through the genomic technology of immunohistochemistry and gene expression profiling becomes a critical component (Fragomeni et al., 2018). The four molecular subtypes of breast cancer include luminal A, luminal B, and human epidermal growth factor receptor2 (HER2)-positive and basal-like. Luminal A is estrogen receptor (ER)/ progesterone receptor (PR) positive and HER2 negative and accounts for 50% of invasive breast cancers (Makki, 2015). Patients in this group benefit from endocrine therapy such as tamoxifen and aromatase inhibitors with good prognosis (Fragomeni et al., 2018). In the subtype of luminal B, the ER/PR is positive and HER2 is variable. The prognosis is poorer compared with luminal A as the response to endocrine therapy and chemotherapy is variable (Makki, 2015). From the definition of HER2 positive, the ER/PR is usually negative and HER2 is strongly positive in this group. The patients in this group showed the highest sensitivity to HER2-targeting drugs such as trastuzumab and pertuzumab (Makki, 2015). Basal-like is a morphologically, genetically, and clinically heterogeneous category of breast cancer and is associated with unfavorable prognosis (Fragomeni et al., 2018). As ER, PR, and HER2 are all negative in the subgroup of basal-like, it is also called triple-negative breast cancer (TNBC). Tumors with the BRCA1 mutation fall into this subtype and show a high histologic grade.

The role of genomics in breast cancer etiology and pathogenesis

Cancer is the most common genetic disease that results from the accumulation of genetic alterations (Low et al., 2017). Germline alterations can be inherited as they are found in germ cells whereas somatic are cellular alterations. Somatic alterations are acquired during a person’s lifetime and are accounted for by most breast cancers. The BRCA1, BRCA2, CYP2D6, and fibroblast growth factor receptor2 (FGFR2) are examples of germline mutations identified by using the technology of GWAS, NGS, and genetic linkage analysis. PIK3CA, TP53, GATA3, and PTEN are the somatic mutations that were uncovered in luminal breast cancer through the genomic technology of targeted re-sequencing, whole-exome sequencing (WES), or whole-genome sequencing (WGS). The identification of patients who are predisposed to the high risk of breast cancer by investigating germline mutations and the exploration of molecular portraits of breast cancer by analyzing somatic mutations potentially aid in individualized patient care.

Genomic Applied to Breast cancer treatment and Precision Medicine

Precision medicine also called personalized medicine, is defined by the National Institute of Health (NIH) as ‘an approach to patient care that allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease’ (NIH, 2017). The eradication of tumors from the breast and regional lymph nodes and preventing metastatic recurrence for non-metastatic breast cancer as well as prolonging life and symptom palliation for metastatic breast cancer are the two principles of therapy for breast cancer patients (Waks & Winer, 2019). The decision-making for individualized patient care is also based on several factors including tumor morphology, grade classification, presence of lymph node metastases, and genomic expression of ER, PR, and HER2 (Fragomeni et al., 2017). Furthermore, the individualized treatment plan relies on the understanding of prognostic and predictive biomarkers.

Genomics applied in the early stage breast cancer treatment

Traditionally, the early stage breast cancer treatment includes surgery and chemotherapy. As germline variants play an important role in the choice of treatment and the prediction of therapeutic effectiveness, the approach to breast cancer treatment has changed. In the study of Wockel et al. (2018), the treatment with denosumab in BRCA1 mutation showed promising results, the adjuvant use of tamoxifen in premenopausal women is also one of the effective treatments, and the treatment with aromatase inhibitors becomes the standard practice in postmenopausal patients with breast cancer. Hamdan et al. (2019) found that adjuvant chemotherapy has a significant reduction in the risk of metastatic relapse in patients with ER-positive, and HER2-negative without lymph node involvement. The discovery of the 21-gene expression assay served as a valuable prognostic and predictive biomarker for patients who received hormonal therapy (Wockel et al., 2018). To provide the right dose for the right patient, the discovery of variants on the enzyme CYP2D6, which activates tamoxifen by pharmacogenomics study has reduced the drug-induced adverse event (Low et al., 2017).

Genomics applied to the treatment of HER2-positive breast cancer

Apart from the surgery intervention, neoadjuvant and adjuvant chemotherapy regimens may be considered. To be able to make the right therapeutic decision, the detection of HER2 status in the primary tumor or metastatic samples has been suggested by Hamdan et al. (2019). The neoadjuvant therapy can be administered to patients if the postoperative chemotherapy is indicated (Wockel et al., 2018).

Genomics applied to the treatment of TNBC

The treatment of TNBC is very challenging owing to the lack of hormonal receptor expression and HER2 amplification, therefore, chemotherapy remains the first-line treatment choice (Low et al., 2017). Makki (2015) revealed that most of the high-grade invasive breast cancers belong to this molecular subtype and the prognosis is poor. However, studies demonstrated that breast cancer patients with BRCA1 mutations are very sensitive to chemotherapy with platinum agents such as cisplatin and carboplatin (Godet &Gilkes, 2017). According to Hammerl et al. (2017), this type of breast cancer may benefit from immunotherapy because TNBC bears the highest number of T cells.

