Breast Cancer Awareness

Wondering when to start or how often to get screening mammograms? Dr. Lisa Richardson explains in this video.

Ask your doctor when you should get a mammogram.

Other than skin cancer, breast cancer is the most common cancer among American women. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms.

Are you worried about the cost? CDC’s National Breast and Cervical Cancer Early Detection Program offers free or low-cost mammograms to women who have low incomes and are uninsured or underinsured. Find out if you qualify.

What Are the Symptoms?

There are different symptoms of breast cancer, and some people have no symptoms at all. Symptoms can include—

  • Any change in the size or the shape of the breast.
  • Pain in any area of the breast.
  • Nipple discharge other than breast milk (including blood).
  • A new lump in the breast or underarm.

If you have any signs that worry you, see your doctor right away.

What Are the Risk Factors?

Some main factors that affect your chance of getting breast cancer include—

Being a woman.

Being older. Most breast cancers are found in women who are 50 years old or older.

Having changes in your BRCA1 or BRCA2 genes.

How Can I Lower My Risk?

You can do things to help lower your breast cancer risk.

  • Keep a healthy weight and exercise regularly.
  • Choose not to drink alcohol, or drink alcohol in moderation.
  • If you are taking hormone replacement therapy or birth control pills, ask your doctor about the risks.
  • Breastfeed your children, if possible.

Fast Facts About Breast Cancer

  • Each year in the United States, about 240,000 women get breast cancer and 42,000 women die from the disease.
  • Men also get breast cancer, but it is not very common. About 1 out of every 100 breast cancers diagnosed in the United States is found in a man.
  • Most breast cancers are found in women who are 50 years old or older, but breast cancer also affects younger women.

Linda, a virtual triple-negative breast cancer survivor

Learn about triple-negative breast cancer and talk to Linda, a virtual triple-negative breast cancer survivor.

Photo of Charity

CDC’s Bring Your Brave campaign shares stories of young women whose lives have been affected by breast cancer.

Photo of a woman getting a mammogram

What does it mean to have dense breasts? This video explains what it means and why it’s important.

Stay Informed

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February 2022

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Advances in Breast Cancer

Screening and Treatment Get Personal

Illustration of a doctor showing a female patient a mammogram machine

Breast cancer is the second most common cancer among American women. Breast cancer death rates have been falling over the past 30 years. But nearly 13% of women are still diagnosed in their lifetime. Men can get breast cancer too, although it’s rare.

Cancer is caused by changes to genes Stretches of DNA you inherit from your parents that defines features, like your risk for certain diseases. that control the way our cells function. These changes affect how cells grow and divide. Cancer results when cells divide uncontrollably. In breast cancer, this happens in the breast tissue.

Researchers are studying the risk factors for different types of breast cancer. They’re also searching for more personalized treatments.

Unraveling The Risks

“Breast cancer is caused by a combination of factors,” says Dr. Montserrat García-Closas, a cancer researcher at NIH. Your genes, lifestyle, and environment all contribute to your risk. Researchers are trying to better understand how each plays a role.

People with a family history of breast cancer are at increased risk for the disease. Some are born with rare versions of certain genes that put them at high risk. These include the genes BRCA1 and BRCA2 .

“But the vast majority of patients have no known family history and no known gene that causes cancer,” explains Dr. Margaret Gatti-Mays, a breast cancer treatment specialist at The Ohio State University.

So researchers are also searching for combinations of genes that may lead to breast cancer. “Women can inherit hundreds or thousands of common versions of genes that each have tiny effects, but in combination can put them at substantial risk for developing breast cancer,” García-Closas says. An NIH study called the Confluence Project is trying to unravel these combinations.

Other factors can increase your risk for breast cancer, too. These include your age, whether you’ve had children, alcohol use, and obesity.

Studies are examining how all these factors—genes, medical history, and lifestyle—interact to affect cancer risk. One is called Connect for Cancer Prevention. “It’s recruiting 200,000 people in the U.S. and following them for years to see who develops different types of cancers,” says García-Closas.

Staying Ahead of Breast Cancer

Another study, called the Wisdom Study, is exploring how to best personalize breast cancer screening. Screening tests look for signs of a disease before symptoms appear. Finding cancer early may increase the chance that it can be treated and cured.

If you’re at high risk for breast cancer, your doctor may advise you to get screenings at an earlier age than most, or more often.

“Women from 40 to 50 should talk with their doctor about when they should start screening. And that should be based on their personal risks,” says Dr. Brandy Heckman-Stoddard, an NIH expert on breast cancer.

Mammograms are the most common way to screen for breast cancer. These are X-ray pictures of the breast. An NIH study called TMIST is comparing whether 2D or 3D mammograms are better for screening. 2D mammograms are taken from two sides of the breast. 3D mammograms are taken from different angles around the breast. Then, a computer builds a 3D-like image.

Magnetic resonance imaging (MRI) is sometimes used to screen women at high risk of breast cancer. MRIs can create a clearer image of the breast and don’t use radiation.

Researchers are looking for other ways to detect breast cancer, too. García-Closas’ team is trying to detect cancer using blood samples. These “liquid biopsies” detect DNA from cancer cells, which travel around the body in the bloodstream.

“Liquid biopsies should reflect what’s going on in your whole body,” García-Closas says, “versus when you look at a tissue biopsy, you’re taking a tiny sample of tissue in a particular location.”

Liquid biopsies may one day be able to detect cancer before other clinical tests, she says. “And, they might be able to better monitor what’s happening in your body after cancer has been diagnosed.”

Fighting Back

When breast cancer is found, treatment depends on the type of tumor. Surgery and radiation are common. Chemotherapy may also be used. Doctors might recommend other treatments as well, depending on the type of breast cancer.

“There are three main types of breast cancer,” Gatti-Mays says. “The subtype is determined by the presence or absence of three receptors Molecules that receive and respond to signals, such as hormones. .” These receptors respond to the hormones Substances made in the body’s glands that signal another part of the body to react a certain way. estrogen or progesterone or a protein called HER2.

“If your tumor has estrogen and progesterone receptors, then you can be treated with hormone therapies,” says Heckman-Stoddard. These block the action of hormones that can cause certain cancers to grow.

Hormone treatments can also be used to prevent or lower the risk of cancer for certain women. One such drug is called tamoxifen. But it has side effects that make it unappealing for prevention. Heckman-Stoddard’s team is studying whether using the drug as a gel lessens the side effects.

There are newer treatment options called targeted treatments. These block specific proteins that control how cancer cells grow, divide, and spread. Targeted treatments for HER2-positive cancer have improved survival over the last decade.

The most recent type of cancer treatment is called immunotherapy. It trains your body to fight cancer using your own immune system The system that protects your body from invading viruses, bacteria, and other microscopic threats. .

“Immunotherapy is very promising, but the benefits are still limited to only some patients with triple negative breast cancer,” says Gatti-Mays. These cancers lack all three receptors. But researchers are trying to expand this treatment to more patients with breast cancer. They’re also testing whether using it in combination with other treatments will work better.

Scientists continue to look for ways to improve screening, prevention, and treatment. “In the next five to 10 years, there should be better ways for women to determine their risk of breast cancer,” says García-Closas. “That should help them have a conversation with their physicians on what will be the best tailored prevention strategies.”

No matter what your personal risk of cancer, a healthy lifestyle is the best way to prevent it. Eat a heart-healthy diet, reduce alcohol intake, don’t smoke, and get regular exercise. See the Wise Choices box and talk with your health care provider about ways to lower your risk.

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Breast Cancer Awareness Month

For nearly four decades now, the country has recognized october as national breast cancer awareness month. it is a time annually devoted to educating everyone about breast cancer — including metastatic breast cancer (mbc) — and the importance of early detection and access to timely, high-quality care..

No matter who you are or where you live, breast cancer may touch your life. It’s necessary to understand the warning signs of breast cancer, your risk of breast cancer and what’s normal for you so you can take action if there are any changes in your breasts or underarm areas.

Since 1989, Susan G. Komen has helped drive down mortality rates from breast cancer thanks to our focus on early detection and improvements in treatment. However, that progress may be in jeopardy. During the COVID-19 pandemic, many people delayed their regular breast cancer screening. The pandemic disrupted treatment and research progress.

And more progress is still needed. Through research, growing knowledge about breast cancer has led to new therapies and targeted treatments that improved outcomes for many people. It is research that brings hope to people facing this disease, especially those living with MBC. We need to ensure more treatment options are available for all people facing breast cancer, especially when treatments stop working. 

The COVID-19 pandemic also highlighted the inequities in breast cancer treatments for under-resourced communities across the country, as well as the inequity in treatment between Black and white women. Black women in the U.S. are about 40% more likely to die from breast cancer than white women.

That’s why Susan G. Komen encourages you to dedicate this October as a time of action — both for yourself and others.  

1 in 8 women will be diagnosed with breast cancer in her lifetime. That’s one person every 2 minutes in the U.S.

The two most common risk factors of breast cancer are being born female and getting older ., in 2022, it is estimated that nearly 44,000 people in the u.s. will die from breast cancer., know your risk.

Knowing your family history is lifesaving. Talk to a doctor about  your family history  and see how that history impacts your risk of breast cancer. You and your doctor can create a personalized plan to monitor for signs of the disease.

Get Screened

For those at average risk, have a  mammogram  every year starting at age 40. If you have any signs of breast cancer, finding it early and treating it early may save your life.  

Know Your Normal

It’s important to know what’s  normal for you so you can talk with your health care provider if something doesn’t look or feel right.

Make Healthy Lifestyle Choices

Living a healthy lifestyle is within your control and may lower your risk of breast cancer. Maintain a healthy weight, limit alcohol intake and exercise regularly. It all matters when it comes to your overall health and risk of disease.

Take Action

There are many ways you can join our fight to save lives. Whether it’s by supporting one of our generous   corporate partners ; becoming an Advocacy Insider; fundraising through the  Race for the Cure , MORE THAN PINK Walk  or our Komen 3-Day ; participating in a  fundraising challenge on Facebook  or  creating a fundraise r of your own that is meaningful to you, your support can help us take action to invest in research and help those facing breast cancer today.  

The  Komen Breast Care Helpline  is a free resource available for every person, including survivors, caregivers, those living with metastatic breast cancer and people who have not yet been touched by breast cancer but have questions about how to better care for themselves. The Helpline specialists and oncology social workers provide emotional support and guidance to resources and Komen’s other Patient Care Center services, such as financial assistance, access to screening and diagnostic services, and patient navigation.

1-877-GO KOMEN ( 877-465-6636 ) | [email protected] Monday – Thursday, 9 a.m. – 7 p.m. ET and Friday, 9 a.m. – 6 p.m. ET | Se habla español.

Early detection and effective treatment are critical to reducing breast cancer deaths. Together, we can end breast cancer by supporting those in need today while tirelessly searching for tomorrow’s cures. 

Breast Cancer Research Results and Study Updates

See Advances in Breast Cancer Research for an overview of recent findings and progress, plus ongoing projects supported by NCI.

Some people with no evidence of cancer in nearby lymph nodes after presurgical chemotherapy can skip radiation to that area without increasing the risk of the cancer returning, a clinical trial found. But some experts caution that more details are needed.

For women in their 70s and older, the risk of overdiagnosis with routine screening mammography is substantial, a new study suggests. The findings highlight the need for conversations between older women and their health care providers about the potential benefits and harms of continuing screening mammography.

Many young women who are diagnosed with early-stage breast cancer want to become pregnant in the future. New research suggests that these women may be able to pause their hormone therapy for up to 2 years as they try to get pregnant without raising the risk of a recurrence in the short term.

For younger women with advanced breast cancer, the combination of ribociclib (Kisqali) and hormone therapy was much better at shrinking metastatic tumors than standard chemotherapy treatments, results from an NCI-funded clinical trial show.

In a large clinical trial, a condensed course of radiation therapy was as effective and safe as a longer standard course for those with higher-risk early-stage breast cancer who had a lumpectomy. This shorter radiation course makes treatment less of a burden for patients.

Adding the immunotherapy drug pembrolizumab (Keytruda) to chemotherapy can help some patients with advanced triple-negative breast cancer live longer. In the KEYNOTE-355 trial, overall survival improved among patients whose tumors had high levels of the PD-L1 protein.

People with metastatic breast cancer whose tumors had low levels of HER2 protein lived longer after treatment with trastuzumab deruxtecan (Enhertu) than those treated with standard chemotherapy, results of the DESTINY-Breast04 clinical trial show.

