Breast Cancer

Breast Cancer

Definition of breast cancer:
Cancer that forms in tissues of the breast. The most common type of breast cancer is ductal carcinoma, which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Another type of breast cancer is lobular carcinoma, which begins in the lobules (milk glands) of the breast. Invasive breast cancer is breast cancer that has spread from where it began in the breast ducts or lobules to surrounding normal tissue. Breast cancer occurs in both men and women, although male breast cancer is rare.

See also:
Questions to ask your Dr.
Steps to Recovery
Other Treatment Options
Treatment Side Effects
Life-saving Tests
Risk of Recurrence

General Information About Breast Cancer

Key Points

  • Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
  • A family history of breast cancer and other factors increase the risk of breast cancer.
  • Breast cancer is sometimes caused by inherited gene mutations (changes).
  • The use of certain medicines and other factors decrease the risk of breast cancer.
  • Signs of breast cancer include a lump or change in the breast.
  • Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
  • If cancer is found, tests are done to study the cancer cells.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

A family history of breast cancer and other factors increase the risk of breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.

Risk factors for breast cancer include the following:

  • A personal history of invasive breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS).
  • A personal history of benign (noncancer) breast disease.
  • A family history of breast cancer in a first-degree relative (mother, daughter, or sister).
  • Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
  • Breast tissue that is dense on a mammogram.
  • Exposure of breast tissue to estrogen made by the body. This may be caused by:
    • Menstruating at an early age.
    • Older age at first birth or never having given birth.
    • Starting menopause at a later age.
  • Taking hormones such as estrogen combined with progestin for symptoms of menopause.
  • Treatment with radiation therapy to the breast/chest.
  • Drinking alcohol.
  • Obesity.

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

NCI’s Breast Cancer Risk Assessment Tool uses a woman’s risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.

Breast cancer is sometimes caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Some mutated genes related to breast cancer are more common in certain ethnic groups.

Women who have certain gene mutations, such as a BRCA1 or BRCA2 mutation, have an increased risk of breast cancer. These women also have an increased risk of ovarian cancer, and may have an increased risk of other cancers. Men who have a mutated gene related to breast cancer also have an increased risk of breast cancer. For more information, see the PDQ summary on Male Breast Cancer Treatment.

There are tests that can detect (find) mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the PDQ summary on Genetics of Breast and Gynecologic Cancers for more information.

The use of certain medicines and other factors decrease the risk of breast cancer.

Anything that decreases your chance of getting a disease is called a protective factor.

Protective factors for breast cancer include the following:

  • Taking any of the following:
    • Estrogen-only hormone therapy after a hysterectomy.
    • Selective estrogen receptor modulators (SERMs).
    • Aromatase inhibitors.
  • Less exposure of breast tissue to estrogen made by the body. This can be a result of:
    • Early pregnancy.
    • Breastfeeding.
  • Getting enough exercise.
  • Having any of the following procedures:
    • Mastectomy to reduce the risk of cancer.
    • Oophorectomy to reduce the risk of cancer.
    • Ovarian ablation.

Signs of breast cancer include a lump or change in the breast.

These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

  • A lump or thickening in or near the breast or in the underarm area.
  • A change in the size or shape of the breast.
  • A dimple or puckering in the skin of the breast.
  • A nipple turned inward into the breast.
  • Fluid, other than breast milk, from the nipple, especially if it’s bloody.
  • Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin around the nipple).
  • Dimples in the breast that look like the skin of an orange, called peau d’orange.

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

Check with your doctor if you notice any changes in your breasts. The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
  • Mammogram: An x-ray of the breast.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of both breasts. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.

    There are four types of biopsy used to check for breast cancer:

    • Excisional biopsy : The removal of an entire lump of tissue.
    • Incisional biopsy : The removal of part of a lump or a sample of tissue.
    • Core biopsy : The removal of tissue using a wide needle.
    • Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid, using a thin needle.

If cancer is found, tests are done to study the cancer cells.

Decisions about the best treatment are based on the results of these tests. The tests give information about:

  • how quickly the cancer may grow.
  • how likely it is that the cancer will spread through the body.
  • how well certain treatments might work.
  • how likely the cancer is to recur (come back).

Tests include the following:

  • Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
  • Human epidermal growth factor type 2 receptor (HER2/neu) test : A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.
  • Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).

    There are many types of multigene tests. The following multigene tests have been studied in clinical trials:

    • Oncotype DX : This test helps predict whether stage I or stage II breast cancer that is estrogen receptor positive and node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
    • MammaPrint : This test helps predict whether stage I or stage II breast cancer that is node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.

Based on these tests, breast cancer is described as one of the following types:

  • Hormone receptor positive (estrogen and/or progesterone receptor positive) or hormone receptor negative (estrogen and/or progesterone receptor negative).
  • HER2/neu positive or HER2/neu negative.
  • Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative).

This information helps the doctor decide which treatments will work best for your cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
  • The type of breast cancer.
  • Estrogen receptor and progesterone receptor levels in the tumor tissue.
  • Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue.
  • Whether the tumor tissue is triple negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu).
  • How fast the tumor is growing.
  • How likely the tumor is to recur (come back).
  • A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
  • Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Breast Cancer

Key Points

  • After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The following stages are used for breast cancer:
    • Stage 0 (carcinoma in situ)
    • Stage I
    • Stage II
    • Stage IIIA
    • Stage IIIB
    • Stage IIIC
    • Stage IV
  • The treatment of breast cancer depends partly on the stage of the disease.

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose breast cancer are also used to stage the disease. (See the General Information section.)

The following tests and procedures also may be used in the staging process:

  • Sentinel lymph node biopsy : The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
  • Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

 

 

The following stages are used for breast cancer:

This section describes the stages of breast cancer. The breast cancer stage is based on the results of tests that are done on the tumor and lymph nodes removed during surgery and on other tests.

Stage 0 (carcinoma in situ)

There are 3 types of breast carcinoma in situ:

  • Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive.
  • Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer. Information about LCIS is not included in this summary.
  • Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

  • In stage IA, the tumor is 2 centimeters or smaller. Cancer has not spread outside the breast.
  • In stage IB, small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes and either:
    • no tumor is found in the breast; or
    • the tumor is 2 centimeters or smaller.

Stage II

Stage II is divided into stages IIA and IIB.

  • In stage IIA:
    • no tumor is found in the breast or the tumor is 2 centimeters or smaller. Cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or
    • the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes .


    In stage IIB, the tumor is:

    • larger than 2 centimeters but not larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or
    • larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or
    • larger than 5 centimeters. Cancer has not spread to the lymph nodes.

Stage IIIA

In stage IIIA:

  • no tumor is found in the breast or the tumor may be any size. Cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam); or
  • the tumor is larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or
  • the tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy).

