Its incidence is in rise in the developing countries, may be due to the life style changes. Breast Cancer Ribbon Tattoos This cancer, the most accessible cancer; has generated much interest in the recent past in understanding its process of development, the genetics and developing more effective treatment modalities. The surgery has evolved from maximum dissection to minimal and more conservative approach. Newer chemotherapeutic drugs are coming up as well as more precision radiotherapy. Approach to breast cancer has become essentially multidisciplinary in the last decade or two. Here we will search literature to add more knowledge to our existing views on this cancer. The views expressed in it may not be conclusive, may be in a trial phase and does not anyway supersede the opinion of treating doctor of a patient.
Notch pathway in cell division and its inhibitors:The primitive cells during development of baby and also later in life are capable of differentiating to one or other cell types. This recruitment of daughter cells and their multiplication is largely controlled by what is called a Notch pathway. These primitive cells are called the stem cells; can form e.g. bone cell, muscle cell and heart cell etc. This notch pathway is also responsible for regulated tissue growth i.e. no excess or no less; through communication between the cells. It can be likened to cells having sensors on their outer membrane, represented by notch a protein. The communication may be something like this: one cell will say to its neighbor cell; "Hi, I am dividing to muscle cell; you need not go in that line", "Oh yeah, you carry on; I am going in the line of breast cells", would be the reply. Again to have controlled growth close contact between the cells is required. The Notch would be keeping close contact between cells, may be in a way something like this;"Hello my dear neighbor come closer and closer, do not go away."
Any derangement in this notch may give rise to uncontrolled growth of cells. In cancer, there are stem cells which divide continuously to give rise to a visible tumor. These stem cells are resistant to conventional chemotherapy and could be the cause of recurrence of cancer, at least in some 1% of breast cancers; which also makes a large number. So the Notch inhibitors can be instrumental in controlling some cases of breast cancer recurrence, when used in addition to chemotherapy. "The Notch pathway regulates self-renewal of stem cells and research indicates that it also regulates cancer stem cell self-renewal, the impact of using a Notch inhibitor was to sensitize a significant proportion of otherwise treatment-resistant cancer stem cells. This supports the notion that a select sub-population of cells in breast cancer is largely responsible for disease recurrence and cancer spread." I quote from a study's lead author, Jenny Chang, M.D., professor of medicine at Baylor College of Medicine. She and her team implanted mice with human breast cancer biopsy material that included breast cancer stem cells, and then gave them a Notch inhibitor (MRK-003) or a placebo. MRK-003 significantly reduced formation of clusters of tumor cells called mammospheres, when compared with placebo.
Role of spices like turmeric and piperine:As Reported by HealthDay News, 2009 December 11, breast stem cells appear to be sensitive to certain spices. When researchers at the University of Michigan Comprehensive Cancer Center applied curcumin and piperine to breast cancer cells, they noted that the number of stem cells (but not normal cells) decreased. Curcumin is a component of turmeric, and piperine is found in black pepper. Both of these dietary compounds have been studied previously for their effects against cancer, but this is the first study to evaluate their effects on stem cells.
Alcohol and cancer:Even a few glasses of wine or cocktails a week may increase the risk of recurrence for breast cancer survivors, researchers found. Women who averaged three to four or more drinks per week were 34% more likely to have a recurrence, than those who drank less than once a week; according to an observational study led by Marilyn L. Kwan, PhD, of Kaiser Permanente in Oakland, Calif. Likewise, breast cancer-specific mortality risk rose to 51% for the regular drinkers among breast cancer survivors; Kwan's group reported at the San Antonio Breast Cancer Symposium. After a breast cancer diagnosis, women who drink alcohol should consider cutting back, they recommended.
Amplification of fibroblast growth factor receptor-1 in breast cancer:Shiang CY, Qi Y, Wang B, Lazar V, Wang J, Fraser Symmans W, Hortobagyi GN, Andre F, Pusztai L., Department of Breast Medical Oncology, USA, studied that: fibroblast growth factor receptor-1 (FGFR-1) is amplified in 10% of human breast cancers. A FGFR-1 small molecule inhibitor may have direct anti-proliferative effects in addition to its' anti-angiogenic effects. According to Kristjansdottir K, Dizon D.Warren Alpert Medical School of Brown University, USA, a human epidermal growth factor (EGF) receptor (HER)-dimerization inhibitor that represent a novel class of agents, aimed at blocking HER2 from pairing with other receptors of the HER family, may play a role in the management of HER2-positive breast cancers. Trastuzumab is one of the drugs of this group.
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Effect of osteoporosis inhibitor drugs on breast cancer:Researchers from the University of Pittsburgh Cancer Institute, led by Brufsky, concluded that zoledronic acid, a bisphosphonate, is safe and effective for use by postmenopausal women with breast cancer; who are being treated with aromatase inhibitors. Bone mineral density increased 6.2 percent in women taking zoledronic acid, compared with 2.4 percent in the control group. Fractures were also reduced slightly in the treatment group. It may be effective in inhibiting spread of the disease to bone.
Vitamin D and cancer:Researchers say that vitamin D in high doses may have a beneficial effect in preventing breast cancer. High-dose vitamin D significantly reduced muscle and joint pain in breast cancer patients treated with the aromatase inhibitor like anastrozole. Weekly vitamin D supplementation led to significant improvement in pain and mobility after two months, said Antonella Rastelli, MD, of Washington University at the San Antonio Breast Cancer Symposium.
