Breast cancer

Breast cancer

Breast

Definition

  • Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma.

Epidemiology and burden of Breast Cancer

  • The developed countries with a small proportion of the world population account for almost 50% of breast cancers diagnosed worldwide. (Lancet Oncol. 2001;2:533)
  • Breast canceris the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012. This represents about 12% of all new cancer cases and 25% of all cancers in women. (http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics)
  • Incidence rates vary greatly worldwide from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe. In most of the developing regions the incidence rates are below 40 per 100,000 (GLOBOCAN 2008). (http://www.who.int/cancer/detection/breastcancer/en/index1.html)
  • Over 100,000 new breast cancer patients are estimated to be diagnosed annually in India. (World J Surg. 2007;31:1031–40)
  • Breast cancer is the most common cancer in women in India and accounts for 27% of all cancers in women. (http://cancerindia.org.in/cp/index.php/know-about-cancer/statistics#breast-cancer)
  • In India, for every 2 women newly diagnosed with breast cancer, one lady is dying of it. In China, for every 4 women newly diagnosed with breast cancer, one lady is dying of it and in the US, for every 5 or 6 women newly diagnosed with breast cancer, one lady is dying of it. (http://www.breastcancerindia.net/statistics/stat_global.html)

Treatment for Breast Cancer

  • Fulvestrantmonotherapy is associated with similar efficacy, but reduced arthralgia compared with other endocrine therapy (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0061727/)
  • In a meta-analysis, a significant improvement with capecitabine-based chemotherapy was found compared with capecitabine-free chemotherapy in ORR (relative risk [RR] 1.14, 95% confidence interval [CI] 1.03 to 1.26, P = 0.013) and PFS (hazard ratio [HR] 0.77, 95% CI 0.69 to 0.87, P < 0.0001). Overall survival favored capecitabine-based chemotherapy, but this was not significant. (Oncotarget. 2015 Nov 17;6(36):39365-72)
  • Meta-analysis showed that T-DM1 (trastuzumab emtansine) as well as pertuzumab in combination with trastuzumab and docetaxel is efficacious with fewer side effects as compared with other regimens LC (lapatinib), HC (trastuzumab), PEC (pertuzumab), LHC (lapatinib and trastuzumab), and PEHC (pertuzumab and trastuzumab), especially for advanced HER2+ breast cancer. (PLoS One. 2015 May 20;10(5):e0127404)
  • One study has shown that letrozole plus everolimus is the most effective treatment for postmenopausal, hormone receptor-positive breast cancer in the neoadjuvant setting. (Sci Rep.2016 May 13;6:25615)

Prevention of Breast Cancer

  • Aspirin use decreases the risk of breast cancer (RR, 0.90; 95% CI, 0.85-0.95). (Cancer Epidemiol Biomarkers Prev.2015 Nov;24(11):1645-55)
  • Higher dietary intake ratio of n-3/n-6 PUFAs has a significantly lower risk of BC among study populations (pooled RR = 0.90; 95% CI: 0.82, 0.99). (BMC Cancer.2014 Feb 18;14:105)
  • Patients with high vitamin D level are approximately half the risk of death rate from breast cancer as those in the lowest. (Anticancer Res.2014 Mar;34(3):1163-6)
  • Risk of developing breast cancer is lower in people taking high level of dietary fiber intake compared to taking lowest fiber [0.89 (95% CI: 0.83, 0.96)]. (Am J Clin Nutr.2011 Sep;94(3):900-5)
  • Studies have suggested that in Asian countries, soy isoflavones consumption is inversely associated with the risk of breast cancer among both pre and postmenopausal women (OR=0.63, 95% CI: 0.54-0.74 for premenopausal women; OR=0.63, 95% CI: 0.52-0.75 for postmenopausal women). (AIP Conf. Proc. 1739, 020075 (2016)

Risk factors for Breast Cancer

  • Stronger risk ratio has been determined in women with BMI <25 kg/m(2) [0.72 (0.65-0.81)], premenopausal women [0.77 (0.72-0.84)], and estrogen and progesterone receptor-negative breast cancer [0.80 (0.73-0.87)]. (Breast Cancer Res Treat.2013 Feb;137(3):869-82)
  • OGG1 polymorphisms are strongly associated with risk of breast cancer. Highest (~15 fold) increase in breast cancer risk was associated with g.9793680G>A (p < 0.009). Similarly ~14-fold increased risk was associated with Val159Gly (p < 0.01), ~17-fold with Gly221Arg (p < 0.005), and ~18-fold with Ser326Cys (p < 0.004). (Dis Markers.2015;2015:690878)
  • The risk of breast cancer in women with type 2 diabetes is 27% higher compared to healthy women. (British Journal of Cancer (2012) 107, 1608–1617)
  • The findings of a meta-analysis reveal that EBV infection might increase the risk of breast cancer (SOR
    = 3.84, 95% CI: 2.24-6.58). (Infect Agent Cancer. 2016; 11: 1)

