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Int. Res. J. Oncol., vol. 6, no. 1, pp. 104-118, 2023
International Research Journal of Oncology
Volume 6, Issue 1, Page 104-118, 2023; Article no.IRJO.100349
Breast Cancer: Updated and Deep
Insights
Kimberly Morton Cuthrell a* and Nikolaos Tzenios b
a Saint James School of Medicine, United States.
b Public Health and Medical Research, Charisma University, Grace Bay, Turks and Caicos Islands.
Authors’ contributions
This work was carried out in collaboration between both authors. Both authors read and approved the
final manuscript.
Article Information
Open Peer Review History:
This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,
peer review comments, different versions of the manuscript, comments of the editors, etc are available here:
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Received: 17/03/2023
Accepted: 20/05/2023
Published: 26/05/2023
ABSTRACT
Breast cancer is the most common cancer diagnosed in females throughout the entire world, and it
is also the primary reason why people lose their lives due to malignant tumors. The risk of
developing breast cancer is increasing at an alarming rate over the whole planet. In light of this, it is
essential to search for innovative therapeutic techniques in addition to predictive and prognostic
indicators, notwithstanding the progress that has been made in identifying and treating the disease,
which has resulted in a reduction in the overall mortality rate. Several distinct therapy
modalitieutilized, each of which is determined by the molecular subtype. Systemic therapy and
locoregional therapy, which include surgery and radiation therapy, are both components of the
multidisciplinary strategy that is taken to treat breast cancer. Chemotherapy, anti-HER2 therapy for
diseases that are positive for HER2, hormone therapy for diseases that are positive for hormones,
and immunotherapy, which was developed more recently, are all examples of systemic therapies.
Triple negative breast cancer accounts for between 15% and 20% of all breast cancers. This
subtype of breast cancer affects more than 15% of patients. As a result of its poor response to
treatment and the exceedingly invasive nature of the condition, it presents a therapeutic challenge
and, as a result, generates a significant amount of research interest. The treatment of breast cancer
in the future will hopefully be more individualized, with the ability to de-escalate when necessary
Review Article
Cuthrell and Tzenios; Int. Res. J. Oncol., vol. 6, no. 1, pp. 104-118, 2023; Article no.IRJO.100349
105
and escalate when necessary based on the biology of the tumor as well as an early therapeutic
response. This article provides an overview of the research that has been done on breast
carcinoma, which is a disorder that affects women all around the world.
Keywords: Breast cancer; therapy; etiology; breast cancer stages; cancer history.
1. INTRODUCTION
The term "cancer" comes from the field of
medicine and refers to the uncontrolled
multiplication of cells that occurs when this
process is allowed to go without being stopped
[1,2]. Tobacco use, exposure to toxins and
ionizing radiation, viral infections, some other
components of nature, genetic diversity, thyroid
hormone, being in an immune-compromised
posture, and arbitrary change are some of the
potential triggers that might lead to the
development of cancer [3,4]. A large variety of
additional factors, such as certain diseases, a
lack of physical activity, being overweight, and
exposure to toxic metals, can also increase the
likelihood of getting cancer [5]. The DNA or RNA
found in tumor cells is genetically identical to that
found in the cells of the organism from where the
tumor cells originated. Because of this,
inflammatory reactions often are unable
to detect them, particularly if they are of a low
intensity [5,6]. This is especially the case if the
person in question is frail. As a result of
differences in their DNA and RNA, healthy
cells have the potential to give rise to cancerous
tumor cells [7]. Apart from temperature, toxins
found in the atmosphere, moisture, or
nourishment, electrical cell damage, oxidative
stress, speciation, or ageing of DNA or RNA, all
of these components that can cause the
improvements of genetic changes, include pivotal
emission, cosmic emission, pathogens,
microbes, as well as yeasts, protozoa, and a
wide variety of other components. Every single
one of the components have the potential to
bring about different manifestations of the
condition [8]. Because it was discovered that
cancer is linked to an increase in the
unpredictability of the organism to the point
where the body is unable to self-correct, this
condition became known as a "entropic disease."
