Breast Cancer Pathophysiology - An Interdisciplinary Approach by Nima Rezaei
pdf 2024
Download
Series Editor: Nima Rezaei
Department of Clinical Immunology, Karolinska Institutet, Stockholm, Sweden
Pages: 330 Language: English Format: PDF Size: 8.81MB
Contents : . Interdisciplinary Approach in Breast Cancer. Circulating Tumor Cells in Breast Cancer . Breast Cancer Cells Extravasation Across the Blood-Brain Barrier:
From Basic to Translational Research . Turn in Breast Cancer Care: Upregulation of Estrogen Signal
May Be Much More Effective than Its Inhibition. Role of Membrane Estrogen Receptor (GPER1) on the Functionof Immune CellsPathophysiology and Its Consequences on Breast Cancer. The Effect of Dietary n-3 Polyunsaturated Fatty Acidson Non-obese and Obesity-Associated Breast Cancer. The Role of Soy and Its Isoflavones in Breast Cancer: Beneficial
or Harmful ? .. Mammographic Breast Density and Utility in Breast Cancer Screening and Clinical Decision-Making .. Advanced 3D In Vitro Models to Recapitulate the Breast Tumor Microenvironment . Breast Cancer Metastasis to Bone: Look into the Future. Breast Cancer: The Fight for Survival Is Won: What Is the Evidence for Preserving Fertility?. Breast Cancer and Pregnancy: Challenges for Maternal and Newborn Successful Outcomes .. Computer-Aided Approach for BI-RADS Breast Density Classification:
Multicentric Retrospective Study . Correction to: Mammographic Breast Density and Utility in Breast Cancer Screening and Clinical Decision-Making
preface
In 2020, new breast cancer (BC) cases exceeded other cancer types – consideringboth sexes and all ages – worldwide (Sung et al. 2021). BC approximatelyrepresented 11.7% of all cancer incidence in 2020.During the last decades, the survival of BC patients has been prolonged, owing topowerful screening methods, early diagnosis, targeted therapies, and personalizedmedicine. However, the process of breast tumors initiation and progression isvariable among patients; those with aggressive triple-negative breast cancer(TNBC) may lead to death in a short time, while those with hormone receptorpositive (HR+) and HER2-overexpressed probably have a longer course of illness(Tadros et al. 2021).The management of BC patients is undergoing a considerable shift from theone-size-fits-all approach to tailoring therapies. Nowadays, the treatment strategiesfor women with BC need an interdisciplinary perspective. It means that treatmentteams consist of medical oncologist, gynecological oncologist, molecularoncologist, radiation oncologist, pathologist, immunologist, and even psychologist(Raj et al. 2020). The interdisciplinary approach in BC helps physicians make linksbetween all possible ways for attacking cancer cells and minimize recurrence. Thisapproach remarkably improves patient outcomes and their quality of life.This chapter briefly addresses current interdisciplinary strategies for BC diagnosis and management (Fig. 1). We also consider the novel non-invasive screening andmonitoring method for BC. In the following chapters of this volume, differentaspects of treatment approaches for BC have been discussed in detail.BC is detected through screening tests or symptoms, which lead to diagnostic tests.Routine mammography is recommended every 6 months for healthy women agedmore than 50 years and without familial history of BC (Qaseem et al. 2019). Forwomen with a familial history is recommended that screening begins 5 years beforethe earliest age at diagnosis in the family. Moreover, genetic testing in women with afamilial history is a must (Honrado et al. 2005). Regular screenings of healthywomen result in early detection of tumors before metastasis which are less likelyto require chemotherapy. Screening mammography could lead to a 32% reduction inBC mortality for women in their 60s (Shen et al. 2019). Besides its benefits,Molecular pathology also may reveal therapeutically relevant molecularalterations. For instance, PIK3CA mutation testing in the primary tumor, metastaticsites, or plasma is recommended as PI3K inhibitor Alpelisib has been approved byFDA (Mavratzas and Marmé 2021). ESR1 gene mutations are linked to endocrinetherapy resistance. Hence, they could be a metastatic biomarker in BC patients whoreceive aromatase inhibitor therapy (Herzog and Fuqua 2021). Moreover, HER2mutations also are involved in resistance to endocrine therapy or anti-HER2 monoclonal antibodies (Mazumder et al. 2021).Besides somatic mutations with therapeutic value, some germline mutations alsoshow clinical utility. For instance, BC patients with BRCA1/2 germline mutationsare eligible for receiving PARP inhibitor treatment (Imyanitov 2021).Surgical intervention is the primary approach of local tumor resection in BC patients(Murugappan et al. 2018), including two main methods: (1) Breast conservationsurgery (BCS) removes the tumor cells and 1–2 mm of normal tissue (lumpectomy)while leaving as much normal tissue as possible. This procedure is performed in thepresence of a breast imaging radiologist. (2) Mastectomy is a common approach forpatients with a large breast tumor and small breast, aggressive calcifications, ormulticentric tumor cells. Although, for patients with early-stage BC, mastectomywould be a choice.Different classes of drugs exist for additional treatments based on an interdisciplinary approach. Personalized medicine allows physicians to select the most effective drug at the best time, depending on tumor characteristics and disease extent.Generally, adjuvant chemotherapy after surgical intervention is recommended forhigh-risk patients for recurrence. Some clinicopathologic features are consideredindications for chemotherapy: HR/HER2, HER2+, positive lymph nodes, andlarger tumor size (Riedel et al. 2020). RNA-based genomic testing for patients withER+ tumors and negative lymph nodes, such as Oncotype DX and MammaPrint,could be helpful to identify who may benefit from chemotherapy (Xin et al. 2017).Decision-making for applying chemotherapy for BC patients should consider abalance between the patient’s comorbidities and survival benefits. Taxane-basedchemotherapy is commonly used in neoadjuvant/adjuvant settings for BC patients(De Laurentiis et al. 2008). Carboplatin and Mitomycin C are other widely usedchemotherapeutic agents for patients with advanced BC (Kotake et al. 2019).