Genomics applied to surgical treatment of breast cancer

The risk-reduction prophylactic mastectomy surgery has shown a 90% decrease in the lifetime risk of breast cancer (Caso et al., 2017). The blood-based biomarkers such as circulating tumor cells (CTC), and circulating tumor deoxyribonucleic acid (ctDNA) that are released from the primary tumor may indicate the metastases (Low et al., 2017). The test of these biomarkers can be used as an early indication of the presence or recurrence of breast cancer to guide surgical treatment.

Conclusion

The rapid evolution of genomic technology has reshaped the approach to breast cancer treatment. Genomics has had a notable influence on breast cancer prevention, cancer molecular subtype stratification, identification of gene mutations, and personalized treatment. Cancer care will be modified in the future while there are 40 rare disease and cancer flagship projects from Australia Genomics evaluating the clinical utilities of different sequencing modalities, including WGS, whole-exome sequencing (WES), ribonucleic acid(RNA) sequencing, and large capture panels in Australia (Stark et al., 2019). The contribution of genomics in breast cancer care is enormous and will magnify in the future. In conclusion, the statement that ‘genomics adds nothing new to what we have already known’ is incorrect.

Abstract

The present report deals with a campaign aimed at raising awareness of breast cancer. Thousands of females worldwide and especially those living in the so-called developed countries suffer from this disease.

Women in their 30-40s are the most vulnerable groups as they often have little time for their health due to a variety of activities they have to do. The campaign will involve such media as television, internet (with a focus on social networks), print media. Celebrities (as well as ordinary people) should also be a part of the campaign telling their stories or sharing their fears and hopes.

Introduction

Breast cancer is one of the most serious issues related to a female’s health. People have tried to find a way to eradicate this disease for more than a century. It is noteworthy that researchers have learned a lot about this kind of cancer but thousands of women worldwide still die because of it (Breast cancer risk factors, 2009).

In 2010, over 400 thousand women worldwide died of breast cancer (The breast cancer landscape, 2013). The second part of the twentieth century can be seen as a breakthrough in disorder diagnosing and raising awareness among people (Jacobsen & Jacobsen, 2011).

Nonetheless, females often ignore the problem and do not pay much attention to it until it is too late. Furthermore, there are still numerous gaps in breast cancer treatment as people as well as many healthcare professionals still think that surgery is the only effective way to address the issue (The breast cancer landscape, 2013).

Therefore, it is important to develop an effective promotional program to raise awareness about the disease among females (especially young adults).

PR Program

Situation

As has been mentioned above, breast cancer accounts for more than 400,000 deaths globally. Researchers have come up with numerous risk factors, and people are now aware of them. It is known that older women get higher chances of developing the disease they have and the cases of breast cancer increase significantly in women in their 30s (Breast cancer risk factors, 2009).

Residence also affects the development of the disease, and it is quite surprising that the rate of women with breast cancer in developed countries (Europe and North America) is much higher than in less developed countries (Breast cancer risk factors, 2009).

Family history is another important risk factor, and women whose relatives have breast cancer are much more likely to have this problem as well. It is important to add that late diagnosing is another risk factor. It is essential to diagnose cancer in the early stages to make the treatment more effective.

New Information

It is good news that researchers have developed numerous strategies to diagnose, treat, and even prevent the development of breast cancer. For example, this disorder treatment includes surgery, chemotherapy, radiation therapy, antibody and hormone therapy (The breast cancer landscape, 2013).

Researchers have found that there are two major types of breast cancer and these types need different treatment. Unfortunately, in many cases, breast cancer is treated without paying attention to this discovery. Clearly, the pharmaceutical industry is continuing its work on the development of new medication.

Strategy

Audiences

It is clear that the breast cancer campaign will target at women in their 30-40s as this is one of the most vulnerable categories of women as they often pay little attention to the problem and address healthcare professionals at later stages of the disease development (Jacobsen & Jacobsen, 2011). It is important to understand this category of females and their needs to develop proper messages which could work well.

These are usually married women who have families (some of them working mothers). These are also business ladies who focus on their career. Both groups have little time for their health. These women often forget about or simply do not have time for regular check-up or mammography. These women often have quite general information on breast cancer and think that what they know is enough.

Key Messages

The key message to these women will be the appeal to their future. It is essential to make them more attentive to their health to ensure they will be with their families or/and will be able to work in the future. Thus women should be encouraged to be more responsible.

It is also effective to stress that a check-up takes a day while cancer treatment may take months and can lead to really devastating results. Finally, women should seek for more information about the disease as raising awareness can keep women cautious.

Media Vehicle

The issue needs a complex approach and, hence, it is important to employ major media tools. Television, the Internet (with a focus on social networks), magazines and newspapers as well as posters and billboards should be utilized. This will help start a massive campaign which will attract a lot of public attention. As for the use of television, it is possible to launch debates in shows and address some celebrities to participate in the campaign. These celebrities can be representatives of Hollywood, sports, politics and so on.