NCI researchers have shown that an experimental form of immunotherapy that uses an individual’s own tumor-fighting immune cells could potentially be used to treat people with metastatic breast cancer who have exhausted all other treatment options.

Most breast cancer risk tools were developed with data mainly from White women and don’t work as well for Black women. A new tool that estimates risk for Black women may help identify those who might benefit from earlier screening, enabling earlier diagnosis and treatment.

In people with metastatic HER2-positive breast cancer, the targeted drug trastuzumab deruxtecan (Enhertu) markedly lengthened progression-free survival compared with trastuzumab emtansine (Kadcycla), new study results show.

In a large clinical trial, women with HR-positive, HER2-negative metastatic breast cancer treated with ribociclib (Kisqali) and letrozole (Femara) as their initial treatment lived approximately 1 year longer than women treated with letrozole only.

Women with early-stage breast cancer who had one or both breasts surgically removed (a unilateral or bilateral mastectomy) had lower scores on a quality-of-life survey than women who had breast-conserving surgery, a new study has found.

For women undergoing chemotherapy for breast cancer, meeting the national physical activity guidelines may help alleviate cognitive issues, a new study suggests. The benefits may be even greater for patients who were physically active before treatment.

Sacituzumab govitecan (Trodelvy) now has regular FDA approval for people with locally advanced or metastatic triple-negative breast cancer (TNBC). The update follows last year’s accelerated approval of the drug for people with TNBC.

For some people with ER-positive breast cancer, a new imaging test may help guide decisions about receiving hormone therapy, according to a new study. The test can show whether estrogen receptors in tumors are active and responsive to estrogen.

The test, which helps guide treatment decisions, was not as good at predicting the risk of death from breast cancer for Black patients as for White patients, a new study has found. The findings highlight the need for greater racial diversity in research studies.

The drug abemaciclib (Verzenio) may be a new treatment option for people with the most common type of breast cancer, with new study findings suggesting that it can reduce the risk of the cancer returning.

Fertility preservation for young women with breast cancer doesn’t increase their risk of dying in the ensuing decades, a new study affirmed. Experts said the findings support routinely offering fertility preservation to patients who want it.

Some postmenopausal women with HR-positive, HER2-negative breast cancer may not benefit from chemotherapy and can safely forgo the treatment, according to clinical trial results presented at the San Antonio Breast Cancer Symposium.

A heart-related event, like a heart attack, may make breast cancer grow faster, a new study suggests. In mice, heart attacks accelerated breast tumor growth and human studies linked cardiac events with breast cancer recurrence, researchers reported.

FDA has approved sacituzumab govitecan (Trodelvy) for the treatment of triple-negative breast cancer that has spread to other parts of the body. Under the approval, patients must have already undergone at least two prior treatment regimens.

Women with high-risk breast cancer who engaged in regular exercise before their cancer diagnosis and after treatment were less likely to have their cancer return or to die compared with women who were inactive, a recent study found.

Researchers have developed a “microscaled” approach to analyze the proteins and genetic changes (proteogenomics) of a tumor that uses tissue from a core needle biopsy. The analyses can provide important information that may help guide treatment.

Tucatinib improved survival for women in the HER2CLIMB trial, including some whose cancer had spread to the brain. Trastuzumab deruxtecan improved survival and shrank many tumors in the DESTINY-Breast01 trial, which led to its accelerated approval.

A TAILORx analysis shows women with early-stage breast cancer and high recurrence scores on the Oncotype DX who received chemotherapy with hormone therapy had better long-term outcomes than what would be expected from hormone therapy alone.

Men with breast cancer may be more likely to die of the disease than women, particularly during the first 5 years after diagnosis, a new study suggests. The higher likelihood of death was linked in part to undertreatment and later diagnosis.

In a survey of nearly 600 breast cancer survivors, researchers found that the cost of care factored into the decisions the women made about what type of surgery to get. Many women also reported never discussing costs with their physicians.

FDA has expanded the approved use of the drug ado-trastuzumab emtansine (Kadcyla), also called T-DM1, to include adjuvant treatment in some women with early-stage HER2-positive breast cancer.

Many women diagnosed with ovarian and breast cancer are not undergoing tests for inherited genetic mutations that can provide important information to help guide decisions about treatment and longer-term cancer screening, a new study has found.

FDA has approved atezolizumab (Tecentriq) in combination with chemotherapy for the treatment of some women with advanced triple-negative breast cancer. This is the first FDA-approved regimen for breast cancer to include immunotherapy.

The build-up of connective tissue around some types of cancer can act as a barrier to immunotherapy. A new study uses a bone marrow transplant drug, plerixafor, to break down this barrier and improve the efficacy of immune checkpoint inhibitors in animal models of breast cancer.

A new study in mice shows that disrupting the relationship between breast cancer cells that spread to bone and normal cells surrounding them makes the cancer cells sensitive to treatment.

In women with early-stage breast cancer, two clinical trials have shown that both whole- and partial-breast radiation therapy are effective at preventing the cancer from returning after breast-conserving surgery.

Researchers are testing a topical-gel form of the drug tamoxifen to see if it can help prevent breast cancer as effectively as the oral form of the drug but with fewer side effects.

Findings from a clinical study and a mouse study may shed light on genetic risk factors for developing cancer-related cognitive problems in older breast cancer survivors. The results suggest a gene associated with Alzheimer’s disease may play a role.

Arsenic trioxide and retinoic acid work together to target the master regulator protein Pin1, a new study shows. In cancer cell lines and mice, the drug combination slowed the growth of triple-negative breast cancer tumors.

FDA has expanded the approved uses of ribociclib (Kisqali) for women with advanced breast cancer, including new uses in pre- and postmenopausal women. It’s the first approval under a new FDA program to speed the review of cancer drugs.

Using a liquid biopsy to test for tumor cells circulating in blood, researchers found that, in women with breast cancer, the presence of these cells could identify women at risk of their cancer returning years later.

Findings from the TAILORx clinical trial show chemotherapy does not benefit most women with early breast cancer. The new data, released at the 2018 ASCO annual meeting, will help inform treatment decisions for many women with early-stage breast cancer.

Do cancer study participants want to receive their genetic test results? A recent study involving women with a history of breast cancer tested an approach for returning genetic research results and evaluated the impact those results had on the women.

Researchers compared the risk of death for women with breast cancer who had low skeletal muscle mass, or sarcopenia, at the time of their cancer diagnosis and women who had adequate muscle mass.

Some people who have been treated for breast cancer or lymphoma have a higher risk of developing congestive heart failure than people who haven’t had cancer, results from a new study show.

FDA has approved the CDK4/6 inhibitor abemaciclib (Verzenio) as a first-line treatment in some women with advanced or metastatic breast cancer. Under the approval, the drug must be used in combination with an aromatase inhibitor.

A new study in mice raises the possibility that using microscopic, oxygen-carrying bubbles may improve the effectiveness of radiation therapy in the treatment of breast cancer.

The drug olaparib (Lynparza®) is the first treatment approved by the Food and Drug Administration for patients with metastatic breast cancer who have inherited mutations in the BRCA1 or BRCA2 genes.

Joint pain caused by aromatase inhibitors in postmenopausal women with breast cancer can cause some women to stop taking the drugs. Reducing their symptoms may translate into better adherence to therapy.

A new study suggests that the cells in treatment-resistant tumors in women with metastatic breast cancer share important characteristics that could potentially make tumors vulnerable to therapies that otherwise might not have been considered.

A large nationwide clinical trial called TMIST has been launched to compare two techniques used for mammograms: tomosynthesis, often called 3D mammography, and standard 2D digital mammography.

FDA approved abemaciclib (Verzenio™) for the treatment of some people with advanced or metastatic HR-positive, HER2-negative breast cancer whose disease has progressed after treatment with hormone therapy.

Long-term results from a large clinical trial confirm that, for some women with early-stage breast cancer who have lumpectomy as their surgical treatment, a less extensive lymph node biopsy approach is sufficient.

When given at the same time, two immune checkpoint inhibitors were ineffective against breast cancer growth in mice, a new study found. The combination was more effective and safer if the two inhibitors were given in a specific sequence.

FDA has expanded its approval of fulvestrant (Faslodex®) as a standalone treatment for postmenopausal women with advanced HR-positive, HER2-negative breast cancer who have not previously undergone endocrine therapy.

Many women who receive taxane-based chemotherapy to treat breast cancer experience long-term nerve damage, or peripheral neuropathy, data from a large clinical trial show.

Researchers recognized the potential of endoxifen as a treatment for breast cancer and, with NCI support, developed the compound into a drug now being tested in clinical trials.

Researchers have used modified stem cells to deliver a cancer drug selectively to metastatic breast cancer tumors in mice. The stem cells target metastatic tumors by homing in on the stiff environment that typically surrounds them.

FDA has approved neratinib for patients with early-stage HER2-positive breast cancer who have finished at least 1 year of adjuvant therapy with trastuzumab.

Many survivors of early-stage breast cancer prefer that their oncologist handle aspects of routine medical care usually overseen by primary care practitioners, leading to concerns about gaps in care.

Results from the first large prospective study of breast and ovarian cancer risk in women with inherited mutations in the BRCA 1 or BRCA2 genes confirm the high risks estimated from earlier, retrospective studies.

Two clinical trials show that trastuzumab emtansine (T-DM1) improves survival compared with other standard treatments for patients with HER2-positive metastatic breast cancer that has progressed after treatment with other HER2-targeted drugs.

Using one of the largest collections of tumor samples from African Americans with breast cancer, researchers tried to assess the extent to which the molecular characteristics on these tumors might help to explain breast cancer disparities.

A new study shows that the number of women in the United States living with distant metastatic breast cancer (MBC), the most severe form of the disease, is growing. This is likely due to the aging of the U.S. population and improvements in treatment.

In a randomized trial, low-income women who role-played talking with their doctor about their survivorship care plan in a counseling session reported receiving more of their recommended care than women who did not get counseling.

The FDA has approved a new targeted therapy, ribociclib, and expanded its earlier approval of another targeted therapy, palbociclib, for some women with metastatic breast cancer.

Researchers have found that duloxetine (Cymbalta®), a drug most commonly used to treat depression, may also reduce joint pain caused by aromatase inhibitors in some women being treated for early-stage breast cancer.

Breast Cancer Awareness Month

Improve global diagnostic rates to reduce breast cancer mortality.

New Content Item

Breast cancer is the most common cancer worldwide. Major global inequalities in distribution and access to optimal breast cancer care has been highlighted by the WHO. In light of this and in the spirit of the political commitment to the Sustainable Development Goals Agenda , the WHO launched the  Global Breast Cancer Initiative  in 2021 with the final goal of empowering women worldwide and strengthening breast cancer control.

As part of our role  in promoting progress towards achieving the Sustainable Development Goals, BMC Cancer has curated a collection of articles that emphasize the importance of efficient global breast cancer screening programs and early diagnosis to reduce health disparities and promote breast cancer control worldwide.

  • Improvement of screening programs

Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review.  

Reece, J.C., Neal, E.F.G., Nguyen, P. et al. BMC Cancer 21, 373 (2021).

Study protocol comparing the ethical, psychological and socio-economic impact of personalised breast cancer screening to that of standard screening in the “My Personal Breast Screening” (MyPeBS) randomised clinical trial. 

Roux, A., Cholerton, R., Sicsic, J. et al. BMC Cancer 22, 507 (2022).

Patient, primary care provider, and stakeholder perspectives on mammography screening frequency: lessons learned from a qualitative study.  

Ro, V., Jones, T., Silverman, T. et al. BMC Cancer 22, 819 (2022). 

Effectiveness of educational intervention on breast cancer knowledge and breast self-examination among female university students in Bangladesh: a pre-post quasi-experimental study. 

Sarker, R., Islam, M.S., Moonajilin, M.S. et al. BMC Cancer 22, 199 (2022).

Integration of breast cancer care in a middle-income country: learning from Suandok Breast Cancer Network (SBCN). 

Chitapanarux, I., Onchan, W., Wongmaneerung, P. et al. BMC Cancer 22, 26 (2022). https://doi.org/10.1186/s12885-021-09153-0

The impact of a breast cancer educational intervention in Ghanaian high schools.  

Nsaful, J., Dedey, F., Nartey, E. et al. BMC Cancer 22, 893 (2022). 

Patient-centered research: how do women tolerate nipple fluid aspiration as a potential screening tool for breast cancer?

