Introduction
Cancer is a disease that begins with a mutation when a cell in the body (a somatic cell) begins to divide uncontrollably. Normal body cells work according to their internal clock with a working mechanism. This internal clock regulates at what point the cell divides, grows and matures, ages, or dies. In other words, they regulate all those natural processes which make up the cell life cycle – the cell cycle. In a cancer cell, this regulatory mechanism is damaged. In Europe, children and young people under the age of twenty rarely get cancer. Of all diseases, cancer accounts for only one percent of childhood and adolescence. In theory, any cell in the body can break down and become cancerous. This is why there are so many different forms of cancer in both adults and children.
Disease Process
Cancer begins when healthy breast cells change and begin to grow uncontrollably, forming a mass called a tumor. It can be cancerous or benign. A cancerous tumor is malignant, meaning it can sprout and spread to other parts of the body. A benign neoplasm grows but does not spread to other tissues. Breast cancer can sprout into other parts of the body. Also, malignant cells travel to other parts of the body through the blood and lymphatic vessels. This phenomenon is called metastasis. Cancer often spreads to nearby lymph nodes, but it can also spread further throughout the body to the bones, lungs, liver, and brain. This is called metastatic cancer or stage IV breast cancer. If the malignant process returns after primary treatment, it may occur locally, that is, in the breast and regional lymph nodes. Regional lymph nodes are lymph nodes located near the breast, such as under the armpit. Cancer can also recur in any other organ; this would be called distant recurrence or metastatic recurrence.
Even before the first symptoms of a breast tumor appear, each person should assess his or her risks. It is necessary to know the peculiarities of one’s body and family history of oncological diseases. If any male or female relatives have had breast cancer, there is a risk of genetic predisposition. Medicine still does not know what exactly causes cancer. However, oncologists have made significant advances in the study of the problem. It is now safe to say that doctors can predict the likelihood of disease depending on contributing factors. In order to detect breast cancer at an early stage, it is necessary to have regular preventive examinations by a mammologist. Breast cancer at an early stage does not affect patients’ well-being enough to start bothering them. If cancer has already advanced to the third or fourth stage, noticeable changes in the condition begin. In this case, physiological manifestations are difficult to ignore.
Although in pregnant and breastfeeding women, diagnosis is complicated by the certainty of patients that their ill-health is due to hormonal changes or lactation. Early symptoms of breast cancer include breast discoloration primarily. Any pigmentation and discoloration should alert the patient. Asymmetry and swelling are other alarming symptoms. If there is a tumor in the breast, its nipple will be higher than on a healthy breast. Pain with a swollen gland may be intense, moderate, or absent at all. Skin changes and unusual discharge from the nipple are also symptoms. The appearance of folds and focal lesions are all symptoms of breast cancer. Serous, purulent, and bloody discharge from the nipple indicates an urgent need for diagnosis. It is worth noting that the discharge does not necessarily appear in all patients.
Women who have recently finished lactation may mistake this symptom for a normal condition (discharge of colostrum). Another symptom of advanced breast cancer is retraction of the nipple inside. The danger is that women with flat nipples from birth can miss it. Scientists distinguish five stages of breast cancer. Stage zero implies that the tumor is budding. Although there is nothing yet to show the negative impact of cancer cells on health, the tumor is already discernible in the x-ray examination. In the first stage, breast cancer begins to develop. The tumor (neoplasm in the breast) is relatively small, up to 2 cm in diameter. A pronounced increase in lymph nodes is usually not observed. Breast cancer detected at stage I is utterly curable in 90% of cases. At stage II, the tumor reaches 2-5 cm in diameter.
If it is less than 2 cm in diameter, but the axillary lymph nodes on the tumor-affected side are enlarged, this is considered stage II. The third stage of breast cancer is characterized by an increase in several lymph nodes under the armpit and other nearby tissues. It is also characterized by the devastating effects of breast cancer on other body structures – the skin of the breast, the rib cage, or internal lymph nodes of the breast. Breast cancer spreads to other internal organs (lungs and bones) in the fourth, terminal stage.