It is necessary to have assistance from the
outside environment in order to bring the
organism back to an entropic condition that is
stable [9,10]. The organism will finally perish if
the process of defense is not carried out
effectively and an excessive number of cells are
created [11]. There is a possibility that cancer will
grow if inflammatory reactions seek to get rid of
anything [12]. The frequency of DNA or RNA
genetic variations can be excessive only under
certain conditions, such as an unpleasant
environment (due to exposure, toxins, or other
factors), poor foods (which lead to an
undesirable cell habitat), individuals who have a
genetic predisposition for mutations, and elderly
people [13].
Fig. 1. Cancer statistics [14]
Breast Cancer
12%
Lung cancer
12%
Colorectum
11%
Prostate
8%
Stomach
6%
Liver
3%
other cancers
48%
Cancer Statistics
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1.1 Classification of Cancer
Histopathology which relates to the different
kinds of tissue in which they develop, and initial
locations, which refer to the sections of the body
where they originally emerged are the two
categories that are used to classify cancer. There
are many different kinds of cancer [15]. The most
prevalent kind of cancer is referred to as a
histopathology sort. Cancers originating in the
initial areas are the second most prevalent form.
Regarding the designation and histological
classification of such conditions, the worldwide
classification of oncology illnesses, fourth
volume, continues to represent the consensus
view among medical professionals all over the
world (ICD-O-3). The majority of malignancies
may be placed into one of six primary groups,
according to a number of studies on histology
[16-19].
1.1.1 Breast cancer
The unregulated maturation or proliferation of the
cells that form inside of the breast can lead to a
condition known as breast disease. Malignancy
is typically named for the anatomical location in
which it arose [19] Cancer of the breast is a word
that is used to describe the condition that occurs
when breast cells in the breast develop outside
of their normal parameters. There are several
different risk factors that might lead to breast
cancer. The type of breast cancer that a patient
has will be determined by the types of cells that
were damaged by the tumor. It is possible for
cancer to grow in any part of the breast. The
three most important structural components of
the breasts are the lobules, the ducts, and the
soft tissue. The lobules are responsible for the
production of milk, which is then carried to the
nipple through the ducts. Connective tissue
either encases or binds everything. Cancer of the
breast almost always begins in the lobules and
spreads via the ducts. According to [19], arteries
make it possible for cancer to spread to other
organs [19].
Cancer of the breast has a complicated
phenotype: carcinoma in situ and invasive
carcinoma may coexist, as mixed histological
kinds of invasive carcinoma, and infiltrating
ductal carcinomas frequently comprise
regions with varying degrees of disease
severity. This morphological heterogeneity
matches the molecular heterogeneity that is
present, as well as the fact that morphologically
comparable tumors may differ in their genetic
and metabolic processes, and that specific
genetic defects may impact clinical prognosis
[20-22].
Fig. 2. Classification of cancer
Cancer
classification
Carcinoma
Sarcoma
Myeloma
Leukaemia
Lymphoma
Blastoma
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With an elevated incidence of 14.1 million new
cases in the year 2012 and a high mortality rate
of around 8.2 million fatalities all over the world,
breast cancer is the most often diagnosed form
of cancer in females. It is anticipated that the
incidence rate would rise by the year 2040,
reaching a level that is almost twice as high as
the rate in 2012. It is anticipated that young
women between the ages of 20 and 59 will be
diagnosed with breast cancer, and there will be
an increased risk of mortality from cancer within
this age group [23-25]. Pathologic Complete
Response(pCR) may be beneficial for women
after undergoing neoadjuvant therapy because
they may be able to forego breast surgery
1.2 Etiology
Normal epithelium is turned into cancer through a
multistep process. Breast cancer can be caused
by a combination of variables, including those in
the food, the environment, and one's genetic
heritage. Because there is a healthy equilibrium
between negative and positive growth factors in
normal breast tissue, the development of breast
cancer requires either a reduction or an increase
in certain functions. The development of breast
cancer may be influenced by a number of
variables, including those listed below:
1.2.1 Age
The accumulation of somatic mutations may
contribute to the rising rates of breast cancer
seen with advancing age. Both beginning
menstruation at a younger age and delaying
menopause until later in life lengthen the period
of time a woman is exposed to ovarian
hormones, which has been linked to a higher risk
of breast cancer. There is some evidence to
suggest that breast cancer in younger women is
more aggressive than breast cancer in older
women. This would be consistent with a more
quickly growing disease that declares itself
clinically earlier.