Stage IIIB

In stage IIIB, the tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may have spread to:

  • up to 9 axillary lymph nodes; or
  • the lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

Stage IIIC

In stage IIIC, no tumor is found in the breast or the tumor may be any size. Cancer may have spread to the skin of the breast and caused swelling or an ulcer and/or has spread to the chest wall. Also, cancer has spread to:

  • 10 or more axillary lymph nodes; or
  • lymph nodes above or below the collarbone; or
  • axillary lymph nodes and lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

Stage IV
In stage IV, cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Inflammatory Breast Cancer

In inflammatory breast cancer, cancer has spread to the skin of the breast and the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the dimpled appearance called peau d’orange (like the skin of an orange). There may not be any lumps in the breast that can be felt. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.

Recurrent Breast Cancer

Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the skin of the breast, in the chest wall, or in nearby lymph nodes.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with breast cancer.
  • Five types of standard treatment are used:
    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Hormone therapy
    • Targeted therapy
  • Treatment for breast cancer may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with breast cancer.

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

Most patients with breast cancer have surgery to remove the cancer.

Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node where the cancer is likely to spread. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. After the sentinel lymph node biopsy, the surgeon removes the tumor using breast-conserving surgery or mastectomy. If cancer cells were not found in the sentinel lymph node, it may not be necessary to remove more lymph nodes. If cancer cells were found, more lymph nodes will be removed through a separate incision. This is called a lymph node dissection.

Types of surgery include the following:

  • Breast-conserving surgery is an operation to remove the cancer and some normal tissue around it, but not the breast itself. Part of the chest wall lining may also be removed if the cancer is near it. This type of surgery may also be called lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-sparing surgery.
  • Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed and checked for cancer. This may be done at the same time as the breast surgery or after. This is done through a separate incision.
  • Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.

Chemotherapy may be given before surgery to remove the tumor. When given before surgery, chemotherapy will shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment given before surgery is called preoperative therapy or neoadjuvant therapy.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, targeted therapy, or hormone therapy after surgery, to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called postoperative therapy or adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at some time after. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat breast cancer. Internal radiation therapy with strontium-89 (a radionuclide) is used to relieve bone pain caused by breast cancer that has spread to the bones. Strontium-89 is injected into a vein and travels to the surface of the bones. Radiation is released and kills cancer cells in the bones.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

The way the chemotherapy is given depends on the type and stage of the cancer being treated. Systemic chemotherapy is used in the treatment of breast cancer.

See Drugs Approved for Breast Cancer for more information.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

Hormone therapy with tamoxifen is often given to patients with early localized breast cancer that can be removed by surgery and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Hormone therapy with a luteinizing hormone-releasing hormone (LHRH) agonist is given to some premenopausal women who have just been diagnosed with hormone receptor positive breast cancer. LHRH agonists decrease the body’s estrogen and progesterone.

Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone receptor positive breast cancer. Aromatase inhibitors decrease the body’s estrogen by blocking an enzyme called aromatase from turning androgen into estrogen. Anastrozole, letrozole, and exemestane are types of aromatase inhibitors.

For the treatment of early localized breast cancer that can be removed by surgery, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 to 3 years of tamoxifen use. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.

In women with hormone receptor positive breast cancer, at least 5 years of adjuvant hormone therapy reduces the risk that the cancer will recur (come back).

Other types of hormone therapy include megestrol acetate or anti-estrogen therapy such as fulvestrant.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and PARP inhibitors are types of targeted therapies used in the treatment of breast cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.

Types of monoclonal antibody therapy include the following:

  • Trastuzumab is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which sends growth signals to breast cancer cells. It may be used with other therapies to treat HER2 positive breast cancer.
  • Pertuzumab is a monoclonal antibody that may be combined with trastuzumab and chemotherapy to treat breast cancer. It may be used to treat certain patients with HER2 positive breast cancer that has metastasized (spread to other parts of the body). It may also be used as neoadjuvant therapy in certain patients with early stage HER2 positive breast cancer.
  • Ado-trastuzumab emtansine is a monoclonal antibody linked to an anticancer drug. This is called an antibody-drug conjugate. It is used to treat HER2 positive breast cancer that has spread to other parts of the body or recurred (come back).

Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy. Tyrosine kinase inhibitors include the following:

  • Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used with other drugs to treat patients with HER2 positive breast cancer that has progressed after treatment with trastuzumab.
  • Neratinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with early stage HER2 positive breast cancer after treatment with trastuzumab.

Cyclin-dependent kinase inhibitors are targeted therapy drugs that block proteins called cyclin-dependent kinases, which cause the growth of cancer cells. Cyclin-dependent kinase inhibitors include the following:

  • Palbociclib is a cyclin-dependent kinase inhibitor used with the drug letrozole to treat breast cancer that is estrogen receptor positive and HER2 negative and has spread to other parts of the body. It is used in postmenopausal women whose cancer has not been treated with hormone therapy. Palbociclib may also be used with fulvestrant in women whose disease has gotten worse after treatment with hormone therapy.
  • Ribociclib is a cyclin-dependent kinase inhibitor used with letrozole to treat breast cancer that is hormone receptor positive and HER2 negative and has come back or spread to other parts of the body. It is used in postmenopausal women whose cancer has not been treated with hormone therapy.
  • Abemaciclib is a cyclin-dependent kinase inhibitor used to treat hormone receptor positive and HER2 negative breast cancer that is advanced or has spread to other parts of the body. It may be used alone or with other drugs to treat breast cancer that has gotten worse after other treatment.

Mammalian target of rapamycin (mTOR) inhibitors block a protein called mTOR, which may keep cancer cells from growing and prevent the growth of new blood vessels that tumors need to grow. mTOR inhibitors include the following:

  • Everolimus is an mTOR inhibitor used in postmenopausal women with advanced hormone receptor positive breast cancer that is also HER2 negative and has not gotten better with other treatment.

PARP inhibitors are a type of targeted therapy that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied for the treatment of patients with triple negative breast cancer or tumors with BRCA1 or BRCA2 mutations.

Treatment for breast cancer may cause side effects.

Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.

Late effects of radiation therapy are not common, but may include:

  • Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
  • Arm lymphedema, especially when radiation therapy is given after lymph node dissection.
  • In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.

Late effects of chemotherapy depend on the drugs used, but may include:

  • Heart failure.
  • Blood clots.
  • Premature menopause.
  • Second cancer, such as leukemia.

Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:

  • Heart problems such as heart failure.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Early, Localized, or Operable Breast Cancer

Treatment of early, localized, or operable breast cancer may include the following:

Surgery

  • Breast-conserving surgery and sentinel lymph node biopsy. If cancer is found in the lymph nodes, a lymph node dissection may be done.
  • Modified radical mastectomy. Breast reconstruction surgery may also be done.

Postoperative radiation therapy

For women who had breast-conserving surgery, radiation therapy is given to the whole breast to lessen the chance the cancer will come back. Radiation therapy may also be given to lymph nodes in the area.

For women who had a modified radical mastectomy, radiation therapy may be given to lessen the chance the cancer will come back if any of the following are true:

  • Cancer was found in 4 or more lymph nodes.
  • Cancer had spread to tissue around the lymph nodes.
  • The tumor was large.
  • There is tumor close to or remaining in the tissue near the edges of where the tumor was removed.