Patuleia, S.I.S., Moelans, C.B., Koopman, J. et al. BMC Cancer 22, 705 (2022). 

Improved automated early detection of breast cancer based on high resolution 3D micro-CT microcalcification images. 

Brahimetaj, R., Willekens, I., Massart, A. et al. BMC Cancer 22, 162 (2022). 

  • Identification of novel biomarkers

Breast-cancer detection using blood-based infrared molecular fingerprints. 

Kepesidis, K.V., Bozic-Iven, M., Huber, M. et al. BMC Cancer 21, 1287 (2021).

N-glycolylneuraminic acid serum biomarker levels are elevated in breast cancer patients at all stages of disease. 

Shewell, L.K., Day, C.J., Kutasovic, J.R. et al.BMC Cancer 22, 334 (2022). 

The blood level of thioredoxin 1 as a supporting biomarker in the detection of breast cancer. 

Lee, Y.J., Kim, Y., Choi, B.B. et al. BMC Cancer 22, 12 (2022).

Whole genome deep sequencing analysis of cell-free DNA in samples with low tumour content. 

Ganesamoorthy, D., Robertson, A.J., Chen, W. et al. BMC Cancer 22, 85 (2022).

Characterization of surface markers on extracellular vesicles isolated from lymphatic exudate from patients with breast cancer. 

Ekström, K., Crescitelli, R., Pétursson, H.I. et al. BMC Cancer 22, 50 (2022).

Inflammatory biomarkers and risk of breast cancer among young women in Latin America: a case-control study. 

Fontvieille, E., His, M., Biessy, C. et al. BMC Cancer 22, 877 (2022).

Comparison of breast cancer surrogate subtyping using a closed-system RT-qPCR breast cancer assay and immunohistochemistry on 100 core needle biopsies with matching surgical specimens. 

Janeva, S., Parris, T.Z., Nasic, S. et al. BMC Cancer 21, 439 (2021).

Meta-analysis of diagnostic cell-free circulating microRNAs for breast cancer detection. 

Sehovic, E., Urru, S., Chiorino, G. et al. BMC Cancer 22, 634 (2022).

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Breast Cancer Statistics, 2022

Affiliations.

  • 1 Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.
  • 2 Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
  • 3 Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, New York, USA.
  • PMID: 36190501
  • DOI: 10.3322/caac.21754

This article is the American Cancer Society's update on female breast cancer statistics in the United States, including population-based data on incidence, mortality, survival, and mammography screening. Breast cancer incidence rates have risen in most of the past four decades; during the most recent data years (2010-2019), the rate increased by 0.5% annually, largely driven by localized-stage and hormone receptor-positive disease. In contrast, breast cancer mortality rates have declined steadily since their peak in 1989, albeit at a slower pace in recent years (1.3% annually from 2011 to 2020) than in the previous decade (1.9% annually from 2002 to 2011). In total, the death rate dropped by 43% during 1989-2020, translating to 460,000 fewer breast cancer deaths during that time. The death rate declined similarly for women of all racial/ethnic groups except American Indians/Alaska Natives, among whom the rates were stable. However, despite a lower incidence rate in Black versus White women (127.8 vs. 133.7 per 100,000), the racial disparity in breast cancer mortality remained unwavering, with the death rate 40% higher in Black women overall (27.6 vs. 19.7 deaths per 100,000 in 2016-2020) and two-fold higher among adult women younger than 50 years (12.1 vs. 6.5 deaths per 100,000). Black women have the lowest 5-year relative survival of any racial/ethnic group for every molecular subtype and stage of disease (except stage I), with the largest Black-White gaps in absolute terms for hormone receptor-positive/human epidermal growth factor receptor 2-negative disease (88% vs. 96%), hormone receptor-negative/human epidermal growth factor receptor 2-positive disease (78% vs. 86%), and stage III disease (64% vs. 77%). Progress against breast cancer mortality could be accelerated by mitigating racial disparities through increased access to high-quality screening and treatment via nationwide Medicaid expansion and partnerships between community stakeholders, advocacy organizations, and health systems.

Keywords: breast neoplasms; epidemiology; health disparities; incidence; molecular subtype.

© 2022 The Authors. CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society.

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Get Involved > Breast Cancer Awareness Month

Breast Cancer Awareness Month 2023

October is Breast Cancer Awareness Month, an annual campaign to raise awareness of this complex disease. Each year, individuals, businesses, and communities come together to show their support for the many people affected by breast cancer. For people affected by breast cancer, awareness is not just about October. And there’s not just one way to have breast cancer. Breast cancer is complicated.

Living Beyond Breast Cancer helps people diagnosed with breast cancer understand their options, make informed decisions, and connect to people who have been where they are.  Those diagnosed are taking control of their experience by making choices that express their values and individuality. This October, Living Beyond Breast Cancer is sharing some of the ways people thrive with breast cancer and how your support today can help people impacted by breast cancer — all year long. This year’s Breast Cancer Awareness Month theme is Thrive365 .  

So many decisions

Kate shares how she is thriving through informed decision making and self-advocacy.

The cost of cancer

Keneene shares how she was able to thrive despite the financial burden of a breast cancer diagnosis and how she helps other women do same through her advocacy and work with the LBBC fund.

Turning trauma into purpose

Shangrong shares how finding community and running helped her thrive physically and mentally.

Help our community Thrive365

You have the power to make a difference.

More ways to show your support

Donations are always appreciated, but there are many ways to show your support for those diagnosed with breast cancer - from learning about breast cancer to sharing LBBC as resource to someone whose been diagnosed with breast cancer.

Quick facts about breast cancer

  • About 1 in 8 U.S. women and 1 in 833 U.S. men will develop invasive breast cancer over the course of their lives.
  • In 2023, an estimated 300,590 cases (297,790 women and 2,800 men) of invasive breast cancer , along with an estimated 55,720 new cases of ductal carcinoma in situ ( DCIS ), will be diagnosed in the US.
  • An estimated 43,780 people will lose their lives to metastatic breast cancer in 2023.
  • As of January 2022, there were over 4 million women living with a history of breast cancer in the US .
  • About 9 percent of all new breast cancer cases are diagnosed in women 45 and under .
  • Though Black women have a lower incidence of breast cancer than white women, Black women are 40 percent more likely to die of breast cancer. 

These numbers remind us there is still urgent work to do — more than we can accomplish in just one month.

The existence of Living Beyond Breast Cancer allowed me to be vulnerable, share my struggles openly, and accept support.

Leslie Ruminski

Why Living Beyond Breast Cancer?

For over 30 years, Living Beyond Breast Cancer has been a trusted resource for people with breast cancer and their loved ones. We have provided information to and a community for more than a million people. Yet, we have so much more to do. When you support Living Beyond Breast Cancer, you make an immediate, positive difference in the lives of people affected by breast cancer. Living Beyond Breast Cancer is one of the highest-ranking breast cancer organizations in the U. S.:

  • For 18 consecutive years, LBBC has earned a 4-star rating from Charity Navigator . Four stars is the highest possible ranking for financial health and responsibility.
  • Through strong financial management, we earned the Platinum Seal of Transparency from Candid (formerly GuideStar).
  • USA Today recommends LBBC as one of the top breast cancer charities for support services and education.
  • We have been awarded three competitive CDC Cooperative Agreements in a row to serve young women with breast cancer.

Advocating for change

Jamil uses her voice and personal experience to equip and educate Black women on how to thrive and tackle disparities in breast cancer care

Reclaiming what cancer took away

Claire shares how she thrives on her own terms by reclaiming her power after hair loss due to chemo.

Navigating breast cancer and bipolar disorder

Deb shares how she is thriving with metastatic breast cancer and overcoming mental health challenges

Get social: show your support

  • Add a frame to your Facebook and X (Twitter) profile pictures for the month of October. Go to twibbon.com/Support/thrive365 and click Add to Twitter or Add to Facebook to update your profile picture.
  • Share how you #thrive365 with a picture of what thriving means to you and why. Be sure to use the # and tag us @livingbeyondbc
  • Follow us on your preferred social media and re-share our stories, statistics, and posts. See our social media toolkit for sample messages and graphics and write your own posts.
  • Use one of our virtual backgrounds for your meetings during the month of October to show your support for LBBC and our community.

Show us how you Thrive365

Tag yours with #Thrive365

Featured partners

Join LBBC and Maurices for this campaign, running from September 24th through October 31st, 2023

Alexis Bittar

Alexis Bittar's jewelry and handbags sit at the intersection of art and fashion. For the 3rd year in a row, Alexis Bitta...

Ashley Stewart

Founded in 1991, Ashley Stewart is the first word in fashion serving sizes 10-36 around the country. Ashley Stewart is d...

Partner with us

There are many ways to support the breast cancer community – through financial donations, employee engagement, customer involvement, and event and cause-related sponsorship. Join over 80 corporate and industry partners to support one of the highest rated breast cancer charities in the US.  

Support resources

Breast Cancer Awareness Month can be an emotional time for many people. Some find it triggering. We see, hear, and serve the breast cancer community year-round, and we are inspired by all the ways people Thrive365.

We have compiled these support resources to help. If you would like to talk to someone who understands, reach out to our Breast Cancer Helpline  or join one of our  private Facebook Groups . You can also visit  Breast cancer resources and support  for links to organizations offering financial and practical support, support communities, resources for Black and Jewish women, and more.

Related articles

  • Understanding and naming triggers
  • Managing fear of recurrence
  • Emotional health
  • What does thriving after a breast cancer diagnosis look like?

Related blogs

  • Baring their bodies to change the conversation
  • Changing Colors
  • My story: What Breast Cancer Awareness Month means to me

Related videos

  • Supporting the whole you: From wellness to wellbeing
  • Telling stories, making meaning: Moving forward
  • Shared voices: Learning from each other

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Breast Cancer Awareness Month 2022

The International Agency for Research on Cancer (IARC) is marking Breast Cancer Awareness Month by focusing on the need for breast cancer screening worldwide and the intergenerational effects of breast cancer deaths. In 2020, female breast cancer became the most commonly diagnosed cancer type globally: about 2.26 million women were diagnosed with breast cancer, and about 685 000 women died from the disease.

With timely diagnosis and appropriate treatment, breast cancer generally has a very good prognosis. However, breast cancer survival is not uniformly high around the world. There are substantial disparities in survival between more-developed and less-developed countries, as well as between different social groups within countries. These disparities are due in part to reduced access to early diagnosis and timely completion of treatment. IARC studies the barriers to accessing diagnosis and treatment and works with stakeholders to mitigate or eliminate these issues.

IARC researchers also study the intergenerational effects of breast cancer deaths – the knock-on effects that the death of a parent or caregiver has on the bereaved family. Recent results show that the number of maternal orphans (children aged < 18 years at maternal death) due to breast cancer in sub-Saharan Africa exceeds the number of deaths from breast cancer among women in the region. These findings underline the urgent need for continued action to improve breast cancer survival in this region.

View the IARC webpage on breast cancer  

Read the article about maternal orphans and intergenerational effects  

Published in section: Actualité du CIRC

Publication date: 30 Septembre, 2022, 0:20

Direct link: https://www.iarc.who.int/fr/news-events/breast-cancer-awareness-month-2022/

breast cancer awareness articles 2022

  • Open access
  • Published: 21 April 2022

Women’s awareness of breast cancer symptoms: a national cross-sectional study from Palestine

  • Mohamedraed Elshami 1 , 2   na1 ,
  • Ibrahim Al-Slaibi 3   na1 ,
  • Roba Jamal Ghithan 4   na1 ,
  • Mohammed Alser 2   na1 ,
  • Nouran Ramzi Shurrab 4 ,
  • Islam Osama Ismail 5 ,
  • Ibtisam Ismail Mahfouz 6 ,
  • Aseel AbdulQader Fannon 6 ,
  • Malak Ayman Qawasmi 7 ,
  • Mona Radi Hawa 8 ,
  • Narmeen Giacaman 4 ,
  • Manar Ahmaro 4 ,
  • Heba Mahmoud Okshiya 9 ,
  • Rula Khader Zaatreh 10 ,
  • Wafa Aqel AbuKhalil 4 ,
  • Faten Darwish Usrof 11 ,
  • Noor Khairi Melhim 12 ,
  • Ruba Jamal Madbouh 4 ,
  • Hala Jamal Abu Hziema 6 ,
  • Raghad Abed-Allateef Lahlooh 4 ,
  • Sara Nawaf Ubaiat 4 ,
  • Nour Ali Jaffal 4 ,
  • Reem Khaled Alawna 4 ,
  • Salsabeel Naeem Abed 6 ,
  • Bessan Nimer Abuzahra 4 ,
  • Aya Jawad Abu Kwaik 13 ,
  • Mays Hafez Dodin 4 ,
  • Raghad Othman Taha 4 ,
  • Dina Mohammed Alashqar 6 ,
  • Roaa Abd-alfattah Mobarak 4 ,
  • Tasneem Smerat 14 ,
  • Nasser Abu-El-Noor 15   na2 &
  • Bettina Bottcher 6   na2  

BMC Public Health volume  22 , Article number:  801 ( 2022 ) Cite this article

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Early diagnosis is crucial to reduce the morbidity and mortality associated with breast cancer (BC). Awareness of BC symptoms plays a key role in this. This study aimed to evaluate the Palestinian women’s awareness of BC symptoms and determine factors associated with good awareness.

