Introduction: Breast cancer is one of the most common types of cancer in women worldwide, and according to the World Health Organization (WHO), about half of all breast cancer cases occur in women who have no known risk factors other than being female and being over 40 years old. The cancer usually starts in the ductal cells or lobules of the breast and can spread to the lymph nodes or other organs, such as the lungs, liver, brain, or bones. Risk factors include older age, obesity, alcohol use, family history, radiation exposure, reproductive history (such as late age at first pregnancy), and tobacco use. Early detection and appropriate treatment can significantly increase survival rates, as small, unscathed tumors are highly curable. This article reviews aspects of breast cancer prevention, diagnosis, and treatment based on authoritative sources such as the WHO, Mayo Clinic, and the National Cancer Institute (NCI).
Methods: Prevention
Prevention of breast cancer focuses on reducing risk factors and increasing protective factors. Lifestyle changes play a key role:
Physical activity and weight control: Regular exercise reduces the risk of breast cancer, and maintaining a healthy weight is important, especially in postmenopausal women because obesity increases the risk.
Limit alcohol intake: The risk increases with increasing alcohol consumption, so it is recommended to limit its consumption.
Reproductive factors: Early pregnancy and breastfeeding can reduce the risk because they reduce the amount of time breast tissue is exposed to estrogen.
Medical interventions for high-risk individuals include:
Selective estrogen receptor modulators (SERMs): Drugs such as tamoxifen and raloxifene reduce the risk of estrogen receptor-positive breast cancer in high-risk women, but may cause side effects such as hot flashes, blood clots, and endometrial cancer.
Aromatase inhibitors: Drugs such as anastrozole, letrozole, and exemestane reduce the risk of recurrence and new cancers in women with a history of breast cancer or at high risk, but have side effects such as muscle pain and osteoporosis.
Prophylactic mastectomy: Removing one or both breasts in high-risk women (such as those who carry the BRCA1 or BRCA2 gene) significantly reduces risk and also reduces anxiety.
Ovariectomy: Surgical removal of the ovaries, radiation therapy, or estrogen-reducing drugs in high-risk premenopausal women reduces risk, but causes menopausal symptoms and long-term effects such as decreased bone density.
In addition, prehabilitation, which includes lifestyle interventions such as exercise, diet, nutritional supplements, and psychological support between diagnosis and treatment, can minimize the side effects of treatment.
Diagnosis
Early diagnosis is key to reducing mortality and includes two main components: early diagnosis and screening. Early symptoms include a breast lump, change in size or shape of the breast, dimpling of the skin, redness, nipple changes, or unusual discharge.
Physical exam: The doctor checks the breast, collarbone, and armpit for unusual changes, such as skin changes, nipple changes, or lumps.
Imaging: Mammography is an X-ray used to screen for abnormalities, and a diagnostic mammogram may be done for a more detailed examination. A breast ultrasound uses sound waves to determine whether a lump is solid or fluid-filled. A breast MRI uses magnetic fields and radio waves to provide detailed images and is often used with an injection of dye to improve visibility. Screening mammography is usually recommended for healthy women ages 50-69 to detect precancerous lesions.
Biopsy: A sample of tissue is removed for laboratory testing, guided by imaging such as X-rays or ultrasound, and a marker is placed in place for monitoring. Laboratory tests determine the type of cells, their growth rate, and the status of hormone receptors.Staging: From 0 to 4, using blood tests, bone scans, CT, MRI, and PET to assess the spread of the cancer.Most breast lumps are noncancerous, but small, non-spreading cancerous lumps are best treated.
Results: Treatment is determined by the type, stage, and spread of the cancer and is often a combination of surgery, radiation therapy, and medications. Early and complete treatment is more effective, and access to a multidisciplinary team (such as oncologists, radiologists, and dietitians) improves outcomes.
Surgery: Lumpectomy (removal of the cancer and surrounding tissue) to preserve the breast, often with radiation therapy, or mastectomy (removal of the entire breast) with skin or nipple-sparing options for better appearance. Sentinel node biopsy to check for spread to lymph nodes, preferably rather than complete removal of the axillary lymph nodes to reduce complications. Some high-risk women choose to have a preventive mastectomy of the healthy breast.
Radiation therapy: External beam radiation is often given after surgery to kill any remaining cells and reduce the risk of recurrence, with complications such as fatigue and skin irritation. In early stages, it can avoid a mastectomy and in advanced stages, it can reduce the risk of recurrence.
Chemotherapy: Strong drugs given before or after surgery to shrink the tumor or kill any remaining cells, often given intravenously, with side effects such as hair loss and nausea. Used for hormone receptor-negative cancers, especially triple-negative.
Hormone therapy: For hormone-sensitive cancers, blocking estrogen or progesterone with SERMs, aromatase inhibitors, or ovarian suppression, for 5-10 years, with reduced risk of recurrence and side effects such as hot flashes.
Targeted therapy: Attacks specific chemicals on cancer cells, such as HER2, with drugs such as trastuzumab, often combined with chemotherapy.
Immunotherapy: Helps the immune system kill cancer cells, an option for triple-negative cancer.
Palliative care: Supports quality of life and relieves symptoms, along with other treatments.
Conclusion: Breast cancer is manageable with effective prevention through lifestyle changes and medical interventions, early detection through screening, and combination therapies. Recent advances emphasize personalized treatments and multidisciplinary support to improve outcomes and reduce complications. Consultation with specialists is essential for individualized assessment.
Keywords: Breast cancer - Prevention - Early detection - Screening - Mammography - Biopsy - Treatment