Treatment of breast cancer

Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
American family physician (Impact Factor: 2.18). 06/2010; 81(11):1339-46.
Source: PubMed


Understanding breast cancer treatment options can help family physicians care for their patients during and after cancer treatment. This article reviews typical treatments based on stage, histology, and biomarkers. Lobular carcinoma in situ does not require treatment. Ductal carcinoma in situ can progress to invasive cancer and is treated with breast-conserving surgery and radiation therapy without further lymph node exploration or systemic therapy. Stages I and II breast cancers are usually treated with breast-conserving surgery and radiation therapy. Radiation therapy following breast-conserving surgery decreases mortality and recurrence. Sentinel lymph node biopsy is considered for most breast cancers with clinically negative axillary lymph nodes, and it does not have the adverse effects of arm swelling and pain that are associated with axillary lymph node dissection. Choice of adjuvant systemic therapy depends on lymph node involvement, hormone receptor status, ERBB2 (formerly HER2 or HER2/neu) overexpression, and patient age and menopausal status. In general, node-positive breast cancer is treated systemically with chemotherapy, endocrine therapy (for hormone receptor-positive cancer), and trastuzumab (for cancer overexpressing ERBB2). Anthracycline- and taxane-containing chemotherapeutic regimens are active against breast cancer. Stage III breast cancer typically requires induction chemotherapy to downsize the tumor to facilitate breast-conserving surgery. Inflammatory breast cancer, although considered stage III, is aggressive and requires induction chemotherapy followed by mastectomy, rather than breastconserving surgery, as well as axillary lymph node dissection and chest wall radiation. Prognosis is poor in women with recurrent or metastatic (stage IV) breast cancer, and treatment options must balance benefits in length of life and reduced pain against harms from treatment.

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    • "However, ER negative cancer cells are generally more sensitive to chemotherapy, but associated with poor clinical outcomes [6, 7]. In clinic, the radiation therapy following breast-conserving surgery is recommended for early-stage breast cancers [8, 9]. Unfortunately, the majority of patients suffer from a high proportion of drug resistance and die of disseminated metastatic disease [8]. "
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    ABSTRACT: Background S-allyl mercaptocysteine (SAMC), a water-soluble component derived from garlic, has been found to exert multi-antitumor activities. This study was to investigate the responsible molecular mechanisms of SAMC in human breast cancer cell lines. Methods Sulforhodamine B assay was used to determine cell viability, flow cytometry was applied for the analysis of cell cycle and cell apoptosis, the change of protein was detected by Western blot. Results It was found that SAMC exhibited an effective cell growth inhibition of human breast cancer cell lines MCF-7 (ER positive) and MDA-MB-231 (ER negative) in a dose- and time-dependent manner by inducing cell cycle arrested in G0/G1 phase, the block of cell cycle was associated with the up-regulation of p53 and p21. Furthermore, the SAMC-mediated cell cycle arrest was accompanied with promotion of apoptosis, as indicated by the changes in the nuclear morphology and expressions of apoptosis-related proteins. SAMC clearly triggered the mitochondrial apoptotic pathway as indicated by activation of Bax, decreased expression of Bcl-2 and Bcl-XL, and subsequent activation of caspase-9 and caspase-3. Conclusion These results highlight the value of a continued investigation into the use of SAMC as a potential antitumor candidate for breast cancer.
    BMC Complementary and Alternative Medicine 07/2014; 14(1):270. DOI:10.1186/1472-6882-14-270 · 2.02 Impact Factor
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    • "Uncross-linked collagen Type I is unstable over a period of months, but when a crosslinking agent is added the altered mechanics result in decreased enzymatic and thermal degradability. A leading factor in breast-cancer-related death is the recurrence of a tumor following mastectomy [35, 36]. If an anticancer treatment could be incorporated into a tissue-engineered product, the recurrence of cancer might be reduced. "
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    ABSTRACT: Research efforts investigating the potential of natural compounds in the fight against cancer are growing. Tannic acid (TA) belongs to the class of hydrolysable tannins and is found in numerous plants and foods. TA is a potent collagen cross-linking agent; the purpose of this study was to generate TA-cross-linked beads and assess the effects on breast cancer cell growth. Collagen beads were stable at body temperature following crosslinking. Exposure to collagen beads with higher levels of TA inhibited proliferation and induced apoptosis in normal and cancer cells. TA-induced apoptosis involved activation of caspase 3/7 and caspase 9 but not caspase 8. Breast cancer cells expressing the estrogen receptor were more susceptible to the effects of TA. Taken together the results suggest that TA has the potential to become an anti-ER(+) breast cancer treatment or preventative agent.
    11/2013; 2013:369609. DOI:10.1155/2013/369609
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    • "Breast cancer is the most common malignancy in women, with approximately 1.38 million new patients and 459,000 deaths per year worldwide [1]. Depending on breast cancer stage and characteristics, treatment may include surgery, radiotherapy, chemotherapy and/or hormonal and target therapy [2,3]. With screening and treatment strategy advance, the 5-year survival of patients detected with early stage breast cancer is between 80% and 90% [3,4]. "
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    ABSTRACT: Breast cancer is the most common malignancy in women. Along with improvements in treatment, the number of women who survive breast cancer has increased. Rehabilitation can alleviate post-treatment side effects and maintain quality of life. This study aimed to explore the use of rehabilitation among a cohort of patients diagnosed with breast cancer. A retrospective longitudinal cohort study was conducted using a National Health Insurance (NHI) research database in Taiwan. The study cohort consisted of 632 patients with breast cancer diagnosed in 2005. Their NHI claims over a period spanning 2005 through 2009 were analyzed. Overall, 39.6% of the cohort received rehabilitation therapy, with 9,691 rehabilitation visits claimed (an average of 38.8 visits per user). The prevalence of rehabilitation service use among the cohort was 16.5%, 13.3%, 13.0%, 13.3%, and 12.8% in the years 2005 through 2009, respectively. The average number of visits per rehabilitation user was 16.8, 25.0, 31.1, 24.2, and 23.8 in the years 2005 through 2009, respectively. Most rehabilitation therapy occurred as an outpatient service (96.0%). Physical therapy was the most commonly used form of rehabilitation (84.2%), followed by occupational therapy (15.4%). The most frequently recorded diagnoses were malignant neoplasm of the female breast, peripheral enthesopathies and allied syndromes, and osteoarthrosis and allied disorders. Only a small proportion of patients with breast cancer received rehabilitation therapy in the first five years after diagnosis. The average number of rehabilitation visits per user peaked in the third year after diagnosis.
    BMC Health Services Research 08/2012; 12(1):282. DOI:10.1186/1472-6963-12-282 · 1.71 Impact Factor
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