This was a national cross-sectional study conducted from July 2019 to March 2020 in Palestine. Convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces located in 11 governorates. A translated-into-Arabic version of the validated BC awareness measure was utilized for data collection. The awareness level was categorized based on the number of symptoms recognized into: poor (0 to 4), fair (5 to 9), and good (10 to 13).

Of 6269 approached, 5434 participants completed the questionnaire (response rate = 86.7%). A total of 5257 questionnaires were included in the analysis: 2551 from the Gaza Strip and 2706 from the West Bank and Jerusalem (WBJ). Participants living in the WBJ were more likely to be older, have higher monthly income, and suffer from more chronic diseases than participants living in the Gaza Strip.

The most frequently identified BC symptom was ‘lump or thickening in the breast’ ( n  = 4887, 92.9%) followed by ‘lump or thickening under the armpit’ ( n  = 4394, 83.6%). The least frequently identified symptoms were ‘pulling in of the nipple’ ( n  = 2665, 50.7%) and ‘change in the position of the nipple’ ( n  = 2710, 51.6%).

A total of 2191 participants (41.7%) demonstrated good awareness of BC symptoms. Participants from the Gaza Strip were more likely than participants from the WBJ to have good awareness (47.0.0% vs. 36.7%). On the multivariable analysis, being ≥ 40 years, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of having good awareness. However, living in the WBJ was associated with a decrease in the likelihood of having good awareness.

Less than half of women included in this study showed good awareness of BC symptoms. More targeted educational interventions are needed to promote Palestinian women’s awareness of BC symptoms to facilitate early diagnosis.

Peer Review reports

Introduction

Breast cancer (BC) is the most common cancer among women worldwide with 2.26 million new cases diagnosed in 2020 accounting for 24.5% of all cancers in women [ 1 ]. BC was responsible for more than 600,000 deaths in 2020; making it the leading cause of cancer-related deaths among women [ 2 ]. High-income countries have higher incidence rates of BC than low- and middle-income countries. However, low- and middle-income countries have higher mortality rates [ 3 ]. The age-standardized incidence and mortality rates of BC in Western Asia are 46.6 and 16.0 per 100,000 females, respectively. Palestine has higher incidence and mortality rates of 53.5 and 22.6 per 100,000 females, respectively [ 2 , 4 ]. BC is considered a major public health concern in Palestine, where it is the most common cancer among females and has the second highest mortality rate (12.3%) after lung cancer (17.3%) [ 4 ].

BC is highly treatable if detected early through screening programs [ 5 , 6 ]. Raising the awareness of women about the warning signs and symptoms of BC to encourage early seeking to medical advice could be another effective method for early detection [ 6 ]. This could be especially important in low-resource settings, such as Palestine [ 7 , 8 , 9 ]. In Palestine, women are first invited to undergo screening mammography at the age of 40, where they can access screening services free of discharge or at very low cost [ 10 ]. Nonetheless, some reports showed low awareness of the availability and the uptake of BC screening [ 7 , 8 , 9 , 11 ].

A previous study demonstrated low awareness of BC in the Gaza Strip [ 11 ]. However, there is still an unmet need to investigate the national awareness of BC in Palestine. Creating a baseline awareness level may help future education interventions to be more efficient and to measure the magnitude of change in BC awareness. Another point to consider while designing these interventions is the nature of BC symptoms. BC symptoms can vary significantly but can be categorized into three main categories: breast symptoms, nipple symptoms, and other symptoms. Previous studies showed that breast symptoms were the most frequently presenting symptoms of BC followed by nipple symptoms and other symptoms [ 12 ]. Consequently, education interventions should be tailored to address the differing nature of BC symptoms and their role in early presentation. This could be facilitated by evaluating the awareness of each of these categories.

This study aimed to: i) assess the awareness level of BC symptoms among women in Palestine, ii) compare the awareness level between the two major areas in Palestine: the Gaza Strip as well as the West Bank and Jerusalem (WBJ), and iii) identify the factors associated with good awareness of BC symptoms.

Materials and methods

Study design and population.

This study was a national cross-sectional study conducted from July 2019 to March 2020. The study population was Palestinian women aged 18 years and over. Recruitment of participants was done from among female visitors to Palestinian governmental hospitals, primary healthcare centers and public spaces, including malls, markets, gardens, restaurants, churches, mosques, and transportation stations. Recruitment took place in the two main geographical areas of Palestine, the Gaza Strip and the WBJ. Excluded from taking part in the study were women with a citizenship other than Palestinian, women working or studying in the field of health, healthcare and medicine, as well as those visiting oncology departments or clinics.

Sampling methods

Convenience sampling was used to recruit eligible women from the designated data collection sites, governmental hospitals, primary healthcare centers, and public spaces located in 11 governorates across Palestine. This was intended to represent the diversity of the Palestinian community in the study cohort. In 2019, the estimated female population (≥ 15 years) was 947,100 females in the WBJ and 587,271 females in the Gaza Strip [ 13 ]. With a confidence level of 95.0% and a margin of error of 3.0%, a total minimum sample size of 2132 was needed (1066 for each of the WBJ and the Gaza Strip).

Questionnaire and data collection

A modified version of the Breast Cancer Awareness Measure (BCAM) was used to collect data. The BCAM is a validated tool that was designed to measure the public awareness of BC [ 14 ]. The original BCAM was first translated into Arabic by two bilingual experts and then back-translated into English by another two different bilingual experts. The Arabic version of the BCAM was evaluated for clinical relevance and accuracy of translation by five experts in the field of BC, public health, and survey design. This was followed by running a pilot study ( n  = 35) to assess the clarity of questions in the Arabic version of the BCAM. The internal consistency of the Arabic BCAM was tested using Cronbach’s Alpha that reached an acceptable value of 0.753.

The questionnaire included two sections. The first section described the sociodemographic factors of study participants including age, menarche, parity, highest level of education, occupation, monthly income, marital status, place of residency, having a chronic disease, and knowing someone with cancer. The second section evaluated the participant’s awareness of 13 BC symptoms. Of the 13 BC symptoms, 11 were adopted from the original BCAM [ 14 ] and ‘extreme generalized fatigue’ as well as ‘unexplained weight loss’ have been added to the questionnaire since they were included in other forms of Cancer Awareness Measure [ 15 , 16 , 17 , 18 ], and it was thought that it would be helpful to include them in the context of BC. To minimize the possibility of participants answering questions randomly, the original questions evaluating the recognition of BC symptoms with yes/no/do not know responses were modified into a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Meanwhile, the participants’ responses were subsequently converted to correct/incorrect responses similar to what was done in previous studies [ 19 , 20 , 21 , 22 , 23 , 24 ].

For data collection, an electronic tool ‘Kobo Toolbox’ was used [ 14 ]. This secure tool can be used offline and online through smart phones. Participants were invited to complete the questionnaire in a face-to-face interview. Female data collectors with a medical background received a special training on how to use Kobo Toolbox and how to approach potential participants in the waiting areas at hospitals, primary healthcare centers, and public spaces on a daily basis. The inclusion of female data collectors was intended to minimize the possibility of women feeling embarrassed to answer some sensitive questions. Securing privacy was part of the training received and was carefully considered, where recruited women were interviewed in private at the designated place. In addition, all interviews were completed with the presence of the interviewer only.

Statistical analysis

The age of 40 is when women are first invited to undergo BC screening in Palestine [ 10 ]. Therefore, the continuous variable of age was categorized into two distinct groups using this cutoff: 18–39 years and ≥ 40 years. Menarche was categorized into three categories: early (≤ 11 years), normal (11–15 years), and late (≥ 16 years) [ 25 ]. Parity was also categorized into three categories: nulliparity, low multiparity [ 2 , 3 , 4 ], and grand multiparity (≥ 5) [ 26 ]. The minimum wage in the Palestinian community is 1450 NIS (about $450) [ 27 ]. As a result, this was selected as a cutoff to categorize the monthly income into two categories: < 1450 NIS and ≥ 1450 NIS.

Continuous non-normally distributed variables were described using the median and interquartile range (IQR). Categorical variables were described using frequencies and percentages. Baseline comparisons between the Gaza Strip vs. the WBJ were performed using Pearson's Chi-square test if the variable was categorical or Kruskal–Wallis test if it was continuous.

For questions based on the 5-point Likert scale, ‘strongly agree’ and ‘agree’ were considered to be correct answers whereas ‘strongly disagree’, ‘disagree’, and ‘not sure’ were considered to be incorrect answers. BC symptoms were further categorized into three categories: breast symptoms, nipple symptoms, and other symptoms. Recognition of each of the BC symptoms was described using frequencies and percentages with comparisons made by Pearson's Chi-Square test. This was followed by running bivariable and multivariable logistic regression analyses. The model of the multivariable analyses adjusted for age-group, educational level, occupation, monthly income, residency, having a chronic disease, knowing someone with cancer, marital status, and site of data collection. This model was determined based on other previous studies [ 11 , 28 , 29 , 30 ]. Results of bivariable logistic regression analyses were provided in Additional file 1 .

To evaluate the participants’ awareness level of BC symptoms, a previously used scoring system was also utilized in this study [ 19 , 20 , 21 , 22 , 23 , 24 ]. For each correctly recognized BC symptom, the participant was given one point. The total score (ranging from 0 to 13) was calculated and categorized into three categories based on the number of BC symptoms recognized: poor (0 to 4), fair (5 to 9), and good (10 to 13). Comparisons in the awareness level between the Gaza Strip vs. the WBJ were performed using Pearson's Chi-Square test. Bi- and multi-variable logistic regression analyses were also used to test the association between participant characteristics with having a good awareness level.

Sensitivity analyses were performed and included women who were married, divorced, or widowed. Bi- and multi-variable logistic regression analyses were utilized to examine the association between participant characteristics and displaying good awareness. The multivariable models adjusted for the same factors included in the main analyses in addition to parity. Results of the sensitivity analyses were provided in Additional file 1 .

Complete case analysis was used to handle missing data, which were completely at random. Data were analyzed using Stata software version 16.0 (StataCorp, College Station, Texas, United States).

Participant characteristics

Of the 6269 approached participants, 5434 participants completed the questionnaire (response rate = 86.7%). A total of 5257 questionnaires were included in the analysis (13 excluded and 164 had missing data): 2551 from the Gaza Strip and 2706 from the WBJ. The median age [IQR] for all participants was 31.0 years [24.0, 43.0] (Table 1 ). Participants living in the WBJ were more likely to be older, have higher monthly income, know someone with cancer, and suffer from more chronic diseases than participants living in the Gaza Strip.

Good awareness and its associated factors

A total of 2191 participants (41.7%) demonstrated good awareness of BC symptoms (Table 2 ). Participants from the Gaza Strip were more likely than participants from the WBJ to have good awareness (47.0.0% vs. 36.7%).

On the multivariable analysis, being 40 years or older, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of having a good awareness level of BC symptoms (Table 3 ). However, living in the WBJ was associated with a decrease in the likelihood of having good awareness.

Recognition of BC symptoms

Among all participants, breast symptoms were more often recognized than nipple symptoms. The most frequently identified BC symptom was ‘lump or thickening in the breast’ ( n  = 4887, 92.9%) followed by ‘lump or thickening under the armpit’ ( n  = 4394, 83.6%) (Table 4 ). These symptoms were also the most identified symptoms in both the Gaza Strip and the WBJ. The least frequently identified symptoms were ‘pulling in of the nipple’ ( n  = 2665, 50.7%) and ‘change in the position of the nipple’ ( n  = 2710, 51.6%). These symptoms were also the least identified symptoms in both the Gaza Strip and the WBJ.

