Its incidence is in rise in the developing
countries, may be due to the life style changes. Breast
Cancer Ribbon TattoosThis 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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