Standards of Practice: Historical and Current
When analyzing new cancer therapies, it is worth recalling how cancer was treated in earlier history stages. Until the 16th century, cancer was considered an incurable disease. The only method of treatment was surgery, but it was found that the tumor returned after surgery. There was no progress in cancer treatment, which reinforced to the physicians that the disease could not be cured at all. In the 16th and 18th centuries, scientists gained more insight into the human body, anatomy, and disease development. This knowledge helped advance the study of oncology. In general surgery in the nineteenth and twentieth centuries, great strides were made, including surgical techniques and anesthesia. Operations to remove cancerous tumors became more complex and involved removing tissue around the damaged area where cancer cells could enter. The science of oncology emerged thanks to the modern microscope, making it possible to study infected tissues. Consequently, it became clearer exactly what effect the disease had on the human body, and surgery in this area advanced significantly.
During the same period, the technology of mastectomy – the removal of the breast – was developed. Such developments in the fight against cancer persisted for almost 100 years – until the mid-1970s. In parallel, theoretical knowledge of metastases developed, which allowed physicians to understand the limitations of surgery and helped develop other ways to prevent the spread of tumors in the body. After discovering X-rays at the end of the 19th century, radiotherapy began to treat cancer. In the 20th century, chemotherapy was developed, mainly aided by chemicals created between World Wars I and II. In the 1970s, it was discovered that spot surgery was as suitable for most women as radical mastectomy for breast cancer (Waks & Winer, 2019). A lumpectomy removes only the primary tumor from the patient, not the entire breast, and then uses radiotherapy. In the last decades of the 20th century, surgeons have technically improved surgeries to minimize the removal of healthy tissue.
Today, surgical procedures have become even less invasive thanks to fiber-optic technology and miniature video cameras inserted inside to assist in the operations. Cryosurgery, which uses liquid nitrogen to destroy malignant cells, is also being developed (Leyland-Jones, 2020). Laser surgery is also becoming increasingly widespread. Innovative treatments for breast cancer include personalized therapy. Advances in molecular biology and genetics allow molecular genetic analysis of tumor cells and selected combinations of chemotherapies optimal for a particular woman. This approach is called personalized treatment. Some cancer clinics around the world already offer this service. Molecular genetic analysis helps increase the efficiency of chemotherapy and helps patients who are no longer helped by standard combinations of chemo preparation.
Clinical Guidelines
The choice of therapy for a cancerous tumor depends on the stage of the disease. This is the determining criterion for treatment tactics and prognosis regarding cure and survival. A number of other indicators are also taken into consideration: anatomic, histological, structural characteristics, presence of metastases, and complications. According to the classification, there are five stages of the cancer process. It is based on the degree of spread, clinical signs, and the results of histopathological differentiation. At each stage, oncologists provide treatment, but the final goal setting is different. If the chances of cure are 90% in the early stages, then with the progression of the process in stages 3 and 4, optimism decreases. In these cases, the goal is to help the cancer patient improve his or her well-being and quality of life.
With more than 1 million new breast cancer patients being diagnosed worldwide each year, it is essential to identify the disease early, take preventive measures, and treat the first symptoms. Detection of the disease in the first or second stage is critical because successful treatment can always defeat the disease and not become its hostage. Breast examinations and diagnostic procedures include mammography, ultrasound of the breast and lymph nodes, histology and cytology of biomaterial, and blood tests for oncomarkers (Akram et al., 2017). Also, one of the widely used methods of research to detect breast cancer is Ductography. Mammography allows establishing more precise borders of neoplasms and their concrete location in breast tissues to define a tumor’s form and size. Since the tumor poorly reflects ultrasound waves, the screen shows the hypoechogenic area of a heterogeneous structure, which allows suspecting cancerous tumor with small size. Ultrasound examination of the breasts is suitable for breastfeeding mothers and pregnant women because it is not associated with radiation exposure.