Association between recognizing breast symptoms and participant characteristics

On the multivariable analysis, women who had benefitted from post-secondary education were more likely to identify all breast symptoms (Table 5 ). Additionally, women recruited from hospitals or primary healthcare centers were more likely than women recruited from public spaces to recognize three out of the four breast symptoms. In contrast, women residing in the WBJ were less likely than women residing in the Gaza Strip to recognize three out of the four breast symptoms.

Women aged ≥ 40 years were more likely than younger women (18–39 years) to recognize ‘puckering or dimpling of the breast skin’ (OR = 1.52, 95% CI: 1.32–1.76) and ‘redness of the breast skin’ (OR = 1.47, 95% CI: 1.27–1.69). However, women aged ≥ 40 years were less likely to recognize ‘pain in one of the breasts or armpits’ (OR = 0.80, 95% CI: 0.69–0.92).

Association between recognizing nipple symptoms and participant characteristics

Women residing in the WBJ were less likely than women residing in the Gaza Strip to recognize all nipple symptoms (Table 6 ). On the contrary, women recruited from hospitals or primary healthcare centers were more likely than women recruited from public spaces to recognize all nipple symptoms. Additionally, women aged ≥ 40 years had a higher likelihood than younger women (18–39 years) to recognize all nipple symptoms.

Association between recognizing other BC symptoms and participant characteristics

Women residing in the WBJ were less likely than women residing in the Gaza Strip to recognize all other BC symptoms except ‘unexplained weight loss’ for which no difference was noticed (Table 7 ). In contrast, women recruited from hospitals and those with post-secondary education were more likely to recognize all other BC symptoms.

Good BC awareness is associated with early diagnosis, which leads to higher survival rates [ 5 , 31 , 32 , 33 ]. Improving the awareness of BC symptoms could be especially critical in Palestine due to low resources and uptake of BC screening [ 7 , 8 , 9 ]. This study assessed the existing awareness of BC symptoms in Palestine to help in building strategies and establishing programs that work on raising the awareness of BC symptoms. Although several activities for this purpose were carried out [ 34 , 35 ], the results of this study suggest that educational interventions should be tailored more to the context of the Palestinian community. This is in concordance with the findings of Sabi and colleagues in their study, where participants who attended cancer awareness campaigns did not show higher overall knowledge about cancer warning signs and risk factors [ 36 ]. The consensus at the 12 th Breast, Gynecological and Immuno-oncology International Cancer Conference in Egypt concluded that BC awareness campaigns should consider specific disease criteria and socioeconomic status of the country [ 37 ]. This is especially important for women in the Gaza Strip, where most women diagnosed with BC have advanced stages. Moreover, patients do not have access to adequate treatment options locally and movement restrictions impede their ability to travel outside to receive cancer care [ 38 ].

Awareness level of BC symptoms

The low to moderate awareness of BC symptoms in this study is similar to the findings of Al-Mousa and colleagues among Jordanian women with 44.0% displaying good knowledge of BC symptoms [ 39 ]. Hassan and colleagues showed lower knowledge of BC in Egypt with 33.2% demonstrating good knowledge [ 40 ]. Other previous studies from non-Arab countries including China, Turkey, Nigeria, and Singapore also showed inadequate awareness of BC symptoms [ 29 , 41 , 42 , 43 ]. A study conducted in Lebanon found a higher awareness of BC symptoms than of BC treatment options and curability. The authors explained that could be due to the focus of public campaigns on the detection of BC through its symptoms not the potential to cure BC [ 44 ]. Negative beliefs and worry about a potential BC diagnosis were also found to be barriers to early diagnosis in other studies [ 11 , 20 , 45 ] Future educational interventions should focus more on clarifying the link between the recognition of BC symptoms and early diagnosis leading to higher chances of curability [ 20 ]. In concordance with this study, previous studies found that women recognized breast symptoms, especially those with lump, more often than nipple symptoms [ 12 , 46 , 47 , 48 ]. In fact, patients with non-lump symptoms were more likely to delay their medical visit [ 12 ]. This necessitates that the nature of BC symptoms should be included in the design of educational interventions aiming to raise the awareness of BC symptoms.

In comparison with another study looking at the awareness of cervical and ovarian cancer warning signs and symptoms among Palestinian women, good BC symptoms awareness in this study is relatively higher (41.7% vs. 27.4% and 17.4%, respectively) [ 21 , 23 ]. This could be due to local awareness campaigns focusing on BC rather than other cancers. Quintanilha and colleagues demonstrated the efficiency of the ‘Pink October’ in increasing the interest of the Brazilian population in searching the internet about BC awareness [ 49 ]. Another contributing factor for the better awareness of BC symptoms could be the greater incidence of BC than other cancers, which may lead to higher chances that women could know someone with BC [ 1 ]. This may drive women to read more about BC.

Factors associated with good awareness of BC symptoms

In line with this study, previous studies showed that higher education was associated with higher awareness of BC symptoms [ 29 , 43 , 48 , 50 , 51 , 52 , 53 ]. This suggests that targeting women with curricula discussing health-related topics such as BC could be an effective strategy to raise their awareness [ 11 ]. In addition, similar to this study, a study conducted in Kuwait found that participants who knew someone diagnosed with cancer were more likely to recognize BC symptoms [ 54 ]. Knowing someone with cancer might make women feel more worried about having it themselves. This feeling may encourage women to search and ask about the BC symptoms, which will be reflected as a higher level of awareness about BC symptoms [ 21 ]. Further research is needed to explore the emotional and practical driving forces of women to learn more about BC symptoms and what sources they use to enrich their knowledge.

In this study, older women were more likely to have good awareness of BC symptoms. Older women have usually been more frequently exposed to healthcare professionals than younger women for maternity care as well as sexual and reproductive health purposes than younger women.

Such visits may help older women to accumulate more information about health-related topics including BC symptoms [ 21 , 22 , 23 , 24 ]. To further investigate this, a sensitivity analysis was performed among married, divorced, or widowed women and found no association between parity and displaying good awareness of BC symptoms (supplementary table 1). However, the finding that women recruited from hospitals or primary healthcare centers were more likely to have good awareness of BC symptoms (both in the main and sensitivity analyses) indicates that the exposure to healthcare professionals and other sources of information in healthcare facilities seems to play a role in shaping women’s health literacy. Governmental hospitals and primary healthcare centers can be attended free of charge by anyone with public health insurance or at very low cost by those who do not choose to pay for the publicly available low-cost health insurance. Therefore, a broad section of the Palestinian population can be met at governmental hospitals and primary healthcare centers. Women recruited from hospitals or primary healthcare centers display health-seeking behavior by their attendance of healthcare facilities. This might reflect an interest in their health and a greater general awareness of issues around health when compared to the group of women recruited from public spaces [ 11 ]. Therefore, both, more chances to have benefitted from education by healthcare professionals as well as their own health-seeking behavior, might have provided older women and those women visiting healthcare facilities with more opportunities to enhance their awareness of BC symptoms. Thus, exposure to health education and information appears to increase BC awareness and might be an important factor to improve early detection of BC and, hence, outcomes for women suffering from BC [ 32 , 33 , 34 ].

Awareness of BC symptoms in the WBJ vs. the Gaza Strip

Women from the Gaza Strip were more likely than women from the WBJ to recognize BC symptoms. This could be explained by the lower exposure of women residing in the WBJ to healthcare professionals, therefore, they had lower chances to promote their health literacy [ 21 ]. The WBJ has checkpoints and restrictions on the internal movement, even between cities, leading to longer hours of delay to reach healthcare facilities accompanied with the fear and anxiety to come across checkpoints and settlements [ 55 ]. In addition, the WBJ has a wider geographical variation than the Gaza Strip and more women are living in rural areas in the WBJ than the Gaza Strip limiting their access to healthcare centers [ 56 ].

Future directions

The results of this study highlight the substantial need to create sustainable educational interventions to raise Palestinian women’s awareness about BC symptoms. These interventions should adopt different strategies that aim to maximize the outreach especially to women living in underserved areas. This could be facilitated by running health education activities in coordination with the mobile healthcare clinics of the Palestinian Ministry of Health that are distributed across the WBJ [ 57 ]. Education programs should include the less known BC symptoms beyond the breast lump as well as the more positive outlook on prognosis with an early diagnosis in order to improve impact.

Involving healthcare professionals in these activities should also be considered [ 37 ]. This will necessitate training Palestinian healthcare professionals on how to deliver information about health topics, including BC, in a way that is appropriate to the health literacy of the public. In addition, a special training could be implemented to improve the communication skills of Palestinian healthcare professionals so that women would have more confidence to talk about their concerns if they recognized any possible BC symptoms. The diagnosis of BC could be stressful for women and training healthcare professionals on how to handle such situations could help reduce women’s stress especially that BC patients may rely on oncologists for their diagnosis-related emotional and social issues [ 58 ].

Strengths and limitations

The major strengths of this study include the use of a translated version of the validated tool (BCAM) to assess women’s awareness of BC symptoms and the high response rate. In addition, the large sample size covering most geographical areas of Palestine may have generated the diversity of the Palestinian community in the study cohort. This study also has some limitations. The use of the convenience sampling may potentially limit the generalizability of the findings. However, the large number of study participants, the high response rate, and the diversity of geographical areas covered may mitigate this limitation. For example, the lower monthly income among women from the Gaza Strip than that of women from the WBJ mirrored the difference in the unemployment rates that are higher in the Gaza Strip than in the WBJ (47% vs. 16%) [ 27 ]. Moreover, the sociodemographics of the women included in this study were close to the demographics reported by other studies conducted in Palestine to assess awareness of various cancers [ 21 , 22 , 23 , 24 ]. Another limitation could be that the study included participants who did not experience actual BC symptoms and looked at their perceived knowledge. Finally, the recognition of BC symptoms was assessed while it might have been helpful to assess the recall of these symptoms as well.

Conclusions

Less than half of study participants (41.7%) demonstrated good awareness of BC symptoms. Participants from the Gaza Strip were more likely to have good awareness than participants from the WBJ. The factors associated with good awareness included being 40 years or older, completing a post-secondary education, knowing someone with cancer, and visiting hospitals and primary healthcare centers. The most frequently identified BC symptom was ‘lump or thickening in the breast’ followed by ‘lump or thickening under the armpit’. Future educational interventions aiming to raise BC awareness should be tailored to the needs of women in Palestine.

Availability of data and materials

The dataset used and analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

  • Breast cancer

West Bank and Jerusalem

Breast cancer awareness measure

Confidence interval

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Acknowledgements

The authors would like to thank all participants who took part in the survey.

No funding was received for this study.

Author information

Mohamedraed Elshami, Ibrahim Al-Slaibi, Roba Jamal Ghithan, and Mohammed Alser contributed equally as a first co-author.

Nasser Abu-El-Noor and Bettina Bottcher contributed equally as a senior co-author.

Authors and Affiliations

Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

Mohamedraed Elshami

Ministry of Health, Gaza, Palestine

Mohamedraed Elshami & Mohammed Alser

Almakassed Hospital, Jerusalem, Palestine

Ibrahim Al-Slaibi

Faculty of Medicine, Al-Quds University, Jerusalem, Palestine

Roba Jamal Ghithan, Nouran Ramzi Shurrab, Narmeen Giacaman, Manar Ahmaro, Wafa Aqel AbuKhalil, Ruba Jamal Madbouh, Raghad Abed-Allateef Lahlooh, Sara Nawaf Ubaiat, Nour Ali Jaffal, Reem Khaled Alawna, Bessan Nimer Abuzahra, Mays Hafez Dodin, Raghad Othman Taha & Roaa Abd-alfattah Mobarak

Faculty of Medicine, Al Azhar University-Gaza, Gaza, Palestine

Islam Osama Ismail

Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine

Ibtisam Ismail Mahfouz, Aseel AbdulQader Fannon, Hala Jamal Abu Hziema, Salsabeel Naeem Abed, Dina Mohammed Alashqar & Bettina Bottcher

Department of Medical Laboratory Sciences, Hebron University, Hebron, Palestine

Malak Ayman Qawasmi

Tulkarem Governmental Hospital, Tulkarem, Palestine

Mona Radi Hawa

Al-Shifa Hospital, Gaza, Palestine

Heba Mahmoud Okshiya

Caritas Baby Hospital, Bethlehem, Palestine

Rula Khader Zaatreh

Department of Medical Laboratory Sciences, Faculty of Sciences, Islamic University of Gaza, Gaza, Palestine

Faten Darwish Usrof

Department of Pharmacy, An-Najah National University, Nablus, Palestine

Noor Khairi Melhim

Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine

Aya Jawad Abu Kwaik

Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine

Tasneem Smerat

Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine

Nasser Abu-El-Noor

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Contributions

ME, IA, RJG, and MA contributed to design of the study, data analysis, data interpretation, and drafting of the manuscript. NRS, IOI, IIM, AAQF, MAQ, MRH, NG, MA, HMO, RKZ, WAA, FDU, NKM, RJM, HJAH, RAL, SNU, NAJ, RKA, SNA, BNA, AJAK, MHD, ROT, DMA, RAM, and TS contributed to design of the study, data collection, data entry, and data interpretation. NAE and BB contributed to design of the study, data interpretation, drafting of the manuscript, and supervision of the work. All authors have read and approved the final manuscript. Each author has participated sufficiently in the work to take public responsibility for the content.