Timetable

• June-July 2014 – addressing nurses and volunteers
• June-July 2014 – billboards and commercials with open questions
• August 2014-April 2015– messages and invitations sent to participants
• September 2014-April 2015 – programs and debate with volunteers and celebrities
• October 2014-May 2015 – discussion, activities, events.
• June-July 2015 – program evaluation

Budget

• Development of commercials – $20,000
• Materials (commercials, posters, billboards including development of designs) – $10,000
• Total – $30,000

Tactics

Creative Communication Plan

It is possible to start with some hooks. For instance, the campaign can start with several open questions. Several pictures of celebrities or ordinary women can appear on a picture with a big question ‘Do you know what unites these women?’ The next stage will be introduced by the answer ‘They know about breast cancer. Do you?’ These pictures (as well as the rest of visual materials should have the sign of breast cancer awareness symbol, the pink ribbon).

The campaign should be very informative as women should understand exactly what breast cancer (as well as its treatment) is. Vague and non-informative discussions will be frustrating and ineffective (McCartney, 2013).

Researchers should discuss the latest discoveries in the field and young women (and older females) should share their experiences. These women have to have different backgrounds to make the message clear to a wider audience. Females should be aware of risks and they should also hear success stories.

It is necessary to create short social commercials articulating the messages mentioned above. It is crucial to make females understand that the problem persists and they should be more responsible for the sake of their own and their families’ future.

Evaluation Plan

At the end of the campaign, it is possible to implement a survey to understand whether breast cancer awareness increased or not. It is also important to understand whether women’s attitude towards the disease and their check-ups has changed. These are major tools to evaluate the effectiveness of the campaign.

Reference List

Breast cancer risk factors: A review of the evidence. (2009). Web.

Jacobsen, G.D., & Jacobsen, K.H. (2005). Health awareness campaigns and diagnosis rates: Evidence from national breast cancer awareness month. Web.

McCartney, M. (2013). The patient paradox. London: Pinter & Martin Publishers.

The breast cancer landscape. (2013). Web.

Genomics Pedigree

It is important to note that the genetic red flags in Figure 1 depicted above include heart disease, hypertension, and breast cancer. Among these three conditions, breast cancer is the most likely to express some form of hereditary nature of transmission, whereas heart disease and hypertension are complex diseases heavily impacted by environmental conditions. For example, heart disease and hypertension can be caused by poor diet, unhealthy lifestyle, physical inactivity, or risky habitual behaviors, such as smoking (Jorde et al., 2019). However, when it comes to breast cancer, there is a strong element of genetic influence and hereditary pattern of passing the genes (Jorde et al., 2019). From the pedigree above, one can observe that non-cancer diseases do not have any indications of hereditary patterns since my grandparents from the father line do not suffer from hypertension or heart disease. Similarly, no person from my mother’s side suffers from these two conditions despite the grandfather’s heart condition contributing to his death. It should be pointed out that the described observations are mostly speculative since genes can be carried recessively and passed on, which makes the assessment more demanding for closer analyses.

The most serious genetic red flag is breast cancer, which is well-known to have a hereditary aspect to it, such as the famous Angelina Jolie’s case. My grandmother from the mother’s line died due to breast cancer metastasis, and a similar health condition can be observed in my aunt. Although my mother does not have any indication of breast cancer since she checks for it regularly, it does not translate to having any risk. Breast cancer genes, such as the BRCA1 and BRCA2, are autosomal dominant, which means that they have a strong likelihood of being inherited and expressed as a health condition of cancer (MedlinePlus, 2021). Therefore, my family is highly aware of the risk of breast cancer risk, which is why we undergo annual examinations for preventative purposes.

For the onset at an earlier age than expected and condition occurrence in the gender that is least expected, there is no specific observation that can be made on the pedigree. Both hypertension and heart disease are most likely non-genetic but rather environmental. Breast cancer follows the typical pattern of being more predominantly impactful among females since male breast cancer is rather rare (MedlinePlus, 2021). In the case of disease occurrence in the absence of known risk factors, both my father and his brother suffer from a metabolic health condition, which shows no apparent risk factors from their parents. Thus, the latter skews the assumptions towards environmental factors’ involvement.

Ethnic predisposition plays a critical role in public health. It is stated that “in 2018, African Americans were 30 percent more likely to die from heart disease than non-Hispanic whites …African American adults are 40 percent more likely to have high blood pressure” (United States Department of Health and Human Services, 2022, para. 1). However, due to complex nature of heart diseases and hypertension, it is impossible to firmly state that the ethnic predisposition is at play for this specific pedigree. Lastly, there is no close biological relationship existing between parents since their corresponding families come from different regions, backgrounds, and genetic tree lines.

References

Jorde, L. B., Carey, J. C., & Bamshad, M. J. (2019). Medical genetics (6^th ed.). Elsevier.

MedlinePlus. (2021). Breast cancer. Web.

United States Department of Health and Human Services. (2022). Science & tech spotlight: Deepfakes. Web.