1.2.2 Factors related to genetics
Complex acquired genetic modifications are
believed to be the cause of breast cancer, and it
is likely that genetic anomalies in the
premalignant and malignant breast epithelium
play a role in the development of the disease.
The fact that only five percent of breast cancer
patients have a significant family history that
points to the inheritance of mutations that
promote tumor growth in the germ line provides
compelling evidence that the majority of breast
cancers are caused by acquired mutations.
BRCA1 and BRCA2 are two genes that are
substantially responsible for the inheritance of
breast cancer in its early stages. Other
conditions that are linked to an increased risk of
breast cancer include the Li-Fraumeni
syndrome, ataxia telangiectasia, and Cowden's
disease.
1.2.3 Hormonal status
Exposure to mammotropic hormones, including
oestrogen, progesterone, prolactin, and insulin-
like growth factor 1 during adolescent and adult
life tends to increase the chance of developing
breast cancer. It is possible that this might be
explained by an increased epithelial cell
population that is vulnerable during the
preinitiation stage, which affects clonal
expansion and modulates growth augmentation
in subclinical tumors. Although oestrogen is the
primary factor in breast development, the role it
plays is contingent on the presence of oestrogen
receptor (ER) expression in the target tissues.
Over the past few years, it has come to light that
women who have an overexpression of
oestrogen receptors in their normal breast
epithelium have an increased risk of developing
breast cancer.
1.2.4 A history of noncancerous breast illness
There is abundant evidence indicating that
several subtypes of benign breast disease are
linked to the development of breast cancer. In
benign breast neoplasia, the inactivation of tumor
suppressor genes and loss of heterozygosity
have both been documented as potential
outcomes. Although ductal and lobular
carcinomas in situ do not have the ability to
invade or metastasize, they do have a partly
malignant morphological phenotype and are
associated with an increased risk of invasive
cancer. Other lesions that are associated with
abnormal cell proliferation are also associated
with a slightly increased risk of developing
cancer. These lesions include atypical
hyperplasia (both ductal and lobular), florid
hyperplasia of the usual type (that is, without
atypia), and florid hyperplasia without atypia.
Although the frequent coexistence of
premalignant lesions and invasive breast cancer
is consistent with progression from these lesions
to cancer, there are many controversies in this
area, and clonal relationships are not always
clear [4]. However, progression from these
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lesions to cancer is consistent with progression
from these lesions to cancer.
1.2.4.1 “Omics” and promising biomarkers in
breast cancer
Recently, with the merging of “omic” technologies
such as genomics, proteomics, metabolomics,
transcriptomics, etc., a great advancement has
been achieved in the field of cancer biology with
better understanding of carcinogenesis, cancer
progression, metastasis, and target therapy.
Microarray, mass spectrometry, and sequencing
techniques provide evolutionary era for promising
cancer biomarkers. Transcriptional profiling has
been reported as a valuable tool for classification
and determination of prognosis in patients of
breast cancer. Apart from diagnosis, prediction of
response to therapy, and prediction of breast
cancer patients’ outcomes, biomarkers may
estimate risk assessment of getting cancer.
Genetic alterations in breast cancer or
methylation of promoters of cancer-specific or
associated genes will definitely linked to altered
expression of certain proteins and may be used
as emerging cancer biomarkers [26].
1.3 Epidemiology
The most frequent malignant tumor in women
worldwide is breast cancer. Up to 36% of
oncological patients are breast cancer patients.
In 2018, an estimated 2.089 million women
received a breast cancer diagnosis [27]. All
across the world, the prevalence of this
cancerous tumor is rising, but it is more prevalent
in developed nations. A global average shows
that industrialized nations account for about half
of the instances. This tendency is mostly
attributable to the so-called Western lifestyle,
which is known for its unhealthy eating habits,
high levels of stress, and lack of exercise [27].
Mammography is now accepted as a screening
method for breast cancer. Women between the
ages of 50 and 69 are the group of women who
benefit from mammography the most. Classical
mammography has a sensitivity range of 75–
95% and a specificity range of 80–95% [28,29].
Magnetic resonance mammography is utilized as
a screening test for women who may have
hereditary breast cancer. If a lesion is
discovered during a mammogram, a thick needle
biopsy may be required, coupled with a
histological evaluation of the tumor [30,31].
In 2018, there were 66,101 instances of breast
cancer in Japan, 55,439 cases in the United
Kingdom, 56,162 cases in France, 71,888 cases
in Germany, and 85,5/105 cases in the United
States (all crude rates of 85/105) [32,33].
Belgium has the greatest crude incidence rate in
the globe (113/105), and Australia has the
highest crude incidence rate among the
continents (94/105) [33]. Breast cancer is the
most often diagnosed malignant tumor among
women in Poland. The number of instances has
steadily increased (1990 saw 8000 new cases;
2018 had 20,203 new cases). In Europe, the
incidence rate is 84/105 on average. The nations
of Southeast Asia and Africa have the lowest
incidence rates, with a standardized incidence
rate of no more than 25/105 [33]. The Republic of
The Gambia (crude rate: 6.5/105) and Bhutan
(crude rate: 5/105) had the lowest incidence
rates in 2018 [33].
Breast cancer is the leading cause of mortality
from malignant tumors in women worldwide,
despite improved early diagnosis or the quick
development of pharmacotherapy in recent
years. 626,679 people lost their lives to breast
cancer in 2018. Contrary to morbidity, the
highest rates of mortality from this malignant
tumor are found in developing nations, where up
to 60% of all breast cancer deaths occur (Fiji,
crude rate 36/105, highest rate; Somalia,
crude rate 29/105; Ethiopia, crude rate 23/105;
Egypt, crude rate 21/105; Indonesia, crude rate
17/105; Papua New Guinea, crude rate 25/105)
[34].
Breast cancer may develop mostly due to the
lower screening rates than in wealthy nations,
the accessibility of diagnostics, and
contemporary treatment approaches. In
comparison, the standardized death crude rate
was 16.3/105 in Belgium, 13./105 in the US, and
9.3/105 in Japan. Poland has a substantially
lower incidence of breast cancer than other EU
nations (the standardized incidence rate for
Polish was 51.8 in 2013 compared to 106.6 for
the EU). Over the past 30 years, the prevalence
of adult premenopausal women (20-49 years old)
has nearly doubled [35]. Unfortunately, self-care
among Polish women may be a great concern.
Attention to the the health of their breasts may be
minimized and downplayed value of routine
checkups. Polish women receive less
preventative treatment than women in other
European nations; in the Netherlands, 80% of
women claim access to free mammography
prevention program, in England, 71%, and in
Poland, just 44% [35]. The 5-year breast cancer
survival rate in Poland is 78.5%, which is much
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lower than, for instance, the 90% figure obtained
in the United States [35-38].
1.4 Classifications of Breast Cancer
1.4.1 Non-invasive breast cancer
Intraductal adenocarcinoma is also referred to as
ductal carcinoma in situ (DCIS).
This type of breast cancer, which is non-invasive
and pre-invasive, is ductal carcinoma in situ and
is one of the most common types of breast
cancer [40,41]. It comes out from within a duct
that is already present in a typical environment.
Even though ductal carcinoma in situ does not
spread to other parts of the body on its own, it
has an extremely high risk of progressing into
invasive tumours. Therefore, in order to protect
any individual from developing invasive cancer,
early diagnosis and the appropriate treatment are
required [42,43].
1.4.1.1 Infiltrating breast tumors
Infiltrating breast tumors are invasive and spread
to the breast stroma that is adjacent to them.
Additionally, they penetrate beyond the lobules
and ducts that are typically found in the breast.
They are found, and almost two-thirds more
women diagnosed with an aggressive form of
cancer are 55 years old or older. Invasive
malignancies always have the potential to spread
to other parts of the body, including organs and
lymph nodes, and have the ability to move
throughout the body. As a result, tumors of the
breast that are particularly aggressive fall into
this group. Depending on the kind of cells or
tissues involved in the process [44,45]. There are
many subtypes of invasive breast cancer,
however they may be broken down into two
categories:
• Invasive ductal carcinoma (IDC), which
is the most common.IDC, or invasive
ductal carcinoma, is by far the most
common form of breast cancer. It is
estimated that around 80 percent of all
breast cancer cases are caused by IDC.
Some of the subgroups that are included in
the IDC category are breast cribriform
carcinoma, breast capillary cancer, breast
mucinous carcinoma, and breast tubular
carcinoma. Other subgroups include breast
medullary carcinoma and breast tubular
carcinoma [46-48].
Fig. 3. Who classification of breast cancer [39]
Noninvasive
ductal carcinoma
insitu
lobular carcinoma
insitu
invasive
infiltrating
invasive ductal
carcinoma
invasive lobular
carcinoma
medullary
carcinoma
other types
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Invasive lobular carcinomas (ILC):
Invasive lobular carcinoma (ILC), the
second most common kind of tumor,
accounts for around ten to fifteen percent
of all cases of breast cancer. Although it
can affect women of any age, ILC is most
commonly seen in women who are middle-
aged or older. The ILC subtype accounts
for about 90–95 percent of all breast
cancer cases. Malignancies of the IDC and
ILC have distinct diagnostic features that
are present [49-51]. Lobe carcinomas, on
the other hand, arise from live cells that
are arranged singularly, as single files, and
in sheets. This is in contrast to duct
carcinomas. In addition to this, they have a
number of molecular and genetic
abnormalities. It is of the utmost
importance to differentiate between ductal
and lobular carcinomas since the
prognoses and treatment options for each
kind of carcinoma can be quite distinct
from one another. Metastatic breast
cancer, papillary carcinoma,
phyllodestumors, and breast angiosarcoma
are some of the less common subtypes of
breast cancer. There are many other, less
common types of breast cancer. Different
patients diagnosed with breast cancer
exhibit a variety of symptoms. There are
many people who do not exhibit any
symptoms at all [52,53].
1.5 Triple Negative Breast Cancer
Triple-negative breast tumors, or TNBCs for
short, are among the most aggressive types of
breast cancer. These cancers develop as a result
of aberrant progesterone, estrogen, and human
growth factor receptor 2 expression in the breast
tissue [54]. According to immunohistochemical
results, TNBCs frequently exhibit cellular
expression of progesterone and estrogen
receptors of 1% and human growth factor
receptor 2 expressions between 0 and 1+ [55].
The American Society of Clinical Oncology and
the College of American Pathologists
(ASCO/CAP) created these recommendations.
TNBCs may be classified into four different
transcriptional subgroups. Among these are the
two basal subtypes BL1 and BL2, the
mesenchymal subtype M, the luminal androgen
receptor subtype, and the androgen receptor-
positive subtype of TNBCs. Additionally, TNBC
may be categorized into six different subgroups
based on the molecular heterogeneity of the
tumor: immunomodulatory, luminal androgen
receptor expression, mesenchymal stem-like,
mesenchymal-like, basal-like, and unstable.
Subtypes are created by further segmenting
these subgroups. TNBCs account for 12–17% of
all breast cancer cases and have a history of
spontaneous recurrence [56]. This form of breast
cancer is categorized as a less frequent
subgroup within the broader category of breast
cancers. TNBCs exhibit more aggressive
behavior when compared to the clinical
characteristics of other breast cancer subtypes.
These tumors have a poor prognosis, and are
distinguished by specific patterns of metastasis.
Triple-negative breast cancers (TNBCs), which
make up 24 percent of newly diagnosed
instances of breast cancer, have been increasing
in frequency. TNBC was the most common kind
of breast cancer in women in 2018, with an
estimated 2,088,849 cases detected, according
to research from 2020 [57]. In light of the
medication that is currently available, the
average survival rate from the disease is
approximately 10.2 months, with a 65% 5-year
survival rate in cases with regional tumors and
an 11% survival rate in cases where the tumor
has spread to distant organs [58].
1.6 Breast Cancer Stages
The stage of the disease is determined by both
the extent to which cancerous cells have spread
throughout the breast tissue as well as the type
of cells that have been affected. In comparison,
stage 0 included the infiltrating type of non-
invasive cancer and described stage 4 [44,59].
The following is a description of the many stages
of cancer:
1.6.1 Stage 0
DCIS, or ductal cell carcinoma in situ, is a good
example of such a disease stage since it reveals
that both malignant and non-malignant cells have
been contained inside the boundaries of either
the region of a breast where the cancer cells first
emerge. This stage of the illness occurs when
the cancer cells are still in the early stages of
their development. In one research it is stated
that they are not preserved as proof of invasion
in the tissues around the entire region [60,61].
1.6.2 Stage 1
There is still the possibility of a microscopic
invasion, and therefore, each stage can be
thought of as a form of cancer that spreads by
infiltrating healthy tissue. There are two
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Fig. 4. Breast cancer stages
variations of this step: step 1A and step 1B. step
1A refers to cancers that are longer than in
length and are not associated with any lymphatic
system, whereas step 1B refers to a small cluster
of tumor tissue that is larger than 0.2 millimetres
and is found in a lymph system. Both of these
stages are considered malignancies [62,63].
1.6.3 Stage 2
In addition, there are two variations of this phase,
designated 2A and 2B respectively. Cancer that
has been found in the lymphatic and circulatory
systems but not in the chest cavity is depicted in
Phase 2A of the staging process. Thecancer
might be as little as less than 2 centimetres or as
large as over 5 centimetres in size. On the other
hand, phase 2B indicates that the cancer may be
larger than 5 centimetres in size but that it has
not migrated to the axillary lymphatic nodes [64].
1.6.4 Stage 3
The levelsare broken up into three distinct
divisions, numbered 3A, 3B, and 3C respectively.
Step 3B explains every length of cancer that was
caused by inflammation and an ulcer upon this
breast's skin and has expanded to as many as
nine axillary lymphatic nodes or just to sentry
lymph nodes, whereas step 3A explains
cancerous cells that have not been discovered
inside the chest, and they may be discovered in
four to nine axillary lymphatic nodes or within
guardian lymph nodes. Phase 3B tumors can be
classified as inflammatory due to the fact that the
surface of the tumor is reddened, heated, and
puffed up. Therefore, the expansion of the
malignancy to 10 is included in phase 3C of the
process. Research from 1989 showed that the
lymph nodes that make up the lymphatic system
may be found behind the collarbone and in the
axilla [65,66].
1.6.5 Stage 4
The proceeding or progression stage of the
illness refers to the spread of the disease to
further organ systems, such as the liver, the
brain, the lungs, the bones, and so on [67,68].
2. BREAST CANCER HISTORY
In contrast to a group of women who did not
have any disorders, those who have had chest
cancer in the past are more likely to get it one or
more times in their lives. The presence of either
malignant or non-malignant breast tumors is
associated with an increased risk of developing
tumors in the future [69].
2.1 Hard Chest Cells
Mammary cells with a larger thickness are
associated with an increased likelihood of
developing chest cancer. It appears that
persistent hormonal shifts may increase the risk
of developing a chest tumor. This must be the
outcome of the menstrual cycle starting earlier
than usual, in conjunction with anovulation
starting later than usual. During this time period,
Stage 0
(Carcinoma
insitu-early form)
Stage 1
(localized)
Stage 2 (Early
localized
advanced)
Stage 3 (Late
locally advanced) Stage 4 (
Metastasized)
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hormone levels tend to be higher. Suckling,
particularly after the age of one year, appears to
reduce the risk of developing a chest tumor. This
is likely because both pregnancy and lactation
reduce the amount of hormones consumed by
the body [70].
2.2 Construct the Mass
Consuming an excessive amount of fructose
might be a factor. Because higher hormone
levels are present during menstruation, it is
possible that women who are obese and have a
round figure have a higher risk of developing
breast cancer [71,72].
2.3 A Person Who Drinks Beer
It appears that this is connected to a loosening of
restrictions on drinking heavily and frequently.
Emission displaythe medication of the tumor that
does not carcinoma raises chances of
developing a check tumor behind under viability.
This is due to the fact that drinking more than
three beers on a regular basis is associated with
a one and a half times greater risk of developing
breast cancer in women [73].
2.4 Estrogen Medicine
Employment for estrogen substitution treatment,
also known as (hormone replacement therapy),
with oral pregnancy prevention pills was
previously connected with cancer. This
association was made because to the higher
hormonal alterations that were caused by the
treatment [74].
2.5 Diethylstilbestrol's manifesting
Characteristics
Diethylstilbestrol manifestation was another
hormone-like drug that women who were
pregnant took beginning in the 1940s and
continuing until the middle of the 1970s. They did
this in the belief that it would lower their chances
of having a stillbirth or abort their unborn
children. Cancer strikes young women at a
somewhat higher rate than it does older women.