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Correspondence to Mohamedraed Elshami .

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The Helsinki Committee in the Gaza Strip, a committee within the MoH that gives study approvals, approved this study. In addition, the Islamic University of Gaza Ethics Committee and the Human Resources Development department at the Palestinian MoH approved this study. Written informed consents were obtained from the study participants before starting the interview. All study methods were carried out in accordance with relevant guidelines and regulations. All participants were given a detailed explanation about the study with the emphasis that participation was completely voluntary, and their decision would not affect the medical care they receive. Data confidentiality was maintained throughout the study.

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Elshami, M., Al-Slaibi, I., Ghithan, R.J. et al. Women’s awareness of breast cancer symptoms: a national cross-sectional study from Palestine. BMC Public Health 22 , 801 (2022). https://doi.org/10.1186/s12889-022-13224-7

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DOI : https://doi.org/10.1186/s12889-022-13224-7

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1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. In 2023, an estimated 297,790 women and 2,800 men will be diagnosed with invasive breast cancer. Chances are, you know at least one person who has been personally affected by breast cancer. 

But there is hope. When caught in its earliest, localized stages, the 5-year relative survival rate is 99%. Advances in early detection and treatment methods have significantly increased breast cancer survival rates in recent years, and there are currently over 3.8 million breast cancer survivors in the United States. 

Awareness of the facts and statistics surrounding breast cancer in the United States is key in empowering individuals to make informed decisions about their health.

Table of Contents 

Facts & statistics Incidence statistics Statistics by age Statistics by ethnicity Survival & mortality statistics Male breast cancer statistics Facts & statistics images

What Is Breast Cancer?

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. There are many different types of breast cancer that can affect both women and men.

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To determine the extent of an individual’s breast cancer and if it has spread outside of the breast, the cancer is assigned a stage upon diagnosis . The early detection of breast cancer through annual mammography and other breast exams is the best defense against receiving a late-stage breast cancer diagnosis. Generally speaking, the earlier the cancer is detected, the greater the likelihood of a successful outcome.

Key Statistics & Facts About Breast Cancer In The United States

breast cancer awareness articles 2022

  • In 2023, an estimated 297,790 new cases of invasive breast cancer will be diagnosed in women in the U.S., as well as 55,720 new cases of non-invasive (in situ) breast cancer . 1
  • There are currently over 3.8 million breast cancer survivors in the United States. 1
  • An estimated 43,700 U.S. women will die from breast cancer in 2023. 1  
  • Risk of breast cancer recurrence depends on the type and staging of the initial breast cancer. Typically, the highest risk of recurrence is during the first few years after treatment and decreases over time. 2

Breast cancer incidence in the United States

  • 1 in 8 women, or approximately 13% of the female population in the U.S., will develop breast cancer in their lifetime. 1
  • Breast cancer is the most common cancer in American women , except for skin cancers. 1
  • It is estimated that in 2023, approximately 30% of all new female cancer diagnoses will be breast cancer. 1
  • On average, every 2 minutes a woman is diagnosed with breast cancer in the United States. 1
  • Approximately 64% of breast cancer cases are diagnosed at a localized stage , before cancer has spread outside of the breast, when it is easiest to treat. 3
  • The 5-year relative survival rate for cancer diagnosed at the localized stage is 99%. 1
  • Approximately 15% of women diagnosed have a family history of breast cancer. Those with a first-degree relative (mother, sister, daughter) with breast cancer are nearly twice as likely to develop breast cancer themselves. 4

Breast cancer statistics by age

Though breast cancer in the United States occurs primarily in middle-aged and older women, age is not the only risk factor for a breast cancer diagnosis. Many risk factors beyond age may contribute to a breast cancer diagnosis, and sometimes there are no discernable risk factors at all.

  • The average age of U.S. women diagnosed with breast cancer is 62 years old. 1
  • Half of U.S. women who develop breast cancer are 62 years of age or younger when they are diagnosed. 1
  • About 9% of all new breast cancer cases in the U.S. are diagnosed in women younger than 45 years old. 5
  • Younger people, particularly those under age 35 at the time of their original breast cancer diagnosis, face a higher risk of breast cancer recurrence. 6

Breast cancer statistics by ethnicity

In the United States, breast cancer occurs within every racial and ethnic group. However, there are variations in statistics and outcomes across the different groups. Learn more about how NBCF is addressing disparities in breast cancer .

Black Women:

  • The average age of Black women diagnosed with breast cancer is 60 years old , compared to an average age of 62 for white women. 1
  • Black women are 40% more likely to die from breast cancer than white women. 1
  • Black women have the lowest 5-year relative breast cancer survival rate of any racial or ethnic group. 1  
  • 1 in 5 Black women with breast cancer are diagnosed with triple-negative breast cancer , which is harder to treat. This is higher than any other racial or ethnic group. 1

Hispanic Women:

  • Overall, Hispanic women have a 20% lower incidence rate of breast cancer than other groups. 7
  • Hispanic women are more likely than white women to be diagnosed with breast cancer at later stages when it is more difficult to treat. 1
  • Breast cancer is the leading cause of cancer death for Hispanic women. 1

Asian, Pacific Islander, American Indian, and Alaska Native Women:

  • Asian and Pacific Islander women are more likely to be diagnosed with localized (earlier stage, more treatable) breast cancer than other groups. 1
  • Asian and Pacific Islander women have the lowest death rate from breast cancer . 1
  • American Indian and Alaska Native women have the lowest incidence rate of developing breast cancer. 1
  • Chinese and Japanese women have the highest breast cancer survival rates. 7

Breast cancer survival & mortality statistics

Breast cancer survival rates are calculated using different forms of data, including the type and staging of breast cancer at diagnosis. These rates give an idea of what percentage of people with the same type and stage of cancer are still alive after a certain time period—usually 5 years—after they were diagnosed. This is called the 5-year relative survival rate.

  • The 5-year relative survival rate in the U.S. for all types and stages of breast cancer combined is 91%. 1
  • The 5-year relative survival rate in the U.S. of localized ( early stage ) breast cancer is 99%. 1
  • Breast cancer is the second leading cause of cancer death in U.S. women, behind lung cancer. The chance that a woman will die from breast cancer is 1 in 39, or about 2.5%. 1
  • In 2023, an estimated 43,700 women will die from breast cancer in the U.S. 1
  • Breast cancer death rates have slowly decreased since 1989, for an overall decline of 43% through 2020. This is in part due to better screening and early detection efforts, increased awareness, and continually improving treatment options. 1
  • Women who receive regular screenings for breast cancer have a 26% lower breast cancer death rate than women who do not receive screenings. 5

Breast cancer in men statistics

All people are born with some breast cells and tissue, including men. Although rare, men get breast cancer too . 

  • In 2023, an estimated 2,800 men will be diagnosed with invasive breast cancer in the United States. 1
  • An estimated 530 U.S. men will die from breast cancer in 2023. 1
  • The lifetime risk of a U.S. man developing breast cancer is about 1 in 833. 1
  • Black men with breast cancer tend to have a worse prognosis, or outlook, than white men with breast cancer. 1

Awareness is the first step in making informed choices about breast health. Donate now to help NBCF support more women and men facing breast cancer in communities throughout the United States.

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1 in 8 women in the United States will develop breast cancer in her lifetime

Breast Cancer Disparities

Breast Cancer death rates are 40 percent higher among black women than white women

Sources: 1 American Cancer Society ( cancer.org ) 2 Johns Hopkins ( hopkinsmedicine.org ) 3 National Cancer Institute ( cancer.gov ) 4  BreastCancer.org ( breastcancer.org ) 5  Centers for Disease Control & Prevention ( cdc.gov ) 6  Mayo Clinic ( mayoclinic.org ) 7  National Institutes of Health ( nih.gov )

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Awareness and current knowledge of breast cancer

Muhammad akram.

1 Department of Eastern Medicine and Surgery, Directorate of Medical Sciences, GC University Faisalabad, Old Campus, Allam Iqbal Road, Faisalabad, 38000 Pakistan

Mehwish Iqbal

2 Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan

Muhammad Daniyal

Asmat ullah khan.

3 Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, RibeirãoPreto Medical School of the University of São Paulo, AV. Bandeirantes, 3900, RibeirãoPreto, 14049-900 São Paulo, Brazil

4 Department of Eastern Medicine and Surgery, School of Medical and Health Sciences, University of Poonch Rawalakot, Hajira Road, Shamsabad, Rawalakot, 12350 Azad Jammu and Kashmir Pakistan

Associated Data

Not applicable.

Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.

Breast cancer is the most common cancer and also the primary cause of mortality due to cancer in female around the World. About 1.38 million new breast cancer cases were diagnosed in 2008 with almost 50% of all breast cancer patients and approximately 60% of deaths occurring in developing countries. There is a huge difference in breast cancer survival rates worldwide, with an estimated 5-year survival of 80% in developed countries to below 40% for developing countries [ 1 ]. Developing countries face resource and infrastructure constraints that challenge the objective of improving breast cancer outcomes by timely recognition, diagnosis and management [ 2 ]. In developed countries like the United States, about 232,340 female will be diagnosed and death of 39,620 female will occur due to breast cancer in 2013 [ 3 ]. The lifetime risk of developing breast cancer in an American female is 12.38% [ 3 ]. The significant decline in morality due to breast cancer in the United States from 1975 to 2000 is attributed to constant enhancement in both screening mammography and management [ 4 ]. According to the World Health Organization (WHO), enhancing breast cancer outcome and survival by early detection remains the foundation of breast cancer regulations. Different modern medicines are prescribed to treat breast cancer. Medical therapy of breast cancer with antiestrogens such as raloxifene or tamoxifen might avoid breast cancer in individuals who are at increased possibility of developing it [ 5 ]. Surgery of both breasts is an added preventative measure in some increased probability of developing cancer in female. In patients who have been identified with breast tumor, different strategies of management are used such as targeted therapy, hormonal therapy, radiation therapy, surgery and chemotherapy. In individuals with distant metastasis, managements are typically aimed at enhancing life quality and survival rate [ 6 ]. The unpleasant side effects of breast cancer treatment are one of the most motivating factors to find some alternative methods. The use of herbs for treating the patients having breast cancer is considered a natural alternative, because some plants may contain properties that naturally have the ability to treat breast cancer [ 7 – 11 ].

Epidemiology

Currently, one in twelve females in Britain between age of 1 and 85 years gets breast cancer. With one million new cases of cancers reported in the World, breast cancer is common in females and comprises 18% of all women cancer. Incidence of breast cancer is predicted to increase to 85 per 100,000 women by 2021 [ 12 ]. In 2012, 1.67 million new cases of breast cancer were diagnosed that is 25% of all cancers among women. Ferlay et al. [ 13 ] stated that 883,000 cases are in less developed countries and 794,000 in most developed countries. According to the data, 145.2 women in Belgium and 66.3 in Poland between 100,000 suffer from breast cancer [ 14 ]. Incidence of breast cancer in the United States is one out of eight women and In Asia one woman suffers from breast cancer out of 35. In Iran, there are 10 cases in 100,000 populations and 7000 new cases have been reported annually [ 15 ]. Prevalence of breast cancer is increasing in Pakistan [ 16 – 18 ]. Breast cancer is found mostly in highly populated areas of South Asian developing counties [ 19 , 20 ]. Breast cancers in males have been detected in Northern areas of Pakistan [ 21 ]. Yang et al. [ 22 ] stated that new cases of breast cancer in China were 168,013 in 2005 and 121,269 in 2000.