Postoperative systemic therapy

Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to lessen the chance the cancer will come back after surgery to remove the tumor.

Postoperative systemic therapy is given depending on whether:

  • The tumor is hormone receptor negative or positive.
  • The tumor is HER2/neu negative or positive.
  • The tumor is hormone receptor negative and HER2/neu negative (triple negative).
  • The size of the tumor.

In premenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include:

  • Tamoxifen therapy with or without chemotherapy.
  • Tamoxifen therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.
  • Aromatase inhibitor therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.

In postmenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include:

  • Aromatase inhibitor therapy with or without chemotherapy.
  • Tamoxifen followed by aromatase inhibitor therapy, with or without chemotherapy.

In women with hormone receptor negative tumors, no more treatment may be needed or postoperative therapy may include:

  • Chemotherapy.

In women with HER2/neu negative tumors, postoperative therapy may include:

  • Chemotherapy.

In women with small, HER2/neu positive tumors, and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes, or the tumor is large, postoperative therapy may include:

  • Chemotherapy and targeted therapy (trastuzumab).
  • Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for tumors that are also hormone receptor positive.

In women with small, hormone receptor negative and HER2/neu negative tumors (triple negative) and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes or the tumor is large, postoperative therapy may include:

  • Chemotherapy.
  • Radiation therapy.
  • A clinical trial of a new chemotherapy regimen.
  • A clinical trial of PARP inhibitor therapy.

Preoperative systemic therapy

Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Preoperative systemic therapy is given to shrink the tumor before surgery.

In postmenopausal women with hormone receptor positive tumors, preoperative therapy may include:

  • Chemotherapy.
  • Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for women who cannot have chemotherapy.

In premenopausal women with hormone receptor positive tumors, preoperative therapy may include:

  • A clinical trial of hormone therapy, such as tamoxifen or aromatase inhibitor therapy.

In women with HER2/neu positive tumors, preoperative therapy may include:

  • Chemotherapy and targeted therapy (trastuzumab).
  • Targeted therapy (pertuzumab).

In women with HER2/neu negative tumors or triple negative tumors, preoperative therapy may include:

  • Chemotherapy.
  • A clinical trial of a new chemotherapy regimen.
  • A clinical trial of monoclonal antibody therapy.

Locally Advanced or Inflammatory Breast Cancer

Treatment of locally advanced or inflammatory breast cancer is a combination of therapies that may include the following:

  • Surgery (breast-conserving surgery or total mastectomy) with lymph node dissection.
  • Chemotherapy before and/or after surgery.
  • Radiation therapy after surgery.
  • Hormone therapy after surgery for tumors that are estrogen receptor positive or estrogen receptor unknown.
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Locoregional Recurrent Breast Cancer

Treatment of locoregional recurrent breast cancer (cancer that has come back after treatment in the breast, in the chest wall, or in nearby lymph nodes), may include the following:

  • Chemotherapy.
  • Hormone therapy for tumors that are hormone receptor positive.
  • Radiation therapy.
  • Surgery.
  • Targeted therapy (trastuzumab).
  • A clinical trial of a new treatment.

Metastatic Breast Cancer

Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include the following:

Hormone therapy

In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include:

  • Tamoxifen therapy.
  • Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) is also given.

In premenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive, treatment may include:

  • Tamoxifen, an LHRH agonist, or both.

In women whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include:

  • Aromatase inhibitor therapy.
  • Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant.

Targeted therapy

In women with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as:

  • Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors.
  • Antibody-drug conjugate therapy with ado-trastuzumab emtansine.
  • Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) which may be combined with hormone therapy.

In women with metastatic breast cancer that is HER2/neu positive, treatment may include:

  • Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib.

Chemotherapy

In women with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include:

  • Chemotherapy with one or more drugs.

Surgery

  • Total mastectomy for women with open or painful breast lesions. Radiation therapy may be given after surgery.
  • Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery.
  • Surgery to remove cancer that has spread to the lung.
  • Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery.
  • Surgery to remove fluid that has collected around the lungs or heart.

Radiation therapy

  • Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life.
  • Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body.

Other treatment options

Other treatment options for metastatic breast cancer include:

  • Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.)
  • A clinical trial of high-dose chemotherapy with stem cell transplant.
  • Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Treatment Options for Ductal Carcinoma In Situ (DCIS)

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of ductal carcinoma in situ may include the following:

  • Breast-conserving surgery and radiation therapy, with or without tamoxifen.
  • Total mastectomy with or without tamoxifen. Radiation therapy may also be given.

Updated: April 12, 2018

Source: National Cancer Institute


Other treatments

Sulphoraphane
Shown to target breast cancer stem cells according to this study
Food sources: Cruciferous vegetables eg broccoli, Sprouts, cabbages, cauliflower

Blueberries
Blueberries suppress the generation of breast cancer stem cells according to this study.

Vitamin C and Doxycycline
This study found that antibiotics, such as Doxycycline, could eradicate Cancer Stem Cells in multiple cancer types. These include: DCIS, breast (ER(+) and ER(-)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma. Doxycycline was also effective in halting the propagation of primary cultures of CSCs from breast cancer patients, with advanced metastatic disease. The study authors propose the combined use of Doxycycline and Vitamin C as a new strategy for eradicating CSCs.


Falcarinol and falcarindiol
Polyacetylenes derived from carrot and parsley

The authors of this study say the anticancer function of falcarindiol was further demonstrated with breast cancer cells in which falcarindiol contributed to autophagy-dependent tumor cell death.

This study says falcarindiol inhibits development of breast and other cancers.

CAPE (antioxidant extracted from honeybee hive propolis)
The authors of this study showed that CAPE inhibits the growth of breast cancer stem cells and potentially makes them more susceptible to chemotherapeutic agents when used in combination.

The authors of this study say their results strongly suggest that CAPE could be a powerful inhibitor of cancer stem cell growth and functions that are responsible for CSC-mediated recurrence of breast cancer and increased patient mortality.

Antihistamines drugs used to treat allergies.
This study investigated the effects of six antihistamines on breast cancer-specific and overall mortality in a nation-wide study of all 61,627 Swedish women with newly diagnosed breast cancer between 2005 and 2013. 14,711 women used at least one of the antihistamines. The effects of antihistamine use at or following diagnosis, as well as the use among different subgroups of patients with regard to age, stage and estrogen receptor status, were analyzed. The study authors found a consistently beneficial effect of desloratadine and loratadine (2 antihistamines) use on breast cancer surviva, regardless of age, stage and estrogen receptor status, and a consistently negative effect on breast cancer survival of clemastine (an antihistamine) use.