Currently recommended Breast cancer treatment

  1. Hormone receptor-positive and HER2-positive disease (HR+/HER2+, Triple positive, Luminal B):
    • First line: Trastuzumab + Paclitaxel
    • Second line: Trastuzumab emtansine or Lapatinib
    • Third line: Eribulin
  2. Hormone receptor-positive and HER2-positive disease (HR+/HER2-, Luminal A):
    • First line: Single agent Docetaxel or Endocrine therapy (tamoxifen) or Chemotherapy (single docetaxel)
    • Second line: Single agent Vinorelbine or Capecitabine or Everolimus (only if discounted price) or Fulvestrant
    • Third line: Single agent Vinorelbine or Capecitabine (if not used as 2nd line) or Eribulin
  3. Hormone receptor-negative and HER2-positive disease (HR-/HER2+)
    • First line: Trastuzumab
    • Second line: Trastuzumab emtansine
    • Third line: Eribulin
  4. Hormone receptor-negative and HER2-negative disease (HR-/HER2-, Triple negative, Basal-like, 10-20% population):
    • First line: docetaxel or bevacizumab + capecitabine
    • Second line: Single agent Vinorelbine or Capecitabine
    • Third line: Single agent Capecitabine or Vinorelbine (if not used as 2nd line) or Eribulin

(Source: NICE, NCCN, ASCO)

Systematic reviews

  • The intrauterine environment contributes to the predisposition of women to breast cancer in adulthood..m0re
  • Family history and the risk of breast cancer: a systematic review and meta-analysis..more
  • MS is associated with a moderately increased risk of postmenopausal breast cancer (PBC)..more
  • Yoga can be recommended as an intervention to improve psychological health during breast cancer treatment..more
  • Factors affecting uptake and adherence to breast cancer chemoprevention..more

Treatment with Medicinal Herbs

  • Fenugreek (Trigonella foenum-graecum) – Dose 1 tbsp mashed seed/8 oz water, up to 3x/day as gargle; 1-6 g seed 3 x/day; 5-90 g seed/day; 0.25-0.5 cup seed; 6-12 g dry seed; 50 g powdered seed with 0.25 liter water
  • Fig (Ficus carica) – Dose – Food farmacy; 30 g fig syrup; steep 2 fruits in wine or booze overnight, then eat on an empty stomach for whooping cough; boil 3 sun-dried leaves for 15 minutes in 300 g water for diabetes 
  • Agrimony (Agrimonia eupatoria) – Dose 3 -6 g herb; 1 tsp herb/cup water; 1-3 ml extract (1:1 in 25% ethanol) 3x/day; 2-4 ml liquid herb extract; 1-4 ml tincture (1:5) in 45% alcohol 3x/day

Reference: Handbook of Medicinal Herbs (2006)

Herbals

Melatonin may suppress breast cancer tumor growth

Based on a theory that the sleep-deprived culture of modern society puts women at higher risk for breast cancer, researchers found melatonin may be a way to control the growth and proliferation of cancer cells. Melatonin decreased the number and size of cancer cells in lab experiments, suggesting deficiencies of the natural hormone contribute to the growth of breast cancer, according to a study published in the journal Genes and Cancer. The hormone melatonin is made by the brain at night and helps control the body’s sleep and wake cycles. And while sleep, or lack thereof, has been considered as playing a role in a range of diseases and adverse health conditions, few studies have confirmed this. More at: http://www.upi.com/

 

TR1 (1)Common virus’ link to breast cancer investigated

Epstein-Barr virus (EBV), a member of the herpes virus family, is easily transmitted through oral transfer of saliva and by genital secretions. An incredible 90 percent of all humans on earth are thought to be infected by EBV. Most sexually active adults will pick up the virus at some point in their lives, and about half of all 5-year-olds have evidence of previous infection. Over the years, EBV has also been associated with a number of specific cancer types such as African Burkitt lymphoma (a cancer of the lymphatics), Hodgkin’s disease (a blood cancer), nasopharyngeal carcinoma (a rare head and neck cancer), gastric adenocarcinoma (a type of stomach cancer), and leiomyosarcoma (a smooth muscle tumor). Along with the cancers named above, a number of studies have glimpsed a relationship between EBV and breast cancer. Studies carried out in India, North Africa, China, and southern Europe have all noted a relationship. An estimated 200,000 malignancies are caused by EBV annually. More at: http://www.medicalnewstoday.com/

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