Anatomy of breast

Both males and females have breasts [ 23 ]. The breast is made up of fatty tissue called adipose tissue [ 24 ]. The female’s breasts usually contain more glandular tissue than that of the males [ 25 ]. Female breasts contain 12–20 lobes which are further divided into smaller lobules [ 26 ]. These lobes and lobules are connected via milk ducts. The adipose tissue of the breast is supplied by a network of nerves, blood vessels, lymph vessels, lymph nodes, and is also composed of fibrous connective tissue and ligaments [ 27 ]. The female breast is designed to provide optimal nourishment for babies and to provide sexual pleasure for the female herself. The breasts are glandular organs that are very sensitive to hormonal changes in the body [ 28 ]. They adopt cyclic changes in synchrony with the menstrual cycle. They are closely associated with the genital system of females. Nipple stimulation enhances secretion of prolactin from the pituitary gland. This hormone also affects the uterus and can cause contractions. Lymph node draining the breast tissues is also found in the armpits. After a female has had a baby and her milk comes in, mother may develop striking swelling under arms from engorgement of the breast tissue in that region. Breasts come in all sizes and shapes, as do nipples. Most female possess one breast that slightly smaller than the other [ 29 ]. The epidermis of the areola and nipple is very much pigmented and to some extent wrinkled, and the nipple skin contains several apocrine and sebaceous sweat glands and somewhat small hair. The 15–25 milk ducts go into the base of the nipple, wherever they expand to synthesize the milk sinuses. These milk ducts functions as the carriers of milk towards the nipples [ 30 ]. Slightly under the surface of nipple, these sinuses end in cone-shaped ampullae. The spherical areola is present around the nipple and is between 15 and 60 mm in diameter. Sebaceous glands, sweat glands and lanugo hairs are present on its skin, Montgomery’s glands, are big, modified sebaceous glands with tiny milk ducts that open into Morgagni’s tubercles in the areola epidermis. Deep in the nipple and areola, several smooth muscle fibers are set circularly and radially in the dense connective tissue and longitudinally alongside the lactiferous ducts that lengthen up into the nipple. These muscle fibers are cause emptying of milk sinuses, nipple erection and contraction of areola. The greater part of the breast parenchyma expand inferiorly from the point of the 2nd or 3rd rib to the inframammary fold, which is at about the point of the 6th or 7th rib, and crossways from the border of the sternum to the anterior axillary line. The mammary tissue also expands erratically into the axilla as the glandular tail of spence. The posterior surface of the breast rests on segment of the fasciae of the pectoralis major, rectus abdominis muscles, external abdominal oblique and serratus anterior.

A global prospective

Globalization, which thus greatly characterizes our period, was primarily linked with commercial-related actions, consequently with ecological concerns, and especially in recent times with the dark truth of terrorism. Up till now the “globalization” of numerous human being actions, together with health care, has been departing on for several decades, enhancing in step with improvement in information machinery. Correctly or incorrectly, and whether planned or not, numerous clinicians in developing countries keep an eye on what Americans are achieving, or are alleged to be achieving, as “state of the art” and recent most excellent performance that ought to be copied. The actions reviewed and our current narration with transplantation of bone marrow recommends that present “standard of care” United States described interventions are inappropriate to global utilization. Unluckily, extensive deficiency of community wellbeing strategies to breast cancer has made understanding of such rights for females not viable. Impractical, deadly, and extremely expensive treatments for breast cancer cannot assist the huge number of females in the earth at danger for or who develop breast cancer [ 31 ].

Types of breast cancer

According to site, it is divided into invasive and non-invasive breast cancers

Non-invasive breast cancer

It is a cancer that has not extended away from the lobule or ducts where it situated [ 32 ]. An example of a kind of non-invasive breast cancer is ductal carcinoma in situ. Ductal carcinoma in situ appears when atypical cells develop within the milk ducts, however have not extended to close proximity of tissue or outside. The word “in situ” describes “in place.” Even though the atypical cells have not extended to tissues outer the lobules or ducts, they can progress and grow into invasive breast cancer. The normal background of every scientific unit is demonstrated and a biological understanding of the accessible information is presented. Lobular carcinoma in-situ is understood merely a risky sign moderately than a predecessor for the successive growth of invasive cancer, so that one time the judgment is made, additional operative involvement is avoidable and sequential follow-up only is suggested. The management of ductal carcinoma in-situ should be kept in mind that breast-preserving treatment is at the present considered best therapy of breast cancer, the illness we are attempting to stop [ 33 ]. The pitfalls of suggested management based on retrospective statistics are have been taken into account and the requirement to conduct clinical studies intended to establish the best possible beneficial treatment of non-invasive breast cancer is affirmed [ 34 ].

Lobular carcinoma in situ (LCIS)

This type of breast cancer develops into breast lobules [ 35 ]. The breast cancer has not extended exterior to the lobules into the breast tissue [ 36 ]. Lobular carcinoma in situ is usually identified as non-invasive breast cancer [ 37 ].

Ductal carcinoma in situ

It is the most general kind of non-invasive breast cancer, is limited to the breast duct. Example of ductal carcinoma in situ is ductal comedocarcinoma [ 38 ].

Invasive breast cancer

It exists when abnormal cells from within the lobules or milk ducts split out into close proximity of breast tissue [ 39 ]. Cancer cells can pass through the breast to different parts of the body through immune system or the systemic circulation [ 40 ]. They may move early in the development when the tumor is a minute or afterward when the tumor is huge Invasive breast cancer is most occurring general carcinoma in females. The regions of elevated threat are the prosperous populations of Australia and Europe wherever 6% of females suffer from invasive breast cancer prior to 75 years of age. The prevalence of breast cancer enhances quickly with increasing age [ 41 ]. Invasive breast cancer that extends to different organs of the body is also recognized as metastatic breast cancer [ 42 ]. Most common organ to which these cells spread are brain, bones, lungs and liver. These cells once more segregate and expand irregularly and produce new cancers. The new forming cells are developing in different part of the body, it is still breast cancer [ 43 ].

Infiltrating lobular carcinoma (ILC)

Infiltrating lobular carcinoma is also recognized as invasive lobular carcinoma. ILC originates in the milk glands (lobules) of the breast, but frequently extends to other areas of the body [ 44 ].

Infiltrating ductal carcinoma

Infiltrating ductal carcinoma is also recognized as invasive ductal carcinoma. IDC originates in the milk ducts of the breast and extends to the duct wall, invading the breast fatty tissues and probably other parts of the body [ 45 ].

Medullary carcinoma

Medullary carcinoma is an invasive breast cancer that designs a discrete margin normal tissue and medullary tissue [ 46 ].

Mucinous carcinoma

It is recognized as colloid carcinoma , mutinous carcinoma is a uncommon breast cancer created by the mucus-forming cancer cells. Females with mutinous carcinoma usually have an improved prediction than females with additional general kinds of invasive carcinoma [ 47 ].

Tubular carcinoma

Tubular carcinomas are a particular kind of invasive breast carcinoma. Females with tubular carcinoma usually have an improved prospects than women with additional general kinds of invasive carcinoma [ 48 ].

Inflammatory breast cancer

Inflammatory breast cancer is the form of swollen breasts (red and warm) with dimples and/or broad ridges due to cancer cells blocking lymph vessels or channels in the skin over the breast. Though inflammatory breast cancer is uncommon and is tremendously fast-growing [ 49 ]. Treatment involves vigilant synchronization of all multidisciplinary strategies, including radiation therapy, surgery, chemotherapy and imaging. The administration of neoadjuvant chemotherapy has accorded considerably to enhancement in general survival from the time when the earliest report of this matter and has performed the function of locoregional treatment such as radiation and surgery significant to sustained improvements in this ailment [ 50 ].

Paget’s disease of the breast

It is the uncommon type of breast cancer that usually shows visible changes to the nipple of the breast [ 51 ]. Its symptoms include red itchy rashes involving the nipple and then it can sometime spread to the normal skin as well. However it resembles with the other skin conditions such as eczema and psoriasis but it can be differentiated as the other skin conditions usually affects both the breasts and can start from the areola rather than the nipple of the breast however Paget’s disease of the breast most often affects only one breast and starts with the nipple of the breast instead of areola (breastcancercare.org.uk) Nearly 1–3% of all the breast cancers are Paget’s disease and can affect both men as well as women. The actual theory behind the pathogenesis or development of Paget’s disease of the breast isn’t clear yet however there are few theories supporting it’s pathogenesis. Their warning signs include bleeding and oozing of discharge from the nipple, flattening or inversion of nipple, lump found in the breast etc. It can be diagnosed by using punch biopsy. It’s prognosis is good if it remains within the nipple or in ducts of the breast [ 52 ].

Phyllodes tumor

Phyllodes tumors are can be either benign or malignant [ 53 ]. Phyllodes tumors develop in the connective tissues of the breast and may be treated by surgical removal [ 54 ]. Phylloides tumors are extremely uncommon; fewer than 10 females die of this kind of breast cancer every year in the United States [ 55 ].

Triple-negative breast cancer

Breast cancer is at the present extensively documented that is a heterogeneous disorder with special sub-forms, distinguished by means of their dissimilar clinico-pathological characteristics, prevision and responses to management. Triple-negative breast cancer is described by the deficiency of progesterone receptor, human epidermal growth factor receptor 2 and estrogen receptor expression [ 56 ]. This type is mainly destructive, commonly observed in premenopausal females, and is responsible for 10–15% of cases in white females, with a elevated occurrence [ 57 ].

Pathogenesis of breast cancer

The breast is a complex tubulo-alveolar organ fixed within an asymmetrical connective tissue [ 58 ], that go through a chain of alteration from child bearing age to senility. The changes seen with every menstrual cycle and pregnancy guided us to assume the occurrence of precursor cells in the mature tissue that is able of synthesizing novel duct-lobular units [ 59 ]. The typical breast architecture contains a stratified epithelium bordered by a basement membrane and fixed in a template of blood vessels, lymphatic and stromal cells [ 60 ]. In the usual breast, the stratified epithelium comprised of two dissimilar cell populations, myoepithelial and epithelial, which can be distinguished by way of immunohistochemical staining with antibodies against myosin and CK, correspondingly. It has been postulated that the creation of cellular heterogeneity in breast disorders depends on the primary developmental series of the usual breast. This heterogenicity of the breast carcinoma might happen from the neoplastic change of either myoepithelial or epithelial cell, or yet from a stem cell that has the ability to develop into myoepithelial or epithelial cells [ 61 ]. According to the oncology of breast cancer, neoplastic cells differ from the normal body cells. Normal tissues of the body have limited growth promotion and regulation which helps to keep the structure and functions of tissues usual. However, cancerous cells have prolonged and chronic proliferation without any external stimuli [ 62 ]. Cancer cells overcome the growth suppressor genes [ 63 ]. Breast cancer is a malignant disease that initiates in the breast cells. Like other malignant tumors, there are numerous causes that can increase the possibility of developing breast cancer. Injure to the deoxyribonucleic acid (DNA) and hereditary alteration can guide to breast cancer have been associated with the exposure of estrogen. Some patients inherit fault in the deoxyribonucleic acid (DNA) and genes like the P53, BRCA1 and BRCA2 among others. The patients with a family history of breast or ovarian cancer have possibility of developing breast cancer [ 64 ]. Neoplastic cells require considerable potential to multiply and convert into a massive tumor [ 65 ]. The immune system usually tries to find out cancer cells and cells with injured deoxyribonucleic acid (DNA) and demolish them. Breast cancer might be outcome of malfunction of such an useful immune defence and surveillance. Breast cancer commonly occurs due to an association between genetic and environmental factors. RAS/MEK/ERK pathway and PI3K/AKT pathway defend normal cells from cell suicide. When mutation occurs in genes that are involved in encoding of these protective pathways, the cells become unable of committing suicide when they are no longer required which then leads to development of cancer. These mutations were confirmed to be experimentally associated with estrogen exposure [ 66 ]. It was recommended that deformity in the growth factors signaling can assist growth of malignant cells. Over expression of leptinin breast adipose tissue enhances proliferation of cell and cancer [ 67 ]. These are numerous growth factors signaling and other factors that interrelate between epithelial cells and stromal cells. Interruption in these might result in development of breast cancer. In cancer cells, enzyme telomerase turns away the chromosomal shortening and allows the extensive replication of cells [ 68 ]. Tumor cells get their nutrients and oxygen supply by angiogenesis [ 69 ]. Cancer cells break their boundaries and can enter into the blood, lymphatic tissues and other tissues of the body to produce a secondary tumor [ 70 ].

