Science Series #7: Breast Cancer

What is breast cancer?

Breast cancer is a group of diseases in which cells in breast tissue change and divide uncontrollably, typically resulting in a lump or mass. Breast cancer can begin in different areas of the breast, such as the ducts, lobules, and the tissue in between. There are different types of breast cancers, including non-invasive, invasive, and metastatic breast cancers, as well as the intrinsic or molecular subtypes of breast cancer.

(Source: Centers for Disease Control and Prevention)

Incidence

According to the latest Global Cancer Statistics in 2018, breast cancer represented 11.6% of all cancers, which places this disease as the second most commonly diagnosed type after lung cancer. Breast cancer also caused 6.6% of the total cancer deaths in 2018.

In 2020, an estimated 276,480 new cases of invasive breast cancer and 48,530 cases of non-invasive (in situ) breast cancer in women, are expected to be diagnosed in the US alone. Additionally, the expected mortality rate sits at around 42,170 for women in the US. Death rates have been steady in women under 50 since 2007, but have continued to drop in women over 50. For women under 45, breast cancer is more common in black women than white women.

Economically developing countries such as African, Asian and Central American countries, have low incidence rates with high mortality compared to developed countries such as Western Europe and North America, where high incidence and low mortality of these are seen.

Developing countries lack resources, have poor access to cancer screening and prevention programs; these countries are also lagging in the control of environmental factors contributing to the development of breast cancer. Access to early diagnosis and early treatment is vital to repressing mortality rates. An estimated 60% of deaths worldwide attributed to breast cancer occur in economically developing countries.

(Source: GLOBOCAN and National Center for Biotechnology Information)

Symptoms

Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue. Breast pain is not usually a symptom of breast cancer. Most breast lumps are not cancerous, but it is always best to have them checked by a doctor. If you notice any of these symptoms, ask your doctor:

  • A change in the size or shape of one or both breasts.
  • Discharge from either of your nipples, which may be streaked with blood.
  • A lump or swelling in either of your armpits.
  • Dimpling on the skin of your breasts.
  • A rash on or around your nipple.
  • A change in the appearance of your nipple, such as becoming sunken into your breast.

(Source: National Health Service)

How is diagnosed?

Breast cancer can be diagnosed through multiple tests, including:

A machine that uses sound waves to make detailed pictures (sonograms) of areas inside the breast.

This is a more detailed X-ray of the breast. A problem with the breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may recommend a diagnostic mammography.

A type of body scan that uses a magnet linked to a computer. The MRI scan will take detailed pictures of areas inside the breast.

Known as scintimammography or breast-specific gamma imaging (BSGI), is a type of nuclear medicine imaging test for the breast. A radioactive chemical is injected into the blood and a special camera is used to see into the breast.

A newer imaging test of the breast that is very similar to a PET scan. A form of sugar attached to a radioactive particle is injected into the blood to detect cancer cells. A PEM scan may be better able to detect small clusters of cancer cells within the breast.

Also known as contrast-enhanced spectral mammography (CESM), is a newer test in which a contrast dye containing iodine is injected into a vein a few minutes before two sets of mammograms (using different energy levels) are taken. The contrast can help the x-rays show any abnormal areas in the breasts.

This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).

The two most common lab tests are the hormone receptor test and the HER2/neu test.

(Source: Centers for Disease Control and Prevention)

Types of breast cancer

Types of breast cancer include:

A non-invasive cancer where abnormal cells are found in the lining of the breast milk duct.

The abnormal cancer cells that began forming in the milk ducts, have spread beyond these,  into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body. It is also sometimes called infiltrative ductal carcinoma.

A condition where abnormal cells are found in the lobules of the breast. The atypical cells have not spread outside of the lobules into the surrounding breast tissue.

Invasive breast cancer that begins in the lobules (milk glands) of the breast and spreads to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.

When the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER-2/neu gene– are not present in the cancer tumor.  This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR).

An aggressive and fast growing breast cancer in which cancer cells infiltrate the skin and lymph vessels of the breast. It often produces no distinct tumor or lump that can be felt and isolated within the breast.

Could also classified as Stage 4 breast cancer. The cancer has spread to other parts of the body. This usually includes the lungs, liver, bones or brain.

(Source: National Breast Cancer Foundation, INC)

What are the types of breast cancer treatment?

Some treatments remove or destroy the disease within the breast and nearby tissues, such as lymph nodes. These include:

  • Surgery: To remove the whole breast, called a mastectomy, or to remove just the tumor and tissues around it, called a lumpectomy or breast-conserving surgery.
  • Radiation therapy: Uses high-energy waves to kill cancer cells.

Other treatments destroy or control cancer cells all over the body:

  • Chemotherapy: Uses drugs to kill cancer cells. As these powerful medicines fight the disease, they also can cause side effects, like nausea, hair loss, early menopause, hot flashes, and fatigue.
  • Hormone therapy: Uses drugs to prevent hormones, especially estrogen, from fueling the growth of breast cancer cells. Some types of hormone therapy work by stopping the ovaries from making hormones, either through surgery or medication.
  • Targeted therapy: In addition to chemotherapy and hormone therapy, there are newer, more effective treatments that can attack specific breast cancer cells without harming normal cells. Currently, these targeted methods are commonly used in combination with traditional chemotherapy. However, targeted drugs often have less severe side effects than standard chemotherapy drugs.
  • Immunotherapy: Uses the body’s own immune system to target cancer. The drug atezolizumab (Tecentriq) and sacituzumab govitecan-hziy (Trodelvy) have been approved to treat patients with triple negative breast cancer which has spread.

 (Source: WebMD)

Reduce the risk of breast cancer

Many factors over the course of a lifetime can increase the risk of breast cancer. You cannot change some factors, such as getting older or your family history, but you can help lower your risk of breast cancer by taking care of your health in the following ways:

  • Keep a healthy weight
  • Exercise regularly
  • Don’t drink alcohol, or limit alcoholic drinks.
  • If you are taking, or have been told to take hormone replacement therapy (those that include both estrogen and progesterone) for more than five years or certain oral contraceptives (birth control pills), ask your doctor about the risk.
  • Breastfeed your children, if possible.
  • If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, talk to your doctor about other ways to lower your risk.

Staying healthy throughout your life will lower your risk of developing cancer, and improve your chances of surviving cancer if it occurs.

 (Source: Centers for Disease Control and Prevention)

Our background in breast cancer

The Jacinto Convit World Organization (JCWO) is currently developing a low cost and potentially safe and effective breast cancer immunotherapy named ConvitVax, which was designed by Dr. Jacinto Convit during his last years of life. Following Dr. Convit’s principles, this therapeutic vaccine is mainly targeted towards underprivileged and underserved patients in developing countries who lack the resources to access new and innovative treatments, or even conventional therapies.

            Three research articles have been published showing results from preclinical studies using ConvitVax and a combination of our therapy with another immunotherapy (Convit et al., 2015, Godoy-Calderon et al. 2018 and Godoy-Calderon et al. 2019). More recently another study was successfully conducted to validate the safety of this therapy (Duarte, et al., in revision). Additionally, ConvitVax is approved by the Food and Drugs Administration (FDA) with IND # 18487 to initiate a phase I clinical study in stage IV breast cancer female patients.

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