the five-year survival rate after diagnosis for stage 4 breast cancer patients in developed countries: 22%; the five-year relative survival rate in developed countries: 72%; the five-year relative survival rate for stage 2 breast cancer patients in developed countries: 90%.
♦ It is a low-dose of X-ray radiation imaging of breasts.
♦ It aims at detection of calcified lesions in breasts that are less than 1cm in size.
♦ Screening begins at age 40 yrs and is repeated every 2 year(s) upto the age of 75 years).
♦ It is known to have a sensitivity of 67.8% and specificity 75%. However, when it is combined with clinical breast examination, sensitivity rises to 77.4% and specificity reduces to 72%.
♦ Comprehensive clinical review must be done.
♦ All breast quadrants are examined for lumps, changes of skin colour or swelling and nipples for blood or any other discharge.
♦ Sensitivity and specificity of CBE have been found by some studies to be 51.7% and 94.3% respectively.
♦ It is not mainly used for screening of breast cancer alone though its use advised in males, lactating women, small-breasted women and in premenstrual women.
♦ It is also used as guidance in taking of image-directed biopsies
♦ It should be done on the same day each month at day 10 of menstrual cycle).
♦ A core needle biopsy (manually or ultrasound / stereotactic guided)
♦ Fine needle aspiration is not recommended for diagnostic use.
♦ Histopathological reporting of biopsy should include the following:
_Specification of the histological type of breast cancer
_Grade of cancer
_Number of nodes sampled
_Number of nodes involved
_Presence of necrosis
♦ The standard treatment in a Low-Resource setting (LRS) is doxorubicin + cyclophosphamide or;
_The alternative regime in the LRS is cyclophophomide + methotrexate + 5FU or;
_Doxorubicin + cyclophosphamide and paclitaxel or other taxanes concurrently or sequentially
_Cisplatin or carboplatin can also be used in the above combination.
♦This regime is administered with Growth factors that stimulate bone marrow such as filgrastim and pegfilgrastim.
♦If tumors overexpress HER2, add trastuzumab at least a year.
♦ In case the presence of estrogen and progesterone receptor expression administer hormone therapy that include: tamoxifen, raloxifene, aromatase inhibitors such as anastrozole, letrozole and exemestane
♦ In premenopausal women
_Surgical removal of ovary (ovarian ablation by surgery) or
_Radiation therapy or
_Luteinizing-releasing hormone (LRH) agonist such as buserelin, goserelin, leuprolide or
_Ovarian ablation + Tamoxifen or an aromatase inhibitor such as anastrozole, letrozole and exemestane.
♦ In postmenopausal women;
_An aromatase inhibitor such as anastrozole, letrozole and exemestane.
aromatase inhibitors are being increasingly used as primary hormone therapy. _Chemotherapeutics: capecitabine, doxorubicin, gemcitabine, paclitaxel and docetaxel, and vinorelbine.
_For tumors that overexpress HER2: trastuzumab alone or with hormone therapy or chemotherapy.
_Radiation therapy alone may be used to treat isolated, symptomatic lesions
_Bisphosphonates such as zoledronate reduce pain in the bone pain as well as reducing loss of bone. They are also useful in the treatment of hypercalcemia.
Stage 0 (lobular carcinoma in situ, LCIS)
♦ Since 10-20% of LCIS cases are also DCIS positive wide excision is recommended before therapy to rule out DCIS
♦ Monitor or
♦ Monitor + estrogen antagonist such as Raloxifene (for postmenopausal women) or Tamoxifen (for pre or postmenopausal women)
♦ Prophylactic mastectomy (bilateral) in patient with high risk of breast cancer
Stage 0 (ductal carcinoma in situ, DCIS)
♦ Lumpectomy (breast-conserving surgery) with the following;
_No radiation therapy + No lymph node surgery (in case of lower-level evidence) or
_No axillary dissection + whole-breast radiation therapy
_with Tamoxifen for 5 years in patient with estrogen receptor (ER) -to reduce the risk
♦ Total mastectomy with or without sentinel node biopsy
Stage I, IIA, IIB, or IIIA
_Excision or mastectomy + axillary dissection or sentinel node biopsy
_Radiotherapy + chemotherapy