Insights into breast cancer new

A. Introduction

-              Most common in women

-              A lot (2.3 mil) new cases globally

-              Mortality rates 685,000 deaths globally (2020 stats)

-              Prevalence – 3.8 mil women in US have history of breast cancer

B. Anatomy and Pathophysiology of Breast Cancer

·       Located anterior to pectoral muscles & extends from 2^nd to 6^th rib & from sternum to mid-axillary line

·       Key structures:

·       Composed of glandular tissue – breast consists of lobes, lobules, & milk ducts responsible for producing & transporting milk

·       ducts, connective tissue, blood vessels

·       lymphatics – axillary lymph nodes, located in armpit, are crucial for lymphatic drainage from breast

·       Cooper’s ligaments – connective tissue strands providing structural support to breast

·       Cancer development:

·       Originates in cells lining the milk ducts or lobules

·       Abnormal changes in cells can lead to development of tumours

·       Over time cells can invade surrounding tissues & potentially spread to other part of the body through lymphatic or blood vessels

·       Emphasis on the importance of regular screening (mammograms…)

·       Types of breast cancer:

·       Ductal carcinoma –

·       Lobular carcinoma –

·       Inflammatory breast cancer –

·       Paget’s disease of the breast/nipple –

·       Pathophysiology of breast cancer:

·       Genetic mutations

C. Disease Progression and Metastasis of Breast Cancer

How can disease progression occur?

·       Locally

·       Regionally

·       Metastatic

How can breast cancer metastasise?

·       Via blood vessels or the lymphatic system

What are the metastatic sites?

·       Bones

·       Liver

·       Lungs

·       Brain

What are the mechanisms of metastasis?

What are the clinical implications of metastasis?

D. Risk Factors and Protective Factors of Breast Cancer

·       Risk increases with age

·       Being a woman

·       Having a family history of breast cancer

·       Personal history of breast conditions and/or cancer

·       Hormonal factors – prolonged exposure to oestrogen & progesterone

·       Early menstruation

·       Lifestyle factors – obesity, sedentary lifestyle, alcohol consumption, tobacco

·       BRCA1 mutation – lifetime risk 55%-72%

·       BRCA2 mutation – lifetime risk 45%-69%

What is the genetic susceptibility of breast cancer?

What are the hormonal influences of breast cancer?

What are the protective factors of breast cancer?

What are ethe protective interventions of breast cancer?

E. Screening and Diagnosis

What is the importance of early detection of breast cancer?

What is a mammography and ultrasonography?

When would a diagnostic procedure be performed?

What types of diagnostic procedures are used in breast cancer diagnosis and staging?

What multidisciplinary approach is used for breast cancer diagnosis and treatment planning?

F. Prognostic and Predictive Factors
What are prognostic factors and what are examples?

How does hormone receptor status help with prognosis?

What is the significance of HER2/neu status?

What is the importance of the histological grade?

What is lymphovascular invasion and its importance?

What are the predictive factors for breast cancer?

What is molecular profiling?

What are gene expression assays?

How can treatment response be predicted?

How does precision medicine improve treatment outcomes?

G. Genetic and Molecular Profiling
How does genetic testing play a role in identifying inherited mutations that increase risk of breast cancer?

What are the BRCA1 and BRCA2 genes and how are the mutations in the genes significant?

H. Posttherapy Considerations
Breast cancer treatment and hormonal changes

-              Surgery, chemo, & endocrine therapy can lead to hormonal changes & menopausal symptoms

Hormone replacement therapy

-              Contraindicated in breast cancer survivors due to concerns about hormone-related cancer recurrence

Evolving perspectives on HRT

-              Decision to use  HRT should be individualised

-              Age

-              Type of breast cancer

-              Treatments received

-              Overall health

Patient centred care

-              Open communication, shared decision making

-              Tailoring interventions to the individuals patients’s needs, preferences, goals

Assessing risks and benefits

-              Severity of menopausal symptoms, impact on quality of life, risk of cancer recurrence, and overall health status

Personalised interventions

-              Tailored to the patients specific needs nd preferences

Shared decision making

Multidisciplinary approach

Survivorship programs

I. Case Studies and Clinical Applications

Case Study 1: Genetic Profiling and Targeted Therapy
• Description: This case study focuses on a patient with advanced
breast cancer who underwent genetic profiling.
• Results of the genetic profiling revealed a specific mutation, guiding
the selection of targeted therapy.
• The case study will showcase the patient's response to the targeted
therapy and the improvement in disease control.

Case Study 2: BRCA1/BRCA2 Mutation and Risk Management
• Description: This case study centres around a patient with a strong
family history of breast and ovarian cancer.
• Genetic testing identified a BRCA1 mutation in the patient, leading to
risk-reducing strategies and heightened surveillance.
• The case study will demonstrate the impact of early intervention and
personalized risk management on the patient's outcomes.

Case Study 3: Molecular Profiling and Treatment Selection
• Description: This case study focuses on a patient with early-stage
breast cancer who underwent molecular profiling.
• The molecular profile test, such as MammaPrint or Oncotype DX,
assisted in determining the patient's risk of recurrence.
• The case study will highlight how the molecular profile results
influenced the treatment decision-making process and optimized the
patient's therapy.

Case Study 4: Personalized Treatment Approach
• Description: This case study illustrates the importance of a
personalized treatment approach in breast cancer management.
• It will showcase a patient with unique characteristics, such as
hormone receptor status, HER2 expression, and genomic
alterations.
• The case study will emphasize how a comprehensive understanding
of the patient's molecular profile guided the selection of tailored
therapies, resulting in improved outcomes.

Case Study 5: Long-Term Survivorship Care
• Description: This case study focuses on the long-term survivorship care
of a breast cancer patient.
• It will explore the role of ongoing genetic and molecular profiling in
monitoring the patient's disease status and optimizing follow-up care.
• The case study will highlight how genetic and molecular profiling
contribute to personalized survivorship care and the early detection of
potential recurrences.

J. Future Directions and Research Implications

Precision medicine in breast cancer

-              Aims to tailor medical treatment to individuals based on their unique characteristics including genetic makeup, molecular profile, lifestyle factors

-              In breast cancer management precision med holds promise for optimising therapy selection, treatment response prediction and personal survivorship care

Genomic and molecular profiling

Liquid biopsies and circulating tumour DNA

Immunotherapy and targeted therapy

AI and machine learning

Long-term survivorship care

Clinical trials and collaborative research

Ethical considerations and patient empowerment