Ductography, as a more precise type of mammography, allows studying the ducts of the breast, their density, location, and structure. The method used is designed to inject a contrasting substance into the gland duct. The blood test for oncomarkers is also used for diagnostic purposes. Oncomarkers are special proteins that signal possible cancer. These substances are released by malignant tumors or by the body in response to the occurrence of this tumor. Cancer markers are not 100 percent proof of cancer, but they can point in the right direction for further testing (Huether & McCance, 2019). That is why the blood test for oncomarkers is widely used as part of a comprehensive breast cancer diagnosis.
Regarding the breast cancer treatment itself, the goal is always the same – complete removal of the enlarged tumor cells. Before treatment, a full range of tests are performed to assess the condition of the tumor, then choose the most appropriate type of surgery. In some cases, chemotherapy follows before surgery. The tumor shrinks, and this makes it possible to have a complete organ-preserving surgery. Practical treatments include chemotherapy, radiation therapy, and hormone therapy. Chemotherapy consists of giving patients cytostatic drugs that inhibit tumor growth and destroy tumor cells. Chemotherapy may be administered both before and after surgery. In preparation for surgery, cytostatic medications help shrink the tumor, making surgery less traumatic and maximizing the preservation of healthy breast tissue. Postoperative chemotherapy helps to stop metastasis and prevent the recurrence of the disease.
Hormone therapy is an effective treatment for hormone-positive breast tumors. It is sometimes called anti-estrogen therapy because it aims to prevent the sex hormone estrogen from affecting cancer cells. Hormone therapy refers to so-called systemic cancer therapy. This means that the drugs in this therapy affect the entire body, unlike those in targeted therapy. The drugs are prescribed according to the results of the determination of the patient’s hormonal status. Breast cancer radiation therapy consists mainly of suppressing a tumor or zones of possible metastases through linear gas pedals. By killing tumor cells or reducing their viability, radiation therapy creates more favorable conditions for surgical intervention, significantly increasing its reliability and radicality.
Management
Treatment for people diagnosed with cancer does not end when active therapy ends. Doctors will continue to check to see if the cancer has relapsed, monitor all kinds of side effects, and monitor the patient’s overall health. This is called follow-up care. It may include regular physical exams, medical tests, or both. Doctors aim to monitor the patient’s recovery in the months and years that follow. This is necessary because, in the early stages of cancer, the possibility of a patient’s cure is very high. However, there is always a risk of tumor recurrence. Cancer recurs because small areas of undetected malignant cells may remain in the body (Sun et al., 2017). Over time, these cells may increase until they show up in test results or cause signs or symptoms. Breast cancer can recur in the breast or other areas of the body. The possibility of recurrence for patients who have already recovered, and the long and arduous treatment process for those who are still ill, have a significant impact on their morale.
A comparison of the physical parameters of a healthy and a sick person is obvious; they differ depending on the severity of the disease. A more interesting factor is the comparison of moral parameters. Patients who have recovered from cancer are in a much better state of mind than those still ill. However, they are also under the strain of worrying about a possible relapse. Some of them remain traumatized after prolonged treatment. In such cases, patients visit clinics for cancer survivors. Such clinics specialize in meeting the post-therapy needs of people diagnosed with breast cancer. The answer to whether breast cancer can be cured entirely depends on at what stage it was detected. Early detection of the tumor is a significant factor in a patient’s ability to be cured. For example, almost all patients are completely cured if cancer is detected at the first two stages. Other factors of curability include the size of the tumor, its dislocation, and the moral and physical fortitude of the patient.
Care Disparities
As in any other field, inequalities are present in breast cancer treatment. First and foremost, socioeconomic and geographic disparities affect cancer treatment and post-treatment rehabilitation. Regarding the first factor, socioeconomic inequality primarily affects the availability of treatment. How high a person’s social status and how much financial wealth they have determined their chances of receiving treatment. At the moment, therapy and surgical treatment are pretty expensive, and not all people can afford them. Meanwhile, cancer affects all social strata of the population. Because people do not have enough money for medicine, they have to sell their possessions and take out loans to keep their loved ones alive. Geographic location also affects access to treatment. Some remote regions do not have proper radiation therapy equipment, and even the hospitals accommodate cancer patients. Because of this, people who live far from regional centers have less chance of receiving treatment.