Exercise and improved survival

Consistent evidence from epidemiologic studies links physical activity after diagnosis with better breast cancer outcomes. For example, a large cohort study found that women who exercised moderately (the equivalent of walking 3 to 5 hours per week at an average pace) after a breast cancer diagnosis had approximately 40% to 50% lower risks of breast cancer recurrence, death from breast cancer, and death from any cause compared with more sedentary women. The potential physical activity benefit with regard to deathfrom breast cancer was most apparent in women with hormone receptor–positive tumors.
Another prospective cohort study found that women who had breast cancer and who engaged in recreational physical activity roughly equivalent to walking at an average pace of 2 to 2.9 mph for 1 hour per week had a 35% to 49% lower risk of death from breast cancer compared with women who engaged in less physical activity.
Source: National Cancer Institute

One prospective observational study of 933 women with local or regional breast cancer found that any moderate-intensity exercise after diagnosis, such as brisk walking, reduced mortality risk by 64% compared to inactive women. Exercise of the same intensity for 2.5 hr/wk—the level recommended for the general population by the U.S. Department of Health and Human Services—was associated with a mortality reduction of 67% compared to inactive women.

Generally, a decreased risk of 40% to 67% was observed across studies. A meta-analysis of six studies, covering 12,108 patients, found that post diagnosis exercise was associated with a 34% lower risk of breast cancer–related deaths, a 41% lower risk of all-cause mortality, and a 24% lower risk of breast cancer recurrence.
Source: The ASCO Post


Surgery in second half of menstrual cycle increases survival.

Research shows that women with breast cancer can sharply improve their chances of survival by timing surgery in the second half of their menstrual cycle. Survival

Women who have breast tumours removed during the first part of the cycle have a survival rate after 10 years of 45 per cent. The survival rate is 75 per cent for women who have the operation in the latter part of the month.


Diet and improved survival

Cruciferous Vegetables and Breast Cancer
Source: Vanderbilt-Ingram Cancer Center April 6, 2012 | Dagny Stuart

A study by Vanderbilt-Ingram Cancer Center and Shanghai Center for Disease Control and Prevention investigators reveals that breast cancer survivors who eat more cruciferous vegetables may have improved survival.sarah-nechuta

The study of women in China was presented by postdoctoral fellow Sarah Nechuta, Ph.D., MPH, at the American Association for Cancer Research Annual Meeting in Chicago.

Nechuta, Xiao Ou Shu, M.D., Ph.D., and colleagues investigated the role of cruciferous vegetables in breast cancer survival among women in the Shanghai Breast Cancer Survival Study, a prospective study of 4,886 Chinese breast cancer survivors who were diagnosed with stage 1 to stage 4 breast cancer from 2002 to 2006.

Shu, Ingram Professor of Cancer Research, is the principal investigator of the Shanghai Breast Cancer Survival Study.

After adjusting for demographics, clinical characteristics and lifestyle factors, the researchers found cruciferous vegetable intake during the first 36 months after breast cancer diagnosis was associated with a reduced risk for total mortality, breast cancer-specific mortality and disease recurrence.

Survival rates were influenced by vegetable consumption in a dose–response pattern. As women ate more of these vegetables, their risk of death or cancer recurrence decreased.

Nechuta noted that cruciferous vegetable consumption habits differ between China and the United States and suggested this fact be considered when generalizing these results to U.S. breast cancer survivors.

“Commonly consumed cruciferous vegetables in China include turnips, Chinese cabbage/bok choy and greens, while broccoli and Brussels sprouts are the more commonly consumed cruciferous vegetables in the United States and other Western countries,” she said. “The amount of intake among Chinese women is also much higher than that of U.S. women.”

Cruciferous vegetables contain phytochemicals known as isothiocyanates and indoles, which appear to have a protective effect against some types of cancer.xiao-ou-shu

Nechuta said the level of these bioactive compounds, proposed to play a role in the anticancer effects of cruciferous vegetables, depends on both the amount and type of cruciferous vegetables consumed.

She said there is a need for future studies that measure the bioactive compounds in these vegetables and the host factors that may influence the effects of these compounds to improve the understanding of the association between cruciferous vegetable consumption and breast cancer outcomes.

“Breast cancer survivors can follow the general nutritional guidelines of eating vegetables daily and may consider increasing intake of cruciferous vegetables, such as greens, cabbage, cauliflower and broccoli, as part of a healthy diet,” Nechuta said.


Antihistamines and improveded survival

This study concluded that women treated with antihistamines have a better overall and Breast Cancer specific survival compared with non users regardless of age, history of allergy, ER status and tumor stage. The results are strongest for Desloratadine use and use after Breast Cancer diagnosis.

Failure to provide Bisphosphonates putting breast cancer patients’ lives at risk

Source: CancerActive

Bisphosphonates can reduce the risk of metastases to the bones in cancer patients.

In fact, bisphosphonates reduce the risk of breast cancer moving to the bones by 28 per cent and prevent 18 per cent of women dying from the disease within a decade of diagnosis.

These were findings in two American studies covered here in Cancer Watch at CANCERactive almost two years ago, yet almost two thirds of breast cancer oncologists in the UK still do not suggest them to their patients, according to an independent charity report.

CANCERactive founder and former Oxford University Biochemist, Chris Woollams, said, “Actually, this is hardly rocket science. The research is very clear.

Breast cancer can progress to the bones, liver or to the other breast. Research is clear: Bisphosphonates strengthen and prevent bone attacks, vitamin K can strengthen the liver and CLA (Conjugated Linoleic Acid) can build up in the other breast and prevent occurrence there.

It’s high time oncologists got to grips with the emerging research. No wonder women are taking their health into their own hands.”

Other research has shown that vitamin K2 is highly preventative of cancer moving to the liver. Normally produced by the gut bacteria in healthy women, its production becomes severely restricted when women are taking gut-bacteria-damaging chemotherapy. (K2 should not be taken if women have blood or cardiovascular problems.)

Also American research has consistently shown the benefits of Conjugated Linoleic Acid in breast cancer tissue.

Vitamin D levels also predict survival times. Unfortunately, 80 per cent of women are low at the time of diagnosis, then levels are further depleted by chemotherapy. There’s good research on this too”, added Woollams who simply believes that people who develop cancer are just not doing the obvious things first. “It is desperately sad, that here is a charity saying two thirds of oncologists don´t know about two research studies on a drug. Well they also don´t know about equally interesting research on other compounds that can keep their patients alive longer.


Vitamin D
Sunlight spurs the body to make vitamin D.

Food sources: Very few foods in nature contain vitamin D.

The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks.


Osteoporosis drug could be used to treat aggressive form of breast cancer, researchers say

Date: May 4, 2018
Source: Science Daily / Rockefeller University Press

Summary:
Researchers have discovered that an enzyme called UGT8 drives the progression of basal-like breast cancer, an aggressive form of the disease that is largely untreatable. But the study reveals that the widely used osteoporosis drug zoledronic acid inhibits UGT8 and prevents the spread of basal-like breast cancer in mice, suggesting that this drug could also be used to treat the disease in humans.


Other tips

This study found that Carotenoids and Selenium can prevent breast cancer returning.

