Insights into Breast cancer

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

J. Future Directions and Research Implications

Precision medicine in breast cancer

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