On a local level, inequalities in breast cancer treatment also exist. For example, at my local hospital, there were economic inequalities in receiving medications. According to the federal treatment program, everyone received their medications for free, on a first-come, first-served basis. Wealthy people were the first to receive medication. This was justified by the fact that they needed it more, but the reason for this is apparent – these people could pay to get the medicine out of turn. Soon after the change of leadership, this practice ceased. The impact of disparities in breast cancer care on patients and physicians cannot be overstated. Patients suffer and do not receive proper treatment because of circumstances over which they have no control. Doctors suffer because inequalities reduce trust in medicine and stereotype their work. Financially, medicine suffers great financial losses because of inequalities in treatment. This happens because, disillusioned with the system, many patients refuse to undergo treatment, resorting to alternative medicine. To summarize, disparities in breast cancer treatment are bad for both physicians and patients and need to be eliminated.
Health Promotion
As medicine advances, scientists are trying to innovate more and more in the treatment of breast cancer. Technological advances are setting the stage for introducing advanced therapies such as image-guided brachytherapy (IGBT). Such methods lead to more stable treatment results and provide a better quality of life for patients. IGBT is a cancer treatment method that is highly personalized and can be tailored to specific circumstances. It helps improve survival rates for many forms of cancer and reduces the risk of complications. With the increasing incidence of cancer worldwide, IGBT offers an opportunity to provide safe, effective, and quality treatment for some of the most common cancers, particularly breast cancer.
Further development and implementation of this technology offer an excellent opportunity to make treatment available to more patients and provide adequate medical care. On a local level, innovations are also being introduced in the treatment of breast cancer. For example, hospitals regularly purchase cutting-edge equipment from global manufacturers. In addition, patient rooms are also being improved, and unique rooms are being set up where patients can spend time with their relatives. Innovations in cancer treatment help not only the patients but also the doctors. With new treatments, they can do their jobs more effectively and reduce the mortality rate from the disease. For patients, innovation means hope for a healthy future. Every new development in this field ensures that at least one life of a cancer patient is saved. By developing new drugs and treatments for cancer, scientists work every day to save hundreds or thousands of lives.
Conclusion
To summarize, it can be said that breast cancer is a severe disease that requires timely detection and prompt treatment. The earlier the cancer is detected, the more chances the patient has for recovery. Surgical intervention is the most popular method of treating cancerous neoplasms. Modern methods of cancer treatment are not without chemotherapy. It is often used on a par with surgical interventions. Radiation and hormone therapy are also used; the latter restores hormones in cancer patients to regulate the vital processes of cancer cells. Effective methods of cancer treatment give patients a longer prognosis. Depending on the stage of cancer, a complete cure with long-term remission is also possible.
New developments and research are being done regularly in the treatment of breast cancer. Researchers are currently developing personalized treatments that will have the most negligible negative impact on the patient’s body. There are also inequalities in cancer treatment that need to be addressed. The main ones are socioeconomic and geographic. For a successful cure and reduced mortality risk, everyone should receive equal treatment and support from the government. By doing so, cancer can recede, and doctors will have the opportunity to save many lives.
References
Akram, M., Iqbal, M., & Daniyal, M. (2017). Awareness and current knowledge of breast cancer. Biological Research, 50(33), 21-47.
Huether, S. E., & McCance, K. L. (2019). Understanding pathophysiology (7th Ed.). Elsevier.
Leyland-Jones, B. (Ed.). (2020). Pharmacogenetics of breast cancer: Towards the individualization of therapy. CRC Press.
Sun, Y. S., Zhao, Z., Yang, Z. N., Xu, F., Lu, H. J., Zhu, Z. Y., Shi, W., Jiang, J., Yao, P. P., & Zhu, H. P. (2017). Risk factors and preventions of breast cancer. International journal of biological sciences, 13(11), 1387–1397.
Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: A review. JAMA, 321(3), 288–300. doi:10.1001/jama.2018.19323