This study demonstrated that Docosahexaenoic acid (DHA) oil inhibited the growth and induced the death of Breast Cancer cells.
DHA  is an omega-3 fatty acid found in cold-water oily fish and in seaweed. DHA is also widely available in supplement form.

Red grape polyphenols (resveratrol, quercitin, catechin) inhibit the progression of breast cancer, according to this study.

This study says eating blueberries can inhibit breast cancer tumor growth.


Overdiagnosis.

Definition of Overdiagnosis (National Cancer Institute)
Finding cases of cancer with a screening test (such as a mammogram or PSA test) that will never cause any symptoms. These cancers may just stop growing or go away on their own. Some of the harms caused by overdiagnosis are anxiety and having treatments that are not needed.

Some cancers that are diagnosed early do not develop symptoms requiring treatment, while others grow so slowly that the patient outlives the cancer and dies of other causes. Many of these are treated unnecessarily, leading to:

  • Unnecessary tests and treatment
  • Exposure to dangerous side-effects
  • Radiation-induced cancers
  • Mental and physical pain
  • Infertility
  • Inflated survival rates

The authors of this study which looked at cancer overdiagnosis stated:
We estimate the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers

This Article, published in 2012 in the New England Journal of Medicine, found: 31% of all breast cancers are over-diagnosed.

This 2016 review concluded:
· At least 20% of Breast Cancer patients, if left untreated would be alive after 5 years
· limited evidence suggests that around 10% of screen detected Breast Cancers may regress.

Breast Cancer Mammography Screening

BreastCheck is an Irish Government-funded programme that provides free mammograms to eligible women every two years.

According to the BreastCheck website:

BreastCheck is being extended and by the end of 2021, all eligible women aged 50 to 69 will be invited for routine screening. This will be done on a phased basis and will be achieved by inviting women who were aged between 50 and 66, on the 1st January 2018, for mammograms until they reach the age of 69.

The aim of BreastCheck is to reduce deaths from breast cancer by finding and treating the disease at an early stage.

Women should be aware, however, that substantial research indicates that regular mammograms may do more harm than good.

A study published in 2017 in the New England Journal of Medicine involving thousands of breast cancer cases, concluded that a significant proportion of tumors detected through mammography are not small because they are found early. Instead, the tumors are small because they are biologically prone to slow growth.

Mammograms can result in over diagnosis and unnecessary treatment according to this study. Mammograms can also be very painful according to this study involving 50-year-old Finnish women attending their first breast cancer screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely).

In this study 89,835 women, aged 40-59, were randomly assigned to mammography (five annual mammography screens) or control (no mammography). Conclusion: Annual mammography in women aged 40-59 does not reduce mortality from breast cancer…

This study conclused:
Screening with both MRI and mammography might rule out cancerous lesions better than mammography alone in women who are known or likely to have an inherited predisposition to breast cancer.

In an interview with National Public Radio, Donald Lannin, a professor of surgery at the Yale School of Medicine, who led the study, said “It takes 15 or 20 years for [these small tumors] to cause any problems. And you can kind of imagine that a lot of patients will die of something else over that 15 or 20 years.

That means a significant proportion of women who get screened for breast cancer with a mammogram go through biopsies, surgery, chemotherapy, radiation — and experience a lot of stress — for tumors that may never pose a health threat.

In the same interview, H. Gilbert Welch, a professor of medicine, community and family medicine at Dartmouth College, who was not involved in the study, said “It appears that screening disproportionately finds good cancers — cancers that may be better off not found,”.

“I think that we all need to realize that we’ve probably oversold the idea that looking for cancer early is the best way to avoid it,” Welch says. “Mammography’s a really close call. It’s a choice. We’ve exaggerated its benefit and we’ve sort of understated its harms.”

2018 update

The National Cancer Institute’s Breast Cancer Screening (PDQ®)–Health Professional Version (updated June 1, 2018) includes the following :

Theoretically, in a given population, the detection of more breast cancers at an early stage would result in a subsequent reduction in the incidence of advanced-stage cancers. This has not occurred in any of the populations studied to date. Thus, the detection of more early stage cancers likely represents overdiagnosis. A population-based study in the Netherlands showed that about one-half of all screen-detected breast cancers, including DCIS, would represent overdiagnosis and is consistent with other studies, which showed substantial rates of overdiagnosis associated with screening.


Swiss Medical Board call for end to Mammography Screening

In 2013, the Swiss Medical Board recommended that Mammography Screening be abolished in Switzerland ( The New England Journal of Medicine ) because of the emerging evidence that the harms of mammography outweigh the benefits.

Furthermore, a Cochrane review of 10 trials involving more than 600,000 women showed no evidence that mammography screening reduced overall mortality (deaths).


This is an eye-opening documentary.

Get the full documentary at thepromisefilm.net


No Mortality Benefit of Breast Cancer Mammography Screening in 25-Year Follow-up of Canadian National Breast Screening Study

By Matthew Stenger
Source: The ASCO Post

Mammography Screening Reconsidered
Anthony B. Miller, MD

dr-miller

As reported in BMJ by Anthony B. Miller, MD, Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, and colleagues, the 25-year follow-up of the Canadian National Breast Screening Study has shown no mortality benefit of annual mammography screening for breast cancer compared with physical examination or usual care. Mammography screening was associated with substantial overdiagnosis.

breast cancer

Overdiagnosis

By the end of the 5-year screening period, there were 142 excess cases of breast cancer in the mammography group (666 vs 524). At 15 years after enrollment, the excess number of cancers in the mammography group became constant at 106 cancers. The excess number represents 22% (106/484) of all screen-detected cancers. Thus, there was one case of overdiagnosis of breast cancer for every 424 women screened by mammography during the trial.

The investigators concluded, “[O]ur data show that annual mammography does not result in a reduction in breast cancer specific mortality for women aged 40 to 59 beyond that of physical examination alone or usual care in the community. The data suggest that the value of mammography screening should be reassessed.”
Continue reading at The ASCO Post

In conclusion, here is a 2017 News Release issued by Nordic CochraneCenter

New study finds breast cancer screening leads to substantial overdiagnosis

Women have been told for decades that they need to attend their routine breast screening appointments to detect early signs of breast cancer. However, a new major study, conducted by researchers at the Nordic Cochrane Centre in collaboration with researchers from Norway, looked into the effects of breast cancer screening programmes and have found a high risk of overdiagnosis and raise doubt about their benefits.

Risk of overdiagnosis outweighs the advantages of breast screening programmes

The cohort study, which was recently published in Annals of Internal Medicine, supports previous findings from the Cochrane review: Screening for breast cancer with mammography on the high risk of overtreating women and the doubts raised about the benefit of the intervention.

In an attempt to diagnose breast cancer early, a mammography screening very often detects small tumours that might not necessarily become malignant. In other words, the tumour would more than likely not be a life-threatening illness or health problem for the woman being treated. A breast cancer diagnosis is a life-changing event with profound implications for the psychological well-being and quality of life for women diagnosed and their families. They are subjected to invasive surgery, radiotherapy and sometimes chemotherapy, all of which are known to have serious, sometimes lethal, harms. The study also found that screening did not reduce the number of late stage tumours (those bigger than 2 cm), which means that breast screening is unlikely to reduce breast cancer mortality or lead to less invasive treatment.

Karsten Juhl Jørgensen, the lead author of the study explains, “In Denmark, we have the conditions to carry out a unique study as the screening programme was rolled out across the country in different regions at different times. We, therefore, had a control group of women of the same age during the same time period where the screening programme existed. This group of women were not screened over a 17-year period, making it possible for us not to have to speculate over what would have happened in the absence of screening”.

Additionally, breast screening leads to a 25 % to 50 % risk of being recalled due to a false positive test result if women attend a screening for the often recommended 20-year period. A false positive recall often means more mammograms and often biopsies. The time until a breast cancer diagnosis is excluded can be very stressful, and can have negative implications for many women’s quality of life even well beyond this period.

In his editorial on the study, Chief Medical Officer for the American Cancer Society, Dr. Otis Brawley recognises the need for accepting the limitations of mammography screening, “Acknowledging the existence of breast cancer overdiagnosis challenges the value of screening: it means that the benefits of breast screening have been overstated, and that some women who have been “cured” were harmed because they received unnecessary treatment”.

The main findings from the study are that:

  • Screening did not reduce the number of late stage tumours (those bigger than 2 cm), which means that breast screening is unlikely to reduce breast cancer mortality or lead to less invasive treatment
  • 1 in 3 breast cancers detected in women offered screening are likely overdiagnosed

Should mammography screening be stopped?

Independent expert groups in Switzerland and France have recommended that breast screening be stopped or reduced substantially. Elsewhere, guidelines are already changing as well, i.e. the American Cancer Society now recommend less frequent screening of a narrower age group than just two years ago. Our study supports this development.

The full report is titled: “Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis.” The authors are K.J. Jørgensen, P.C. Gøtzsche, M. Kalager, and P. Zahl. 

For more information on breast cancer screening and the implication of the findings, please read the Cochrane Review on mammography screening or mammography screening information leaflet. 

Karsten Juhl Jørgensen, the lead author of the study, can be contacted via email: kj@cochrane.dk.


Should you undergo regular breast screening using mammography?
That’s your call. The above information is for educational purposes only.

If you notice any symptoms or changes in your breasts, you should consult your GP without delay.


Chemo and Early Breast Cancer
TAILORx trial finds most women with early breast cancer do not benefit from chemotherapy

June 3, 2018
Source: National Cancer Institute

New findings from the groundbreaking Trial Assigning Individualized Options for Treatment (Rx), or TAILORx trial, show no benefit from chemotherapy for 70 percent of women with the most common type of breast cancer. The study found that for women with hormone receptor (HR)positive, HER2-negative, axillary lymph node­–negative breast cancer, treatment with chemotherapy and hormone therapy after surgery is not more beneficial than treatment with hormone therapy alone. The new data, released at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago, will help inform treatment decisions for many women with early-stage breast cancer.

The trial was supported by the National Cancer Institute (NCI), part of the National Institutes of Health, and designed and led by the ECOG-ACRIN Cancer Research Group. Findings from the study will be published in The New England Journal of Medicine.

“The new results from TAILORx give clinicians high-quality data to inform personalized treatment recommendations for women,” said lead author Joseph A. Sparano, M.D., associate director for clinical research at the Albert Einstein Cancer Center and Montefiore Health System in New York City and vice chair of the ECOG-ACRIN Cancer Research Group. “These data confirm that using a 21-gene expression test to assess the risk of cancer recurrence can spare women unnecessary treatment if the test indicates that chemotherapy is not likely to provide benefit.”

TAILORx, a phase 3 clinical trial, opened in 2006 and was designed to provide an evidence-based answer to the question of whether hormone therapy alone is not inferior to hormone therapy plus chemotherapy. The trial used a molecular test (Oncotype DX Breast Recurrence Score) that assesses the expression of 21 genes associated with breast cancer recurrence to assign women with early-stage, HR-positive, HER2-negative, axillary lymph node­–negative breast cancer to the most appropriate and effective post-operative treatment. The trial enrolled 10,273 women with this type of breast cancer at 1,182 sites in the United States, Australia, Canada, Ireland, New Zealand, and Peru.

When patients enrolled in the trial, their tumors were analyzed using the 21-gene expression test and assigned a risk score (on a scale of 0­–100) for cancer recurrence. Based on evidence from earlier trials, women in the trial who had a score in the low-risk range (0­–10) received hormone therapy only, and those who had a score in the high-risk range (26 and above) were treated with hormone therapy and chemotherapy.

Women in the trial who had a score in the intermediate range (11­–25) were randomly assigned to receive hormone therapy alone or hormone therapy with adjuvant chemotherapy. The goal was to assess whether women who received hormone therapy alone had outcomes that were as good as those among women who received chemotherapy in addition to hormone therapy.

“Until now, we’ve been able to recommend treatment for women with these cancers at high and low risk of recurrence, but women at intermediate risk have been uncertain about the appropriate strategy to take,” said Jeffrey Abrams, M.D., associate director of NCI’s Cancer Therapy Evaluation Program. “These findings, showing no benefit from receiving chemotherapy plus hormone therapy for most patients in this intermediate-risk group, will go a long way to support oncologists and patients in decisions about the best course of treatment.”

The researchers found that the primary endpoint of the trial, invasive disease-free survival—the proportion of women who had not died or developed a recurrence or a second primary cancer—was very similar in both groups. Five years after treatment, the rate of invasive disease-free survival was 92.8 percent for those who had hormone therapy alone and 93.1 percent for those who also had chemotherapy. At nine years, the rate was 83.3 percent for those with hormone therapy alone and 84.3 percent for the group that had both therapies. None of these differences were considered statistically significant.

The rates of overall survival were also very similar in the two groups. At five years, the overall survival rate was 98.0 percent for those who received hormone therapy alone and 98.1 percent for those who received both therapies, and at nine years the respective overall survival rates were 93.9 percent and 93.8 percent.

The researchers also found that women with a score of 0–10 had very low recurrence rates with hormone therapy alone at nine years (3 percent). This confirms similar findings from earlier studies. In addition, they found that women with a score of 26–100 had a distant recurrence rate of 13 percent despite receiving both chemotherapy and hormone therapy. This finding indicates the need to develop more effective therapies for women at high risk of recurrence.

According to the authors, the new findings suggest that chemotherapy may be avoided in about 70 percent of women with HR-positive, HER2-negative, node-negative breast cancer:

  • older than 50 and with a recurrence score of 11–25 (45 percent)
  • any age with a recurrence score of 0–10 (16 percent)
  • 50 years old or younger with a recurrence score of 11–15 (8 percent)

The findings suggest that chemotherapy may be considered for the remaining 30 percent of women with HR-positive, HER2-negative, node-negative breast cancer:

  • any age with a recurrence score of 26–100 (17 percent)
  • 50 years old or younger with a recurrence score of 16–25 (14 percent)

The new results demonstrate that chemotherapy is not beneficial for most women in the intermediate-risk group. This data adds to findings from a TAILORx analysis published in 2015 that provided prospective evidence that the gene expression test could identify women with a low risk of recurrence who could be spared chemotherapy.

