Tumors manifesting in mammary glands are majorly benign, representing almost no threat to the patients. Although their cells are different from others, they lack the ability to transfer to other organs. Cancer is developed from mutations, namely from atypical changes in genes that regulate cell growth and keep them healthy. Malignant cells multiply uncontrollably, and they can go beyond the initial tumor over time and spread to surrounding healthy tissues, lymph nodes, and distant organs. Breast cancer is a malignant tumor that develops from breast cells.
The mammary gland is made up of different tissues, from soft (fatty) to very dense. This tissue comprises lobes, each of which consists of small tubular structures (lobules), which contain milk glands. Narrow ducts connect the glands, lobes, lobules, carrying milk from the lobes to the nipple. The nipple is located in the center of the field, the dark area (areola). Blood and lymph nodes pass through the entire mammary gland, and blood feeds cells. The lymphatic system removes metabolic and other products from the body. The lymphatic vessels are connected to the lymph nodes, small bean-shaped organs that help fight infections.
When breast cells start to divide sweepingly and spread to other tissues because of specific mutations, breast cancer occurs. Such cells form a tumor, and they can be detected by palpation of the breast or by mammography (X-ray of the breast). This disease is classified into certain molecular groups, depending on definite cell surface receptors. These are the progesterone receptor (PR), the estrogen receptor (ER), and the human epidermal growth factor 2 receptor (HER2) (Veronesi et al., 2017). Specific processes in a human organism can form a malignant tumor in different parts of the breast. Most breast tumors are developed from the epithelium of the ducts that carry milk to the nipple (ductal carcinoma). Others are formed from epithelial cells (lobular cancer). There are also less common forms, including non-specific cancers, sarcomas, and breast lymphoma. The tumor can grow locally, spread through the lymphatic system to the lymph nodes (regional metastasis) and throughout the body (distant metastasis). The regional lymph nodes include the axillary, intrathoracic, supra- and subclavian lymph nodes – on the same side as the tumor in the mammary gland.
Most cancers are sporadic and occur because of accidental damage to a person’s genes after birth. There is no risk of passing this gene on to children at all. Cases of hereditary breast cancer are rare; they are developed due to changes in genes called mutations and are passed from parent to child in the family. Breast cancer is often falsely believed to be a female-only disease (Veronesi et al., 2017). Veronesi (2020) claims that male breast cancer is rare; in Western countries, it accounts for nearly 1% of all breast cancers, but its incidence is growing (p. 1). In the United States, there is not proportional distribution of the burden of breast cancer across demographic subgroups. Gentilini et al. (2020) identified that “African-American women account for 14% of cases among women age <40 and 8% >40, whereas Caucasian account for 76% of cases among women <40 and 85% among women >40” (p. 4). Thereby, one can observe some specific patterns of this disease occurring depending on age and nationality.
The incidence of breast cancer also depends on the age of the patient. It is also one of the most common causes of cancer death. Thus, Gentilini et al. (2020) mentioned that:
Breast cancer is the most common malignancy among women, with more than 1.3 million new breast cancers diagnosed annually worldwide and the second leading cause of cancer death among women. The disease is diagnosed mainly in older women, with a median age at diagnosis of 61. Less than 7% of cases are diagnosed among young women, including about 1% before age 30 and 2.5% before age 35. The risk to an individual woman is about 1 in 1500 by age 30 and 1 in 200 by age 40 (p. 9).
Developing of breast cancer also depends on the lifestyle and habits of a person. Thereby, it is recommended to consider environmental and lifestyle factors such as alcohol, smoking, diet, exercise, shift work, and radiation (Gentilini et al., 2020). Thus, diagnostics and prevention of this disease can be more effective in the future if one takes into account these factors.
Diagnosis of breast cancer in most cases does not cause difficulties since this disease belongs to the so-called “cancer of external localizations.” The structure, size, location, and other factors of mammary gland tumors are usually assessed through palpation and examination. Additional examinations, such as an ultrasound sensor, can also be ordered. It allows to examine the tissue condition and clarify whether malignant structures can form. Mammography is the primary diagnostic method, but it is especially important because it examines healthy women without any symptoms. In addition, since earlier times, there have been significant improvements in the quality of mammographic images; they have been evolved from analog to digital (Parker, 2018). One can identify the presence of pathological formations in the mammary glands and somehow judge about their nature with the help of mammography.
The nature of previously discovered formations is typically evaluated using an MRI instrument. This kind of diagnostics is advantageous when the possibility of hereditary cancer is present. During a core biopsy, a medical needle is inserted into the outlined area to extract a tissue sample. After that, histological analysis and an immunohistochemical study can be conducted, proving the diagnosis and choosing a suitable treatment therapy.
Today scientists are making significant progress in understanding the nature of this disease. In particular, research is being carried out on breast cancer elimination approaches and possible reasons for the difficulty in treatment:
Aromatase, the key enzyme involved in the synthesis of estrogen, is often dysregulated in breast cancers. This has led to the administration of aromatase-inhibitors (AIs), commonly used for hormone-dependent breast cancers. Unfortunately, the increasing development of acquired resistance to the current AIs and modulators of estrogen receptors following initial disease steadiness has posed a serious clinical challenge in breast cancer treatment (Molehin et al., 2021, para. 1)
Treatment of patients with stage 1 and stage 2 breast cancer is almost identical with minor differences. There are two main surgical methods for treating localized breast cancer: mastectomy (removal of the breast) or organ-preserving surgery (removal of only the tissue affected by the tumor, or lumpectomy). Radiation therapy at EMC is carried out on linear accelerators, allowing targeted irradiation of the tumor with minimal impact on the surrounding tissue. Such equipment has been installed in only a few dozens of the world’s leading oncology clinics.
Women are at significant risk of death from breast cancer complications. There are many types of diagnostics, including mammography and MRI, and treatment, both surgical and radiational. The forecast depends on many factors. The chances of recovery from breast cancer are relatively high in the early stages of the disease. If one starts the treatment of breast cancer of 1-2 stages, 80% of patients live for five years or more. With stage 3, this figure is 40%; in stage 4, the five-year survival rate is only a few percent. Much also depends on the patient’s age, concomitant diseases, and the degree of aggressiveness of cancer.
References
Gentilini, O., Patridge, A. H., & Pagani, O. (Eds.). (2020). Breast cancer in young women. Springer Nature.
Molehin, D., Filleur, S., & Prutt, K. (2021). Regulation of aromatase expression: Potential therapeutic insight into breast cancer treatment. Molecular and Cellular Endocrinology, 531(111321). Web.
Parker, C. C. (2018). Management of breast cancer. (Vol. 98). Elsevier Health Sciences.
Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O. P., & Leonardi, M. C. (Eds.). (2017). Breast Cancer: Innovations in Research and Management. Springer.