Breast cancer genetic evolution decoded:In the metastatic cancer, 32 protein-altering mutations were found that were not present in healthy tissue from the same woman, according to Samuel Aparicio, BM BCh, PhD, MRCPath, of the British Columbia Cancer Agency, and colleagues. Then, using the same approach, they looked back at cancer tissue taken from the same woman during treatment nine years earlier to see which variants were present then. Five variants, in the genes ABCB11, HAUS3, SLC24A4, SNX4, and PALB2 were common in the DNA of the primary tumor. They had previously been unknown to researchers. Another six in the genes KIF1C, USP28, MYH8, MORC1, KIAA1468, and RNASEH2A were found in between 1% and 13% of the primary tumor cells. There were 19 that were not detected and two were undetermined, the researchers said. This shows that genetic mutation takes place in the course of the disease.
Regular exercise reduces cancer risk:Regular moderate-to-vigorous exercise may reduce breast cancer risk for postmenopausal women, researchers found. Postmenopausal women who maintained more than seven hours per week of higher intensity activity over the 10-year period prior to entry into the study, were 16% less likely to develop breast cancer (RR 0.84, 95% CI 0.76 to 0.93), according to Tricia M. Peters, M.Phil, and colleagues of the National Cancer Institute. It may be that some cancer genes are switched off in exercising population. The same effect has also been seen in case of colon cancer, published in a recent article.
Ginseng appears to help breast cancer patients:The traditional Chinese herb ginseng may improve survival and enhance the quality of life of breast cancer patients, an observational study suggested. Compared with those who never used ginseng, breast cancer patients in China who took it regularly before their diagnosis had a disease specific mortality that was 30% lower, three to four years later; said Xiao-Ou Shu, M.D., Ph.D., and colleagues, of the Vanderbilt-Ingram Cancer Center, published online by the American Journal of Epidemiology.
Breast density and cancer risk:All post-menopausal women should be screened for breast cancer risk by assessing breast density combined with other risk factors, researchers say. They found that breast density was strongly associated with breast cancer. To reduce breast cancer risk overall, they advised, physicians should recommend exercise, weight reduction, a low-fat diet, and reduced alcohol intake. But they also noted that eating fruits and vegetables was not associated with a decreased risk. Still, the researchers concluded that breast density combined with other risk factors is a viable assessment of risk.
Breast feeding and cancer:Breast feeding can significantly reduce the risk of breast cancer, according to a study by Cancer Research UK. The increase in the disease in developed countries is due to women having fewer children and breast feeding for shorter periods of time, the study says.
Metformin under evaluation for cancer treatment:The glucose-lowering drug metformin, used as first line drug in obese type 2 diabetes is showing anticancer activity, reported by "The Lancet". There has been possible association between obesity and different cancers. It may be possible in future to know more about action of metformin. The data come from the studies being conducted in both the diabetes and oncology research communities, according to experts who spoke at the annual meeting of the European Association for the Study of Diabetes.
Soy safe for breast cancer survivors:Soy consumption appears to be safe, and potentially even protective, for women with breast cancer despite fears about estrogen-like effects, according to a population-based study by the researchers. Benefits of soy appeared to increase with intake up to 11 g of soy protein or 40 mgs. of soy isoflavone per day.
Lymphatic chemotherapy:Platinum based drugs used in chemotherapy have many side effects. Researchers have found out that lymphatic route of administration of these drugs may be less toxic than vascular route. When these and some other chemotherapeutic agents are administered subcutaneously gets better concentrated in the lymphatic tissue, which is the most common path of spread of cancerous cells to other organs from the primary.
hormone receptor status:The estrogen receptor(ER) status has much predictive value, and tissue expressing ER in patients of post menopausal status are more likely to be benefited from its inhibitor drugs like tamoxifen.
High precision Radiotherapy:Radiotherapy has become an integral part of multidisciplinary approach to breast cancer treatment. It has undergone tremendous modification to cause least possible damage to the surrounding tissue through delivery of high precision radiotherapy.
Surgery related changes:Surgery has changed from maximum tissue removal to minimal tissue removal and more conservative in approach i.e. from radical mastectomy to lumpectomy or quadrantectomy. Intra-operative frozen section biopsy to determine disease free margin in the tissue to be left with, has facilitated conservation of breast; so also, an intra-operative radiation detecting probe that detects radiation from the cancerous tissue, pre-injected with radio-active substances that accumulates specifically in the cancerous cells. Breast reconstruction has become very attractive option in the recent days adding confidence to the working cancer survivors.
Investigations:Fine needle aspiration cytology FNAC), ultrasound (USG), mammogram, magnetic resonance imaging (MRI), computerized tomography (CT) and positron emission tomography (PET) are some of the armors in the hands of health care personnel, to boost their ability for early diagnosis; and thereby providing effective treatment.
Carcinoma gene expression and prediction of breast cancer:Breast cancer (BRCA) suppressor gene is responsible for error free repair of Genetic material during cell division. Faulty BRCA may be responsible for breast cancer. According to estimates of lifetime risk, about 12.0 percent of women (120 out of 1,000) in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women (600 out of 1,000) who have inherited a harmful mutation in BRCA1 or BRCA2. In other words, a woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation. Breast cancer patients may additionally be tested for carcinoma antigen (CA-125).
We hope to conquer this cancer in the near future, probably more through a genetic manipulation and life style change.
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