Cancer: Overview of Types, Symptoms, & Treatments: Breast Cancer

Breast cancer seems related to a specific lifestyle, diet, age of puberty, the number and spacing of pregnancies. And though the percentage of breast cancer cases has increased in recent years, this program reveals how there is hope in fighting this insidious disease through education, new forms of contraception and gene therapy.

The key to breast cancer prevention is awareness, education and early detection. This program is part of our women's health series designed to comply with the Joint Commission standards for education of patients and family and was awarded a National Telly Award for Education.

Compelling insight into the reality of breast cancer, as seen through the eyes of nine female patients. Their individual stories demystify the deadly disease while painting intimate, often humorous portraits of struggle, survival and hope - including a unique perspective on prevention.

Without question, breast cancer is the disease many women fear the most—not only because of the disease, but also because of what treatment involves. However, as this program illustrates, dramatic differences exist between today’s breast cancer therapies and the way the illness was treated a generation ago. Women with breast cancer detail their experiences with this disease, their reactions to the diagnosis, and the treatments that saved their lives. They also offer advice to other women about how to emotionally survive the breast cancer experience. Experts include Dr. Edith Perez of the Mayo Clinic in Jacksonville, Florida, and Dr. Dennis Slamon of UCLA’s Jonsson Comprehensive Cancer Center.

This program presents a concise overview of critical concerns and issues regarding breast cancer, a disease that affects one in five women. In a logical format using computer graphics and footage with real patients, the program addresses the general pathology of cancer, the specifics of breast cancer, and the various risk factors. A segment on self-examinations clearly demonstrates how these potentially life-saving checks are performed, explaining how they are the key to early detection. Treatment options are fully explained and illustrated, including chemotherapy, mastectomy, and reconstructive surgery.

Breast cancer will be diagnosed in 12% of women in the United States over the course of their lifetimes and more than 250 000 new cases of breast cancer were diagnosed in the United States in 2017. This review focuses on current approaches and evolving strategies for local and systemic therapy of breast cancer. OBSERVATIONS: Breast cancer is categorized into 3 major subtypes based on the presence or absence of molecular markers for estrogen or progesterone receptors and human epidermal growth factor 2 (ERBB2; formerly HER2): hormone receptor positive/ERBB2 negative (70% of patients), ERBB2 positive (15%-20%), and triple-negative (tumors lacking all 3 standard molecular markers; 15%). More than 90% of breast cancers are not metastatic at the time of diagnosis. For people presenting without metastatic disease, therapeutic goals are tumor eradication and preventing recurrence. Triple-negative breast cancer is more likely to recur than the other 2 subtypes, with 85% 5-year breast cancer–specific survival for stage I triple-negative tumors vs 94% to 99% for hormone receptor positive and ERBB2 positive. Systemic therapy for nonmetastatic breast cancer is determined by subtype: patients with hormone receptor–positive tumors receive endocrine therapy, and a minority receive chemotherapy as well; patients with ERBB2-positive tumors receive ERBB2-targeted antibody or small-molecule inhibitor therapy combined with chemotherapy; and patients with triple-negative tumors receive chemotherapy alone. Local therapy for all patients with nonmetastatic breast cancer consists of surgical resection, with consideration of postoperative radiation if lumpectomy is performed. Increasingly, some systemic therapy is delivered before surgery. Tailoring postoperative treatment based on preoperative treatment response is under investigation. Metastatic breast cancer is treated according to subtype, with goals of prolonging life and palliating symptoms. Median overall survival for metastatic triple-negative breast cancer is approximately 1 year vs approximately 5 years for the other 2 subtypes. CONCLUSIONS AND RELEVANCE: Breast cancer consists of 3 major tumor subtypes categorized according to estrogen or progesterone receptor expression and ERBB2 gene amplification. The 3 subtypes have distinct risk profiles and treatment strategies. Optimal therapy for each patient depends on tumor subtype, anatomic cancer stage, and patient preferences.

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001 - 2008, and who were initially operated. Follow-up of vital status ended 2014. 7017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006 to 1.017) per day. Comparing, e.g., surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided.