Despite a remarkable increase in the depth of our understanding and management of Breast Cancer in the past 50 years, the road to management and care is still long and winding, posing significant challenges. However, in recent decades, the increased incidence of breast cancer has led to awareness and significant changes in diagnosis and treatment.
The earliest description of Breast Cancer dates to around 3500 BCE. For centuries thereafter the theories of the great Greek Physician like Hippocrates in 460 BCE and Galen in 200 BCE attributing the cause of Breast Cancer to an “excess of black bile” and treatment options like use of opium and castor oil, prevailed. The role of surgery was advocated around the middle of the 18th century and thereafter the advent of modern medicine in the form of novel drugs and targeted therapies surfaced into clinical practice based on evidence.
Treatment for breast cancer has evolved over time. Breast cancer was originally treated as a local disease, and the primary treatment was radical surgery. Over time, radical surgery evolved into more breast-conserving surgery known as lumpectomy. Radiation was used to control the local/regional disease.
Breast-conserving surgery with radiation is still a very important treatment for local or regional disease; however, this treatment does not address the cancer cells that may have travelled outside of the affected area and require systemic treatment. Treating breast cancer is not just about treating the tumour- it is also about treating the whole body. We have learned that tumours in the breast do not kill women; it is the tumours in the body that lead to mortality.
Advances in Breast Cancer Research
The goal of any clinician is always administering the right treatment basis the prognosis which aids appropriate management. Management of Breast Cancer is multidisciplinary. It includes a loco-regional which targets only the tumour with the help of surgery and radiation therapy) and systemic therapy approach that targets the entire body. The systemic therapy includes endocrine therapy for hormone receptor positive disease, chemotherapy, Anti Her2 therapy for Her2 positive disease, bone stabilising agents, Polymerase inhibitors for BRCA mutation carriers and quite recently immunotherapy.
Researchers are working to advance our understanding of how to prevent, detect, and treat breast cancer. They are also looking at how to address disparities and improve quality of life for survivors of the disease.
Early Detection of Breast Cancer
Breast cancer is one of a few cancers for which an effective screening test, mammography, is available. MRI (magnetic resonance imaging) and ultrasound are also used to detect breast cancer, but not as routine screening tools.
Ongoing studies are looking at ways to enhance current breast cancer screening options. Technological advances in imaging are creating new opportunities for improvements in both screening and early detection.
One new technology is 3-D mammography, also called breast tomosynthesis. This procedure takes images from different angles around the breast and builds them into a 3-D-like image. Although this technology is increasingly available in the clinic, it isn’t known whether it is better than standard 2-D mammography, for detecting cancer at a less advanced stage.
Breast Cancer Treatment
The mainstays of breast cancer treatment are surgery, radiation, chemotherapy, hormone therapy, and targeted therapy. But scientists continue to study novel treatments and drugs, along with new combinations of existing treatments.
It is now known that breast cancer can be divided into subtypes that respond differently to various types of treatment. The three main clinical subtypes of breast cancer are:
HR-Positive Breast Cancer Treatment
Targeted therapy uses drugs or other substances to attack cancer cells with less harm to normal cells. There is a new focus on adding targeted therapies to hormone therapy for advanced or metastatic HR-positive breast cancer. These treatments could prolong the time until chemotherapy is needed and ideally, extend survival.
Human epidermal growth factor receptor 2
(HER2) positive. HER2-positive breast cancers are those that have high amounts of the HER2 protein; they can be HR positive or HR negative. These cancers can be treated with therapies that target HER2.
Triple-Negative Breast Cancer
Triple-negative breast cancers (TNBC) are the hardest to treat because they lack both hormone receptors and HER2 overexpression, so they do not respond to therapies directed at these targets. Therefore, chemotherapy is the mainstay for treatment of TNBC.
Considering complementary and alternative methods
You may hear about alternative or complementary methods that your doctor hasn’t mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision.
A few years back, the mortality rate was very high due to this disease. Now even though mortality is declining, the diagnosis still poses a huge threat for the affected woman and her close family.
Breast cancer surgery, which often includes reconstructive procedures, can help restore a satisfactory body image. The decision on the type of surgery should always be made together with the patient and should focus on her psychosocial needs.
In the past 50 years, breast cancer has been transformed from a disease in which all women were treated with a radical and disfiguring surgical procedure that amputated the breast. Now, for the majority of women, it is usually managed with only minimal removal of breast tissue and sampling of a few axillary nodes.
During this same period of time, women with breast cancer have become increasingly involved in treatment decision-making, and have made it clear that they have a need for attention to the psychological and social aspects of their care, in addition to the targeted treatment of their tumours.