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, akouchekian.m@iums.ac.ir
Abstract: (55 Views)
Breast cancer is the most common malignant neoplasm and a primary cause of mortality among women worldwide. In recent decades, its prevalence has consistently risen, resulting in an escalating public health challenge, especially in low- and middle-income countries (LMICs), where healthcare systems frequently lack the requisite infrastructure and resources to address the increasing demand for cancer treatment. This difference emphasizes the critical need for equal access to preventive, early detection, and treatment methods to address this global health crisis comprehensively.
The increasing prevalence of breast cancer is linked to various factors. Demographic changes, including population aging, and shifts in reproductive behaviors, such as delayed childbirth and reduced breastfeeding duration, have significantly impacted this trend. Lifestyle factors, including rising obesity rates, physical inactivity, and alcohol consumption, have exacerbated the risk. In high-income countries, especially the United States and Europe, dietary patterns marked by high-fat consumption and the prevalence of obesity have become significant contributors to the disease burden. In contrast, low- and middle-income countries (LMICs) in Asia and Africa encounter specific challenges, such as cultural barriers that hinder early detection initiatives and restricted access to screening programs. These limitations frequently lead to diagnoses at higher levels and lower clinical outcomes.
The risk factors for breast cancer are multifaceted, involving both genetic and environmental components. Approximately 5–10% of breast cancer cases are attributable to inherited genetic mutations, most notably in the BRCA1 and BRCA2 genes, which can increase the lifetime risk of developing breast and ovarian cancer to as high as 80%. Advances in genetic screening have made it possible to identify high-risk individuals, enabling the implementation of preventive strategies, such as prophylactic surgeries, that significantly reduce cancer risk. In addition to genetic predisposition, lifestyle factors that can be considerably modified influence susceptibility to breast cancer. Behaviors including alcohol consumption, smoking, obesity, physical inactivity, and poor dietary habits are significantly linked to an increased risk of the disease. Hormonal factors, such as extended exposure to estrogen resulting from early menarche, late menopause, or hormone replacement therapy, significantly contribute to the development of breast cancer. The complex link among genetic, hormonal, and lifestyle factors highlights the importance of thorough preventive strategies that combine lifestyle changes with specific interventions for individuals at elevated genetic risk.
Diagnosing breast cancer requires a synthesis of precise imaging techniques, histopathological analysis, and genetic testing. Mammography is fundamental for early detection, especially in asymptomatic women, and has significantly contributed to decreasing mortality rates in high-income nations. Access to mammography is frequently restricted in low- and middle-income countries (LMICs), resulting in diagnoses at more advanced stages and inferior results. Recent innovations, including magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and contrast-enhanced mammography, have increased the accuracy of breast cancer detection, particularly in women with dense breast tissue, where conventional techniques may be inadequate. Moreover, innovative instruments like liquid biopsies, which identify circulating tumor DNA (ctDNA), provide promising opportunities. These non-invasive tests promote early recognition and generate significant insights into treatment efficacy and the existence of residual disease. These discoveries can change breast cancer treatment globally, especially by reducing gaps in diagnostic availability in resource-constrained environments.
The treatment of breast cancer has significantly improved, proceeding closer to personalized strategies based on the molecular profile of individual tumors. Breast cancer is categorized into subtypes: luminal A, luminal B, HER2-positive, and triple-negative breast cancer (TNBC), which form the basis for targeted treatment approaches. Hormone receptor-positive cancers, including luminal A and B subtypes, show a positive response to endocrine therapies, such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors, which inhibit estrogen's contribution to tumor proliferation. HER2-positive breast cancers, defined by HER2 protein overexpression, have seen improved treatment outcomes due to the introduction of targeted therapies including trastuzumab, pertuzumab, and newer agents like trastuzumab deruxtecan. These therapies have changed the management of HER2-positive disease, leading to notable modifications in survival rates and patient quality of life. This progress illustrates the significance of a precision medicine approach in the management of breast cancer.
Triple-negative breast cancer (TNBC) poses a considerable challenge due to its absence of hormone receptors and HER2 expression, making it resistant to numerous targeted therapies that have altered the treatment of other subtypes. TNBC has been defined by its rapid growth and increased recurrence rates, leading to more intensive and multifaceted treatment strategies. Recent advancements in immunotherapy, especially regarding the use of immune checkpoint inhibitors, have shown improved survival rates for patients with TNBC. Ongoing research is exploring innovative strategies, including the combination of chemotherapy with immunotherapy, and investigating targeted therapies such as PARP inhibitors for patients with BRCA-mutated TNBC. These developments enable modern methods to address this challenging subtype and enhance outcomes for affected individuals.