There is one caveat to the new findings. When the researchers analyzed premenopausal women and those younger than 50 years old at the higher end of the intermediate-risk range (16–25) separately, the results showed there may be a small benefit from chemotherapy, and thus these women should consider chemotherapy with their doctor. However, it is unclear if this benefit is due to the effect of chemotherapy or to endocrine suppression caused by chemotherapy-induced menopause.

“Before TAILORx, there was uncertainty about the best treatment for women with a mid-range score of 11–25 on the Oncotype DX Breast Recurrence Score test. The trial was designed to address this question and provides a very definitive answer,” said Dr. Sparano. “Any woman with early-stage breast cancer age 75 or younger should have the 21-gene expression test and discuss the results with her doctor to guide her decision to the right therapy.”

TAILORx was one of the first large-scale trials to examine a methodology for personalizing cancer treatment. When the trial was activated, the best available genomic profiling data in women with early-stage breast cancer were retrospective.

The study was supported in part by the Breast Cancer Research Foundation, Komen Foundation, and the Breast Cancer Research Stamp. The stamp funding provided more than $5 million to the trial. Since 1998, when the charity stamp was authorized by Congress and first issued by the United States Postal Service, more than $86 million has been raised for breast cancer research. The net proceeds from sales of the stamp are transferred to NIH and the Medical Research Program of the Department of Defense to fund breast cancer research.

The genomic assay used in the trial was the Oncotype DX Breast Recurrence Score test from Genomic Health, Inc., Redwood City, California.

About the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN): ECOG-ACRIN is a membership-based scientific organization that designs and conducts cancer research involving adults who have or are at risk of developing cancer. Research personnel in nearly 1,200 member institutions are involved in Group science, which is organized into three programs: Cancer Control and Outcomes, Therapeutic Studies, and Biomarker Sciences. The Group’s primary funding is from the National Cancer Institute (NCI). Visit www.ecog-acrin.orgExit Disclaimer, follow on Twitter @eaonc, or call 215-789-3631.

About the National Cancer Institute (NCI): NCI leads the National Cancer Program and NIH’s efforts to dramatically reduce the prevalence of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI website at cancer.gov or call NCI’s Contact Center (formerly known as the Cancer Information Service) at 1-800-4-CANCER (1-800-422-6237).

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih.gov.


Biopsies

A Breast Cancer Surgeon Who Keeps Challenging the Status Quo

Source: The New York Times
SEPT. 28, 2015

Late one afternoon this summer, Dr. Laura J. Esserman, a breast cancer surgeon at the University of California, San Francisco, sat in a darkened room scrutinizing a breast M.R.I. With a clutch of other clinicians at her side, she quickly homed in on a spot smaller than a pencil eraser.

She heard the words “six-millimeter mass.” Her response was swift: dr-esserman

“No.”

Meaning no biopsy.

Most doctors, including the radiologist seated next to her, would have said yes. But Dr. Esserman, who has dedicated much of her professional life to trying to get the medical establishment to think differently about breast cancer, foresaw only unnecessary anxiety for the patient, who had had several biopsies in the past — all benign.

Dr. Esserman, 58, is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and overtreatment. Her philosophy is controversial, to say the least. For decades, the specter of women dying for lack of intervention has made aggressive treatment a given.

But last month, her approach was given a boost by a long-term study published in the journal JAMA Oncology. The analysis of 20 years of patient data made the case for a less aggressive approach to treating a condition known as ductal carcinoma in situ, or D.C.I.S., for which the current practice is nearly always surgery, and often radiation. The results suggest that the form of treatment may make no difference in outcomes.

Read the full story at The New York Times


Did you know? Chinese women rarely get Breast Cancer


Molecular Breast Imaging (MBI)

Molecular Breast Imaging: Potential New Tool for Detecting Cancers

Source: Oxford Journals

Mammography may be a “gold standard” for breast cancer screening, but for some women, its interpretation amounts to little more than a coin flip. In women with dense breasts, which contain more stromal and epithelial tissues than fat, interpretation of mammograms is difficult. Among these women, tumor detection rates with mammography barely exceed 60%. Both tumors and breast tissues appear white on a mammogram, but fat looks black. Clinicians can easily detect cancerous lesions against the darker fat backdrop, whereas dense tissues obscure tumors that could be life threatening.

Now researchers at the Mayo Clinic in Rochester, Minn., say that a different screening method— molecular breast imaging (MBI)— may offer a promising alternative for women with dense breasts, who make up much of the female population. Deborah Rhodes, M.D., an assistant professor at the Mayo Clinic, said roughly a quarter of all women older than 40 years have breast tissue that is more than 50% mammographically dense.

Compared with mammography, she said, MBI detected three times as many cancers among a population of 940 dense-breasted women who also had at least one additional breast cancer risk factor, such as a family history of the disease. These preliminary findings, announced in September at the American Society of Clinical Oncology’s 2008 Breast Cancer Symposium in Washington, D.C., came from an ongoing, comparative study of MBI and mammography that was launched at the Mayo Clinic in 2005. “We’re talking about a supplement to mammography that could be readily adopted by communities, instead of just major academic institutions,” said Rhodes, who is also the study’s principal investigator. “While [mammography is] terrific for some women, it doesn’t work well for others. For them, we need a better test, and that’s what MBI could provide.”
Read more at Oxford Journals


Note: Molecular breast imaging is a new technology, so it isn’t yet widely available.



Breast Imaging
New breast exam nearly quadruples detection of invasive breast cancers in women with dense breast tissue

Source:Science Daily
Date: January 23, 2015

Source: Mayo Clinic
Summary:
Molecular Breast Imaging (MBI) is a supplemental imaging technology designed to find tumors that would otherwise be obscured by surrounding dense breast tissue on a mammogram. The new breast imaging technique nearly quadruples detection rates of invasive breast cancers in women with dense breast tissue, according to the results of a major study.
Read more at Science Daily

Deborah Rhodes: A test that finds 3x more breast tumors, and why it’s not available to you.

Source: TED.com

Working with a team of physicists, Dr. Deborah Rhodes developed a new tool for tumor detection that’s 3 times as effective as traditional mammograms for women with dense breast tissue. The life-saving implications are stunning. So why haven’t we heard of it? Rhodes shares the story behind the tool’s creation, and the web of politics and economics that keep it from mainstream use.

See the video at TED.com


Digital Infrared Imaging (Thermography)

DII AS A RISK MARKER FOR BREAST CANCER
Source: breastthermography.com

Studies show that an abnormal infrared image is the single most important marker of high risk for developing breast cancer, 10 times more significant than a family history of the disease (5). Consequently, in patients with a persistent abnormal thermogram, the examination results become a marker of higher future cancer risk (4,5). Depending upon certain factors, re-examinations are performed at appropriate intervals to monitor the breasts. This gives a woman time to take a pro-active approach by working with her doctor to improve her breast health. By maintaining close monitoring of her breast health with infrared imaging, self breast exams, clinical examinations, mammography, and other tests, a woman has a much better chance of detecting cancer at its earliest stage and preventing invasive tumor growth.

Angiogenesis, or new blood vessel formation, is necessary to sustain the growth of a tumor. Digital Infrared Imaging may be the first signal that such a possibility is developing (3).

See full article at breastthermography.com

Where can I get this test?
This test is now available at numerous medical facilities including:

Ireland

Hollywood Health (Northern Ireland)

United States
Breast Thermography (list of testing centers country-wide)


Studies/Reviews
Molecular Breast Imaging: Advantages and Limitations of a Scintimammographic Technique in Patients with Small Breast Tumors


Breast Cancer – Risk of Recurrence?

The following tests can help your physician assess the likelihood of your cancer recurring later on.

Oncotype DX® Breast Cancer Assay

Test available from: Oncotypedx
The Oncotype DX® Breast Cancer Assay can help physicians and patients decide on the best course of treatment. For invasive breast cancer, the Oncotype DX Breast Cancer Assay predicts chemotherapy benefit and the likelihood of distant breast cancer recurrence. The Oncotype DX Breast Cancer Assay for DCIS patients predicts the risk of local recurrence. Even when traditional measures seem conclusive, Oncotype DX Recurrence Score can lead to a different approach.

The Oncotype DX® Breast Cancer Assays provide physicians and their patients with critical information needed to help guide treatment decision making in women with ductal carcinoma in situ (DCIS) or invasive carcinoma. The Oncotype DX® Breast Cancer Assay can predict the potential benefit of chemotherapy and likelihood of distant breast cancer recurrence in women with node negative or node positive, ER-positive, HER2-negative invasive breast cancer. The Oncotype DX® Breast Cancer Assay for DCIS patients quantifies the 10-year risk of local recurrence (DCIS or invasive carcinoma) in women with ductal carcinoma in situ treated by local excision, with or without tamoxifen. These assays are designed to support treatment planning and can lead to a more personalized treatment approach.

Mammostrat® Breast Cancer Assay?

Source: El Camino Genomic Medicine Institute
Test available from:

The Mammostrat® breast cancer recurrence assay is a test that predicts the chance someone with newly diagnosed, early stage breast cancer will develop it again in the future. This is called recurrence. Based on test results, patients are assigned a risk index that indicates whether they have a low, moderate, or high risk of breast cancer recurrence.

Patients assigned a low risk may choose hormone therapy (tamoxifen) alone and forego chemotherapy. Patients assigned a high risk may benefit from more aggressive treatment and choose to do chemotherapy alongside hormone therapy. Mammostrat can therefore help patients and their doctors determine whether chemotherapy treatment would be beneficial to them.

The assay looks at five proteins and determines their expression levels in the tumor. The expression levels of these five markers are thought to influence whether the tumor will metastasize, increasing the patient’s chance of recurrence. These levels are then translated into a risk index, given as a percent chance of recurrence over 10 years:

  • A low risk indicates a 7.6% chance of breast cancer recurrence over 10 years.
  • A moderate risk indicates a 16.3% chance of breast cancer recurrence.

A high risk indicates a 20.9% chance of breast cancer recurrence.

MammaPrint
Source: Mammaprint Test available from: Agendia.com (through your physician)

MammaPrint makes every treatment unique
You have just been diagnosed with breast cancer. But what is the next step? Unfortunately, half of all breast cancer patients receive chemotherapy unnecessarily. MammaPrint is unique. It is the only test which can indicate with precision which stage your tumour is at, so that you and your physician can decide on the most appropriate treatment for your condition.

What is MammaPrint?
Agendia’s MammaPrint is a test which determines how aggressive a breast cancer tumour is. The MammaPrint result will enable your physician to determine what would be the best kind of treatment for you following your operation.

How does MammaPrint work?
MammaPrint is carried out on tumour tissue that is fixated in formalin or fresh, which is put in an mRNA preservative immediately after the operation has taken place. This tumour tissue is sent off to Agendia’s clinical laboratory, where a histological staining test is done, to verify that the tissue indeed carries a tumour: the staining test checks whether the level of tumour cells is at least 30%

MammaPrint is a breast cancer test which is performed using microarray chip technology. This is a small solid surface which is split into thousands of tiny grids. Each grid contains DNA. In each grid the DNA has a different code, which corresponds with the code of precisely one gene. Only the RNA of this particular gene can attach itself to this particular grid. DNA microarrays enable you to study the activity of hundreds or even thousands of genes simultaneously.

MammaPrint measures the mRNA level of 1900 different genes, whereby the expression of 70 specific genes is measured six times, in order to examine them in greater detail. The result of a MammaPrint is very clear: there is either a low risk of metastasis (‘good prognosis’) or a high risk of metastasis (‘bad prognosis’).

Prosigna™
Source: http://www.nanostring.com
Test available from: http://www.nanostring.com (through your physician)

About the Prosigna™ Breast Cancer Prognostic Gene Signature Assay
Prosigna provides a risk category and numerical score for assessment of the risk of distant recurrence of disease at 10 years in postmenopausal women with node-negative (Stage I or II) or node-positive (Stage II), hormone receptor-positive (HR+) breast cancer.

Based on the PAM50 gene signature initially discovered by Charles Perou, Ph.D. and colleagues, the Prosigna Assay is an in vitro diagnostic tool that utilizes gene expression data weighted together with clinical variables to generate a risk category and numerical score, to assess a patient’s risk of distant recurrence. The Prosigna Assay measures gene expression levels of RNA extracted from formalin-fixed paraffin-embedded (FFPE) breast tumor tissue.

The Prosigna Assay requires minimal hands-on time and runs on NanoString’s proprietary nCounter Dx Analysis System, which offers a reproducible and cost-effective way to profile many genes simultaneously with high sensitivity and precision.

The Prosigna Assay will be available for diagnostic use when ordered by a physician in the U.S. The Prosigna Assay has been CE-marked and is available for use by healthcare professionals in the European Union and other countries that recognize the CE Mark and in which Prosigna is registered.




Note: Jane was given only months to live in 1993
Sadly, Jane passed away on 4th March 2016.


Lots more info at GreenMedInfo.com


See also

All Your Treatment Options

Tests you need to know about

Vital questions to ask your doctor / oncologist

Steps to Recovery

Sources for this article include:
National Cancer Institute
digitaljournals.org
GreenMedInfo.com
pubmed
xtorays.com
The ASCO Post
Oxford Journals
Science Daily
TED.com
breastthermography.com
The New York Times
Cyrcadia Health
Vanderbilt-Ingram Cancer Center
CancerActive
El Camino Genomic Medicine Institute
Mammaprint
nanostring.com

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