Women who gave birth while using
diethylstilbestrol had a considerably elevated risk
of getting chest cancer between the years 1949
and the mid-1970s [75].
3. DIAGNOSIS
Mammograms and ultrasounds were among the
early types of scanners. Individuals who are
experiencing tissue growth or repair, particularly
along the course of a chronic disease, those who
actually appraise for bilateral illness, and those
who are concerned about the significant
likelihood of developing chest tumor cancer are
all candidates for MRI evaluation [76]. Individuals
with thick chests, bilateral illness, and a history of
chest chemotherapy and radiotherapy could be
evaluated using magnetic resonance imaging,
which could further storage and help arrange
perioperative medication for histopathology
tumors [77].
MRI allows for a more accurate diagnosis of
epidermis changes that are characteristic of
infiltrative tumors, such as epidermal infiltration.
The randomly orientated tumor, architectural
misalignment, armpit lymphadenitis, and
echogenic darkening are all broadly diagnostic
signs for aggressive, invasive tumors.
Additionally, occasionally ductal micro
calcification precipitates can be seen [78].
The presence of cancer may be determined
through the use of cell biopsies; specimens were
acquired by the use of endoscopic ultrasonic
central injection biopsies, debridement biopsies,
orthogonal histopathology, and magnetic
resonance laparotomy. There is no requirement
for a pneumatic instrument while doing ultrasonic
strong segment injection biopsies, which are
recommended by many medical professionals.
Reports on the types of biopsies would contain
the following: • The stage of cancer is defined by
the rate of cell growth and division. Malignancies
of excellent grade (rank 4) were more diverse
than malignancies of poorer quality (rank 1).
Malignancies of lesser quality were more clearly
characterized [79].
The histochemical, which might vary based on
the susceptibility of the carcinoma to hormones
or the overexpression of the hormone epidermal
growth factor2 within the carcinoma [61].
A potentiality with chemoradiotherapy and also
the occurrence among persons who have acute
tumors may be predicted using the clinical
diagnostic chest relapse Index. When assessing
malignancy, tumor, node metastasis (TNM)
categorization and organizations are both taken
into consideration. A significant number of
women with a histological form of breast cancer
need to undergo testing for BRCA 1 or 2
alterations. Cowden disease and Li-Fraumeni
disease are both associated with an increased
risk of developing chest cancer [80]. Individuals
Cuthrell and Tzenios; Int. Res. J. Oncol., vol. 6, no. 1, pp. 104-118, 2023; Article no.IRJO.100349
113
who have a family history of chest, prostate,
ovarian, colorectal, thyroid, or endometriosis
cancers may be candidates for a more in-depth
genetic evaluation [81].
3.1 Surgery
Surgery is one of the most often used treatments
for tumors. This information might be kept in
conjunction with further medications such as
radiation, surgery, and targeted therapy [82].
There are two distinct forms of chest therapy: the
breast-conserving procedure known as a
lumpectomy and the traditional mastectomy [83].
Mastectomy: The entirety of the chest was
disassembled and discarded [84].
Radiation treatment: In radiation and
chemotherapy, exceptionally high levels of
emission are utilized in order to eradicate
malignant tissue. The process of radiotherapy
involves the continual destruction of tumors.
Many will inevitably pass away due to the fact
that the tissues do not have a measurement for
improvement itself among the regular medication
[85,86]. The use of chemicals in a therapeutic
setting with the intention of eliminating malignant
tissue is known as chemotherapy. To a modest
degree, cancerous tissues participate in the
proliferation, reproduction, and migration of
cancer cells to other parts of the body caused by
chemotherapy and radiation. The treatment,
known as chemotherapy, has the potential to
cause side effects such as nausea, vomiting,
mouth ulcers, exhaustion, and an increased risk
of infection or baldness. There is a possibility that
some cancer medications will have an effect on
male sperm, which might affect the fertility
potential of the patient. Therefore, during
treatment, your cycles might not occur, but when
they do, you might experience fertility problems
[87,88].