Breast cancer treatment generally includes local and systemic treatments, providing a holistic strategy for controlling the disease. Surgery plays an essential role in treatment, with different options from breast-conserving surgery (lumpectomy) to mastectomy, according to tumor features and patient preferences. After treatment, radiation is frequently advised for individuals after breast-conserving surgery to decrease the risk of local recurrence. Systemic treatments, including chemotherapy, hormone therapy, and targeted therapies, are important for inhibiting the metastasis of cancer to other parts of the body. Recent advances in molecularly targeted therapies have markedly enhanced results, especially for HER2-positive and hormone receptor-positive breast tumors. The addition of CDK4/6 inhibitors, including palbociclib and ribociclib, along with endocrine therapy has significantly improved therapeutic efficacy for hormone receptor-positive breast cancer, promising patients with higher prospects for sustainable control and survival.
The future of breast cancer treatment relies mainly on the advancement of personalized medicine. Improvements in genetic and molecular profiling, accelerated by next-generation sequencing technology, have exposed new targets for therapy and facilitated more precise treatments. PI3K inhibitors, aimed at PIK3CA-mutated tumors, represent a notable transition for improving the genetic mechanisms of cancer instead of depending exclusively on standard chemotherapy, therefore providing patients with more personalized and less toxic options for therapy. Immunotherapy promises to be a potential field of advancement, especially for TNBC. Immune checkpoint drugs, including pembrolizumab and atezolizumab, have demonstrated promising outcomes in advanced-stage TNBC, with current clinical trials studying their application in earlier disease stages. Studies that merge immunotherapy with chemotherapy and targeted medicines are in growth, to enhance the immune system's efficacy in attacking cancer. These discoveries indicate a new era in breast cancer treatment, offering promise for better results and an improved quality of life for patients.
In conclusion, breast cancer is a significant worldwide health challenge, influenced by increasing incidence and the complex interaction of genetic, environmental, and lifestyle conditions. However, advances in early detection, molecular profiling, and personalized treatment options offer an opportunity for better results. Reducing breast cancer globally requires expanding access to these technologies, especially in low-resource areas, and refining therapy techniques. The final goal of breast cancer research is to increase survival rates, prevention, early detection, and long-term outcomes, giving hope for a managed and preventive future.
The increasing prevalence of breast cancer is linked to various factors. Demographic changes, including population aging, and shifts in reproductive behaviors, such as delayed childbirth and reduced breastfeeding duration, have significantly impacted this trend. Lifestyle factors, including rising obesity rates, physical inactivity, and alcohol consumption, have exacerbated the risk. In high-income countries, especially the United States and Europe, dietary patterns marked by high-fat consumption and the prevalence of obesity have become significant contributors to the disease burden. In contrast, low- and middle-income countries (LMICs) in Asia and Africa encounter specific challenges, such as cultural barriers that hinder early detection initiatives and restricted access to screening programs. These limitations frequently lead to diagnoses at higher levels and lower clinical outcomes.
The risk factors for breast cancer are multifaceted, involving both genetic and environmental components. Approximately 5–10% of breast cancer cases are attributable to inherited genetic mutations, most notably in the BRCA1 and BRCA2 genes, which can increase the lifetime risk of developing breast and ovarian cancer to as high as 80%. Advances in genetic screening have made it possible to identify high-risk individuals, enabling the implementation of preventive strategies, such as prophylactic surgeries, that significantly reduce cancer risk. In addition to genetic predisposition, lifestyle factors that can be considerably modified influence susceptibility to breast cancer. Behaviors including alcohol consumption, smoking, obesity, physical inactivity, and poor dietary habits are significantly linked to an increased risk of the disease. Hormonal factors, such as extended exposure to estrogen resulting from early menarche, late menopause, or hormone replacement therapy, significantly contribute to the development of breast cancer. The complex link among genetic, hormonal, and lifestyle factors highlights the importance of thorough preventive strategies that combine lifestyle changes with specific interventions for individuals at elevated genetic risk.
Diagnosing breast cancer requires a synthesis of precise imaging techniques, histopathological analysis, and genetic testing. Mammography is fundamental for early detection, especially in asymptomatic women, and has significantly contributed to decreasing mortality rates in high-income nations. Access to mammography is frequently restricted in low- and middle-income countries (LMICs), resulting in diagnoses at more advanced stages and inferior results. Recent innovations, including magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and contrast-enhanced mammography, have increased the accuracy of breast cancer detection, particularly in women with dense breast tissue, where conventional techniques may be inadequate. Moreover, innovative instruments like liquid biopsies, which identify circulating tumor DNA (ctDNA), provide promising opportunities. These non-invasive tests promote early recognition and generate significant insights into treatment efficacy and the existence of residual disease. These discoveries can change breast cancer treatment globally, especially by reducing gaps in diagnostic availability in resource-constrained environments.
The treatment of breast cancer has significantly improved, proceeding closer to personalized strategies based on the molecular profile of individual tumors. Breast cancer is categorized into subtypes: luminal A, luminal B, HER2-positive, and triple-negative breast cancer (TNBC), which form the basis for targeted treatment approaches. Hormone receptor-positive cancers, including luminal A and B subtypes, show a positive response to endocrine therapies, such as selective estrogen receptor modulators (SERMs) and aromatase inhibitors, which inhibit estrogen's contribution to tumor proliferation. HER2-positive breast cancers, defined by HER2 protein overexpression, have seen improved treatment outcomes due to the introduction of targeted therapies including trastuzumab, pertuzumab, and newer agents like trastuzumab deruxtecan. These therapies have changed the management of HER2-positive disease, leading to notable modifications in survival rates and patient quality of life. This progress illustrates the significance of a precision medicine approach in the management of breast cancer.
Triple-negative breast cancer (TNBC) poses a considerable challenge due to its absence of hormone receptors and HER2 expression, making it resistant to numerous targeted therapies that have altered the treatment of other subtypes. TNBC has been defined by its rapid growth and increased recurrence rates, leading to more intensive and multifaceted treatment strategies. Recent advancements in immunotherapy, especially regarding the use of immune checkpoint inhibitors, have shown improved survival rates for patients with TNBC. Ongoing research is exploring innovative strategies, including the combination of chemotherapy with immunotherapy, and investigating targeted therapies such as PARP inhibitors for patients with BRCA-mutated TNBC. These developments enable modern methods to address this challenging subtype and enhance outcomes for affected individuals.
Breast cancer treatment generally includes local and systemic treatments, providing a holistic strategy for controlling the disease. Surgery plays an essential role in treatment, with different options from breast-conserving surgery (lumpectomy) to mastectomy, according to tumor features and patient preferences. After treatment, radiation is frequently advised for individuals after breast-conserving surgery to decrease the risk of local recurrence. Systemic treatments, including chemotherapy, hormone therapy, and targeted therapies, are important for inhibiting the metastasis of cancer to other parts of the body. Recent advances in molecularly targeted therapies have markedly enhanced results, especially for HER2-positive and hormone receptor-positive breast tumors. The addition of CDK4/6 inhibitors, including palbociclib and ribociclib, along with endocrine therapy has significantly improved therapeutic efficacy for hormone receptor-positive breast cancer, promising patients with higher prospects for sustainable control and survival.
The future of breast cancer treatment relies mainly on the advancement of personalized medicine. Improvements in genetic and molecular profiling, accelerated by next-generation sequencing technology, have exposed new targets for therapy and facilitated more precise treatments. PI3K inhibitors, aimed at PIK3CA-mutated tumors, represent a notable transition for improving the genetic mechanisms of cancer instead of depending exclusively on standard chemotherapy, therefore providing patients with more personalized and less toxic options for therapy. Immunotherapy promises to be a potential field of advancement, especially for TNBC. Immune checkpoint drugs, including pembrolizumab and atezolizumab, have demonstrated promising outcomes in advanced-stage TNBC, with current clinical trials studying their application in earlier disease stages. Studies that merge immunotherapy with chemotherapy and targeted medicines are in growth, to enhance the immune system's efficacy in attacking cancer. These discoveries indicate a new era in breast cancer treatment, offering promise for better results and an improved quality of life for patients.
In conclusion, breast cancer is a significant worldwide health challenge, influenced by increasing incidence and the complex interaction of genetic, environmental, and lifestyle conditions. However, advances in early detection, molecular profiling, and personalized treatment options offer an opportunity for better results. Reducing breast cancer globally requires expanding access to these technologies, especially in low-resource areas, and refining therapy techniques. The final goal of breast cancer research is to increase survival rates, prevention, early detection, and long-term outcomes, giving hope for a managed and preventive future.
Keywords: Breast cancer, Epidemiology, Risk factors, Predictive and prognostic factors, Therapeutic approaches
Type of Study: review article |
Subject:
Hematology & oncology
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