Breast Cancer
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Overview
Breast cancer is the most common tumor and the leading cause of death in women globally (67). It is the second most frequently diagnosed neoplasm worldwide and stands out as the most common and lethal cancer among women. In 2020, approximately 2.26 million new cases were reported. Incidence rates are higher in countries with elevated levels of human development compared to regions like sub-Saharan Africa. The global burden of cancer is increasing due to growing and aging populations, along with increases in risk factors.
Several factors influence breast cancer risk, with the most common being being born female and getting older. Other risk factors include age at first childbirth and the number of childbirths, age at first period, age at menopause, Ashkenazi Jewish heritage, and being overweight or obese. Most women who develop breast cancer do not have a family history of the disease. Women who drink alcohol have an increased risk of breast cancer (5), with moderate consumption linked to an approximate 30-50% increased risk. Studies suggest that higher alcohol intake may modify the association between mammographic density and breast cancer. Mammographic density itself is also a recognized risk factor. Red and processed meat consumption may also be risk factors.
While no cancer is completely preventable, there are steps individuals can take to help reduce their risks [previous overview]. It is recommended to maintain a healthy weight throughout life, be physically active, and follow a healthy eating pattern at all ages. It is considered best not to drink alcohol. Dietary patterns, such as the Mediterranean diet, have been reviewed in relation to breast cancer risk and management.
Early detection through screening, such as mammograms, can help find breast cancer early when it is easier to treat. Regularly scheduled mammograms can lower the risk of dying from breast cancer. Guidelines from the US Preventive Services Task Force recommend that women aged 40 to 74 at average risk get a mammogram every 2 years. Discussing breast density with patients is also important following mandates. Diagnosis and staging involve imaging tests and biopsies.
Progress in early detection and treatment has significantly increased survival [previous overview]. Treatment often involves tailored approaches, including surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, and targeted drug therapy. Radiation therapy, like WBRT, can cause long-term side effects such as cardiac toxicities.
A breast cancer diagnosis can be difficult, leading to anxiety, distress, and nervousness about recurrence, all of which significantly affect daily life [previous overview]. The focus of breast cancer care now extends to survivorship, encompassing the physical, mental, social, and economic aspects of the disease. Psychosocial interventions, such as Cognitive Behavioral Therapy (CBT), meditation, and music therapy, can help alleviate distress in breast cancer patients (99, 100). Analysis of online forums indicates that short-term survivors use significantly more depression- and anxiety-loaded language than long-term survivors. Support is available from various organizations.
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Risk Factors and Early Detection Considerations
Several factors influence breast cancer risk, and understanding them can help in assessing individual risk1. Some risk factors are uncontrollable, while others may be influenced by lifestyle.
It’s important to discuss breast cancer screening tests with your doctor to determine which ones are right for you and when you should have them (15). This process, including discussing benefits and risks, is referred to as informed and shared decision-making -
Diagnosis, Staging, and Detection
Early detection through screening, primarily with mammograms, is essential for finding breast cancer at a treatable stage and reducing the risk of death (101, 104, 105). Diagnosis involves clinical exams, imaging like mammograms, ultrasound, or MRI, and a biopsy to identify the cancer type and molecular markers (ER/PR/HER2) [previous overview, 19, 20].
Staging (0-4), including metastatic disease, determines the cancer's extent using tests such as imaging and sentinel node biopsy, impacting prognosis and treatment planning (1, 15, 19, 20).
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Sexual Function & Intimacy
Breast cancer and its treatment significantly impact sexual function and intimacy. Factors include body image changes from surgery and treatment side effects such as fatigue and hormonal symptoms, like genitourinary syndrome of menopause (GSM) causing painful intercourse and dryness.
Psychological issues like anxiety and depression also contribute to reduced sexual satisfaction. Sexual dysfunction is prevalent among survivors. Discussing these concerns with healthcare teams and seeking appropriate management strategies is important for quality of life.
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Dietary Considerations
Dietary considerations are important for both reducing breast cancer risk and managing health outcomes after diagnosis. Healthy eating patterns should focus on plant-based foods, such as fruits, vegetables, whole grains, and legumes. It is recommended to limit red and processed meats, alcohol, added sugars, and highly processed foods.
Maintaining a healthy weight is a key recommendation. Patterns like the Mediterranean diet are linked to benefits. Discussing dietary changes with healthcare professionals is important.
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Treatment Approaches
Breast cancer treatment is multifaceted, often combining surgery, radiation therapy, and systemic therapies tailored to the specific cancer characteristics and the patient's overall health. Surgery is frequently the initial step to remove the tumor. Radiation uses powerful energy beams to kill cancer cells. Systemic therapies use medicines throughout the body and include chemotherapy, hormone therapy for HR+ cancers, targeted therapies for specific mutations like HER2+, and immunotherapy, potentially for TNBC.
Managing side effects and providing psychosocial support are crucial aspects of care.
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Treatment Side Effects
Breast cancer treatments, including surgery, radiation therapy, and systemic therapies (chemotherapy, hormone, targeted, immunotherapy), can cause various side effects [overview]. Physical effects range from fatigue and pain to nerve damage, lymphedema, and potential long-term organ damage like heart or lung issues. Changes to body appearance and mobility are also possible .
Beyond physical impacts, emotional distress, such as anxiety and depression, is common and can affect quality of life. Managing these challenges is a critical part of care.
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Mental Health
Breast cancer and its treatment can significantly impact mental health (1). Distress, often including anxiety and depression, is common among patients and survivors, affecting quality of life and ability to cope. This can stem from treatment side effects, such as cognitive changes ('chemo-brain'), mood shifts, sleep disorders, and pain, as well as altered body image after surgery and radiation.
Mental health challenges, particularly depression and anxiety, may be more prevalent in the short-term survivorship period compared to later stages (2). Screening for distress is recommended (5), with management involving the care team, mental health specialists, and therapies.