3.1.1 A treatment based on hormones
The proteins estrogen and progesterone found at
the covers of many cancer cells can be found in
these cells. Cancers that include estrogen
protein can also manifest in another prevalent
form. This connection between hormones
(estrogen or progesterone) inside a unique
protein on the tumor might accelerate the
expansion of carcinoma. Pharmacological
therapies are used to regulate hormone kinase
cancer by lowering progesterone or estrogen
levels inside the body and reducing their impact
on malignant tissues. This is accomplished by
inhibiting the body's production of these
hormones.
3.1.2 Aromatase inhibitor
Human beings exposed to these inhibitors will
not be able to produce hormones. Only women
who have never given birth can use them.
climacteric signs like heartburn with sexual
dysfunction, excess weight, premature
climacteric (which are irreversible when the
ovaries are eliminated), and muscle and joint
problems could be among the adverse reactions
caused by hormonal treatment [89]. The adverse
reactions caused by hormonal treatment vary
depending on the substance or form of the
hormonal therapy that is used.
3.1.3 Treatment using biological agents
It is a type of treatment that makes use of the
immunological reactions of human patients.
There are several different therapy techniques
that may be used to manage carcinoma.
Herceptin's successor, trastuzumab, was used
more often and extensively. Only females are
capable of storing trastuzumab because only
females have human epidermal growth factor
receptor–positive invasive carcinoma, which is a
kind of cancer that has spread beyond milk ducts
and lobules and into many other places where
malignant cells are present. In order to exert
more control over the enzyme human epidermal
growth factor2 (EGF2), trastuzumab may be
used in conjunction with some chemotherapy
drugs as well as after their administration.
Common cold symptoms (heat, chills, or
vomiting), constipation, lethargy, migraine,
redness, or discomfort/sensitivity only upon
treated region are all possible consequences
with therapeutic intervention [90]. Other possible
complications include redness, discomfort/
sensitivity just upon treated area, and lethargy
[91].
4. CONCLUSIONS AND FUTURE
PERSPECTIVES
Over the course of the past two decades,
treatment for breast cancer has evolved to
become more personalized and targeted. The
molecular subtyping of breast cancer provides
the basis for the many precisions therapeutic
techniques that are currently being developed.
The escalation and de-escalation of treatment in
line with the biology of the tumor and early
Cuthrell and Tzenios; Int. Res. J. Oncol., vol. 6, no. 1, pp. 104-118, 2023; Article no.IRJO.100349
114
prognostic indicators will play a more prominent
role in future therapeutic methods.
Individualization of therapy for each patient will
also play a larger role. In conjunction with
subtyping-based umbrella studies [92], additional
classification of the many breast cancer subtypes
that already exist (such as TNBC) may result in
an improvement in the prognosis of the illness. In
addition, there is an ongoing requirement for the
research and development of innovative
treatments for both early and advanced stages of
breast cancer. The overarching objective of
ongoing study is to get an understanding of the
factors that contribute to resistance to treatment
as well as methods for overcoming this
phenomenon. Single-cell technologies will
provide insight on the interactions that occur
between tumors and the microenvironments in
which they reside. These technologies may also
assist in the development of novel treatment
targets and biomarkers. For instance, a single-
cell analysis suggested that in TNBC, the fraction
of the T cell subgroup that was positive for
CXCL13 was a strong predictor of how effectively
the therapies against PD-L1 performed. This was
seen in patients who had the cancer known as
triple-negative breast cancer.
The primary focus in breast cancer surgery
currently is on de-escalation. In the future,
surgical methods will place a greater emphasis
on understanding the biology of the cancer and
will employ more customized treatment
strategies. In the coming years, it will be
necessary to find answers to two significant
concerns surrounding the treatment of breast
cancer. Patients who have a pCR after
undergoing neoadjuvant therapy may be able to
forgo breast surgery. The second question is
whether or not certain people can completely
avoid undergoing axillary surgery for both the
staging and treatment stages of the disease.
These are very important issues, yet running
randomized controlled trials to get answers to
them might be difficult because of concerns
about people's safety, which highlights the need
for international cooperation. In order to find a
solution that strikes a balance between the
potential for a decrease in undesirable
occurrences and an increase in the danger of
recurrence, each individual situation needs to be
thoroughly analyzed and addressed. It is
essential that clinical trial settings be categorized
utilized in order to investigate any potential de-
escalation strategies or concepts.
CONSENT AND ETHICAL APPROVAL
It is not applicable.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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