Breast can­cer is the most fre­quent ma­lig­nant tu­mor among the pop­u­la­tion and the most com­mon in the fe­male pop­u­la­tion. Every year, more than 2.2 mil­lion new cas­es are di­ag­nosed, and at least 684 thou­sand pa­tients die from this cause around the world. In Trinidad and To­ba­go, breast can­cer is al­so the most com­mon in women: 574 new cas­es and 257 deaths, ac­cord­ing to Globo­can sta­tis­tics for 2020 – the most re­cent avail­able.

In com­mem­o­ra­tion of Breast Can­cer Aware­ness Month, Roche Phar­ma­ceu­ti­cals re­it­er­ates the im­por­tance of ear­ly de­tec­tion and di­ag­no­sis as the most im­por­tant tool to fight this dis­ease. The ear­li­er it is de­tect­ed, the greater the chances of sur­vival for the pa­tient.

"Pay­ing at­ten­tion to any al­ter­ation in the breasts is rec­om­mend­ed. This in­cludes ten­der­ness on pal­pa­tion, nip­ple dis­charge, changes in skin colour or tex­ture and/or lumpy mass­es, hard­en­ing or sag­ging of breasts, nip­ples and/or armpits. Breast self-ex­am­i­na­tion al­lows get­ting to know breasts and iden­ti­fy­ing any changes. How­ev­er, a mam­mo­gram is the di­ag­nos­tic method par ex­cel­lence and it must be per­formed an­nu­al­ly from the age of 45," ex­plained Dr Naresh Nan­dram, MD, Med­ical Ecosys­tem Part­ner for Roche Trinidad and To­ba­go.

In terms of risk fac­tors for breast can­cer, the main one is be­ing a woman; fol­lowed by age, fam­i­ly his­to­ry, hav­ing had breast can­cer, women who have not had chil­dren or those who have them from the age of 40, obe­si­ty, oral con­tra­cep­tives, en­vi­ron­men­tal pol­lu­tion, hor­mone re­place­ment ther­a­py, al­co­hol, among oth­ers.

What are the types of breast can­cer?

Breast can­cer is not a sin­gle dis­ease and know­ing the bi­o­log­i­cal and ge­net­ic as­pects of the can­cer cells that cause it (pro­teins or re­cep­tors) is im­por­tant in or­der to pro­vide the best treat­ment to each pa­tient and in­crease their life prog­no­sis.

Ac­cord­ing to Dr Nan­dram, breast can­cer is char­ac­terised by the un­con­trolled growth of ab­nor­mal cells in the milk-pro­duc­ing glands of the breast or in the ducts that car­ry milk to the nip­ples. "The type of breast can­cer will be de­fined by the pres­ence or ab­sence of three re­cep­tors found on the sur­face of cells: the es­tro­gen re­cep­tor (ER), the prog­es­terone re­cep­tor (PR) and the growth fac­tor re­cep­tor 2 (HER2)."

This dis­ease is clas­si­fied in­to three large groups or sub­types, as shown. Be­low, the de­tails:

Hor­mone re­cep­tor pos­i­tive: It ac­counts for 62% of breast can­cer cas­es. This ma­lig­nant tu­mor grows in re­sponse to oe­stro­gen and prog­es­terone hor­mones. Thus, their chances of re­spond­ing to treat­ments aimed at in­hibit­ing hor­mone growth ef­fects are good.

HER2-pos­i­tive: It is an ag­gres­sive type of can­cer which re­sponds to treat­ments specif­i­cal­ly tar­get­ing the pro­tein known as HER2. This type of can­cer oc­curs in 18% of cas­es.

Triple neg­a­tive: It is char­ac­terised by the pres­ence of can­cer cells that do not ex­press oe­stro­gen, prog­es­terone or HER2 re­cep­tors. It is an ag­gres­sive and dif­fi­cult to treat type of can­cer, as it gen­er­al­ly does not re­spond to stan­dard treat­ments. It ac­counts for about 20% of this dis­ease.

"Cur­rent­ly, treat­ments for this dis­ease are in­creas­ing­ly tar­get­ed and re­spond ac­cord­ing to the mol­e­c­u­lar in­for­ma­tion of the tu­mor. Thanks to these ad­vances, about 85% of women sur­vive the dis­ease five years af­ter be­ing di­ag­nosed", men­tioned Dr Nan­dram.

Ear­ly di­ag­no­sis is key

In Latin Amer­i­ca, be­tween 30% - 40% of breast can­cer cas­es are di­ag­nosed at an ad­vanced stage, com­pli­cat­ing health con­di­tions and life ex­pectan­cy.

Un­der­stand­ing the na­ture of the tu­mor al­lows for the de­sign­ing of a tar­get­ed and ef­fec­tive treat­ment plan.

As a re­sult of an ear­ly di­ag­no­sis cou­pled with Med­i­cine ad­vances, this dis­ease is no longer con­sid­ered as syn­ony­mous with death.

"It is es­sen­tial that the pop­u­la­tion knows the risk fac­tors and signs and when there is sus­pi­cion, vis­it their health­care provider to be screened and get a di­ag­no­sis as ear­ly as pos­si­ble. Un­for­tu­nate­ly, in the coun­try such ear­ly-stage di­ag­no­sis is one of the main chal­lenges in terms of breast can­cer. Thus, we must unite so that there is greater knowl­edge and aware­ness about the im­por­tance of a life-sav­ing, time­ly di­ag­no­sis,” con­clud­ed Dr Nan­dram.

Sources:

Ob­ser­va­to­rio Glob­al de Cáncer. https://gco.iarc.fr/to­day/home. Last en­try: Oc­to­ber 14, 2021.

Amer­i­can­Cancer­So­ci­ety. https://www.can­cer.org/es/can­cer/can­cer-de-seno.html. Last en­try: Oc­to­ber 14, 2021.

AR­TI­CLE SUB­MIT­TED BY ROCHE PHAR­MA­CEU­TI­CALS