Causative factors and associated risks of breast carcinoma

Breast cancer is the leading cause of death among British females who are 40–55 years of age. Breast cancer is more common in single women than in married women [ 71 , 72 ]. The breast is an estrogen sensitive organ. Many females who have been on birth control pills or estrogen replacement have found that the medications result in enlarged and often tender breasts. The activity of this medication, combined with the standard western high fat, low fiber diet, which over-stimulates breast tissue, could be a trigger for breast cancer. Incidence of breast cancer is higher in women above 50 years of age and 2 cases per 1000 are reported in this age group. Epidemiological investigations have also suggested that those women who have many children possess lower risk of breast cancer than those women who have fewer children. Incidence of breast cancer is 10.04% among all cancers and, most commonly occurs in 40–50 aged women. Mean age of breast cancer in Iranian women is 48 years [ 73 ]. An association of clinic pathological characteristic and breast cancer subtypes has been determined in Iranian women [ 74 ]. Breast cancer mostly occurs in obese women [ 75 ]. Depression is most commonly found in women with breast cancer [ 76 ]. Andsoy et al. [ 77 ] conducted a study to investigate knowledge of colorectal, cervical and breast cancer. For this study 226 working nurses were screened. It is very interesting that certain epidemiological studies have claimed that women who give birth to their child before they attain the age of 20 years are known to have decreased risk of breast cancer than those women who have not given birth to any child or who have given birth to their first child after the age of 30 years. The risk increases with age rapidly during premenopausal and slowly during post-menopausal life. Breast feeding decreases the risk of breast cancer [ 78 ]. Menopause resulting from surgical removal of ovaries (oophorectomy) decreases the risk [ 79 ]. Presence of certain kinds of benign tumours in breast increases the risk of malignancy [ 80 ]. The ovaries stop producing the female hormones once the menopause sets in, but in obese women the fatty tissue can provide the estrogen as it is capable of producing it. This increase in hormone production seems to increase the risk of breast cancer in obese post menopausal women. Deficiency of vitamin D and lack of sun exposure is considered to be the important cause of breast cancer [ 81 ]. It is found to be more in women than men [ 82 ]. The risk of breast cancer increases with age however rarely found before the age of 20 years [ 83 ]. Carcinoma in one breast can increase the risk by four times in another breast. While the patients that have the history of ovarian, endometrial or colon cancer have 1–2 times increased risk to develop breast carcinoma [ 84 ]. A female who has had breast cancer has an enhanced danger of occurring breast cancer in the other breast [ 85 ]. The minimal role of the gene has been established in the development of breast cancer. BRCA-1 (breast cancer susceptibility gene) is considered to be the cause of 5–10% of breast cancer that is transferred from either father or mother to the next generation. The study indicates that right environmental conditions are required for cancer promoting gene for expression. Certain families have been recognized with a genetically higher incidence of early onset breast cancer. If some individuals of the female’s family have had a specific kind of cancer, female may have an enhanced danger risk of breast cancer [ 86 ]. The danger is maximum if the affected family member had breast cancer at a juvenile period, had cancer in both breasts, or if female is a close family member. First-degree family members such as daughter, sister and mother are mainly significant in estimating threat. Numerous second-degree relatives such as an aunt and grandmother with breast cancer might also enhance threat. Breast cancer in a male enhances the danger for the entire close female relatives. Women who have a positive family history of breast carcinoma are 2–4 times more likely to develop the cancer, especially the females who are the carriers of BRCA1 or BRCA2 genes have the significant chance to develop carcinoma of breast [ 87 ]. Breast cancer affects both male and females; though, the prevalence is more in female as compared to male. Generally, females are at 100-fold increased danger of breast cancer than male [ 88 ]. Early menarche, nulli parity, pregnancy after the age of 30, oral contraceptives or hormone replacement therapy all these factors can increase the risk of breast cancer [ 83 ]. Steroid hormones include androgens, progesterone and estrogen, which belong to a cluster of structurally connected hormones known as sex hormones that are released into the blood by the gonads and adrenal glands. They are synthesized from single general precursor, cholesterol through a reaction catalyzed by numerous enzymes to make a large diversity of hormones for diverse target organs and tissues [ 89 ]. This procedure is well regulated and the discharge of these hormones into the systemic circulation. These hormones cross the plasma membrane to reach the target cells and bind to specific receptors called steroid hormone receptors to exert their activity [ 90 ]. Oestrogens have important activities on differentiation, growth and performance of several tissues, including urogenital system of man and women, cardiovascular system, brain, uterus and breast [ 89 ]. In accordance with this, Kato et al. [ 91 ], reported that the progression of reproductive organ cancer like prostate and breast cancer frequently occurs because of the androgens, progesterone and estrogen, which exert numerous biological activities in normal as well as abnormal cells. The study indicates that the development of normal and abnormal epithelial cells of the breast can be modulated by stromal cells of the breast and can release growth factors after stimulation by the endogenous hormones. An aromatase enzyme is found in adipose tissues, which makes estradiol from the precursor molecule, cholesterol. Fat cells are found in excess amount in breast of aged females; therefore, the quantity of estradiol is higher in breast tissues of post menopausal female than their plasma level [ 92 ]. This most likely is responsible for the increasing occurrence of breast cancer in aged female and assists the action of steroid hormones in breast cancer pathogenesis. Benign tumors and proliferative lesions without or with atypia can increase the risk of breast cancer [ 85 ]. Breast cancer has been linked with high level of dietary fats and low level of certain nutrients for various years [ 93 ]. Animal fat stimulates colonal bacterial to form estrogen from cholesterol found in the diet, thus increasing level of estrogen in the body. The body fat is also involved in synthesis of oestrone, a type of estrogen. Obesity, increased fat consumption, radiation therapy [ 94 ]. Evidence is accumulating that certain environmental pollutants contribute to estrogenic activity and may contribute to the prevalence of breast problems in the industrialized world. Alcohol consumption is linked with breast cancer risk. This association was felt to be secondary to the fact that consumption of alcohol enhances level of hormones in the blood [ 95 ].

BRCA1 and BRCA2

These are two genes that have been recognized as possessing the firm relationship with breast cancer. Both emerge to contain comparable biological activities such as DNA damage repair and, in their variant kind, they enhance the danger of breast cancer and other ovarian cancers. The preeminent knowledge accessible to date is based on a joint investigation of 22 researches, 11 which established that the prevalence of breast cancer is 65% at 70 years of age in women who acquired a BRCA1 gene and 45% in those women who are carriers of BRCA2 genes. The prevalence of breast cancer in carrier of these genes is 10–30 times more than those females that have no inherited gene variants. In spite of the big boost in breast cancer danger linked with BRCA1 and BRCA2 genes, they are responsible approximately 5% of all breast cancers, as merely 1 in 1000 females have acquired one of them. There are several tribal Subgroups in which BRCA1 and BRCA2 genes are more possible to be innate (e.g. approximately 1% of females of Ashkenazi Jewish descent have acquired increased risk BRCA1 or BRCA2 genes; analogous variants are moreover familiar in women belong to Iceland and different Scandinavian countries). Individual risk indicator as an outcome of hereditary testing for BRCA1 and BRCA2 remains a demanding experience. Almost 2000 variants have been found in the two genes (BRCA1 and BRCA2) and, for numerous; it is yet not recognized whether or not they enhance prevalence of breast cancer. One possible sign is the site of the variant in the gene; it indicates that variants in few parts of the genes might cause bigger threat of breast cancer than others [ 96 , 97 ]. Even though all females who acquire a BRCA1 or BRCA2 variant do not essentially cause breast cancer, it is uncertain what other determinants such as genetic or environmental persuade the risk of breast. There is also promising data that determinants for breast cancer might perform in a different way for carriers of BRCA1 or BRCA2 variants than for females lacking hereditary vulnerability because of these genes [ 98 ]. Literature review also recommends that high-risk genes other than BRCA1 and BRCA2 possibly enhance the risk of developing breast cancer, mainly for younger females.

Fifth most common cause of cancer death is breast cancer. The mortality and age standardized prevalence of breast cancer is higher in the United States compared to world. In Poland, seventeen percent of disease cases occur due to cancer and 14% deaths occur due to cancerous changes. Worldwide death due to breast cancer calculated in 2004 was 519,000 [ 99 ]. In the United States alone, approximately 1,208,000 cancer cases are reported per year and that some 538,000 people die from the previous manifestation of this disease condition, representing about one fifth of the total annual deaths from all causes [ 74 ].

Stages of breast cancer

According to the report of breast cancer.org Stages of the breast cancer depends upon the size and type of tumor and how much the tumor cells have been penetrated in the breast tissues [ 100 ]. Whereas stage 0 describes the non invasive and stage 4 describes the invasive kind of tumor. Descriptions of those tumor stages are:

This is the non invasive stage of tumour which indicates that both cancerous and non cancerous cells are within the boundaries of that part of the breast in which the tumor begins to grow and no evidence found of their invasion in the surrounding tissues of that part, the example of this tumour stage is ductal cell carcinoma in situ (DCIS) [ 101 ].

This stage describes as the invasive breast carcinoma and microscopic invasion is possible in this stage. It has two categories that are 1A and 1B stage. The category 1A describes the tumor which measures up to 2 cm and none of the lymph nodes are involved in it while stage 1B describes that small group of cancer cells larger than 0.2 mm founds in lymph node [ 102 ].

Stage 2 also has two categories 2A and 2B. Stage 2A describes that the tumour is found in axillary lymph nodes or in sentinel lymph nodes but no tumor found in breast. The tumor can be smaller or larger than 2 cm but not more than 5 cm. However stage 2B describes that the tumor could be larger than 5 cm but can’t reach to the axillary lymph nodes [ 103 ].

It has been divided into three sub categories that are 3A, 3B and 3C. Amongst which stage 3A describes that no tumor is found in breast but it can be found in 4–9 axillary lymph nodes or in sentinel lymph nodes while stage 3B describes that the tumour can be of any size but have caused swelling or ulcer on the skin of the breast and can have spread up to 9 axillary lymph nodes or to sentinel lymph nodes stage 3B can be considered as inflammatory breast cancer which includes red, warm and swollen skin of the breast. However stage 3C describes the spread of tumor up to 10 or more than 10 axillary lymph nodes and it also have involved the lymph nodes above and below the clavicle [ 104 ].

This is the advanced and metastatic stage of cancer and this stage describes the spread to other organs of the body that is lungs, bones, liver brain etc [ 105 ].

History and physical examination

The clinical history of patients with breast cancer is aimed at investigating cancer threat and demonstrating the occurrence or lack of manifestations indicative of breast illness [ 106 ]. It must comprise age at menarche, menopausal condition, earlier pregnancies and utilization of hormone replacement therapy after menopause or utilization of oral contraceptives. Personal history as well as family history should be carried out in detail. Personal history includes age at diagnosis of breast cancer, previous breast biopsies and treatment of other cancer with use of radiations. Family history includes history of ovarian cancers and breast cancer in first degree relatives. Patents should be examined for particular manifestations such as breast pain, weight loss, pain in bone, tiredness and nipple discharge [ 107 ]. Physical examination includes inspection of breasts, area around neck and collarbone, and armpits (axillae) carried out by clinicians [ 108 ]. Breasts are observed for any deformities such as lumps or other manifestations of breast cancer. Lymph nodes are also examined that are usually enlarged in patients with breast cancer.

Self examination

Usefulness of the breast self-examination is contentious because the advantage in conditions of reduced deaths has not been established [ 109 ]. Most physicians educate females to carry out monthly BSE to become recognizable with their usual structure and authorize them with reference to their own healthcare [ 110 ]. Women are guided for self examination of the breast cancer. Women can find abnormalities in size and shape of breast on self examination [ 111 – 113 ]. Alipour et al. [ 114 ] conducted a study to investigate the the SMS based and paper based paper learner’s satisfaction and learning effect. Gynecologists gave printed materials and text messages regarding facts of breast cancer and breast cancer tests. Doctors found higher motivation and better effects in the SMS group than the printed material group. Sreedharan et al. conducted a study in United Arab States hospitals. Self administered structured questionnaire was used to investigate practices of self examination and knowledge. Satisfactory results were found from this study [ 115 ]. Ozkan et al. [ 116 ] investigated the level of knowledge regarding self examination of the breast cancer among 113 midwifery and nursing students. These researches have shown that continuous education program about breast cancer can raise the awareness among the population. Ceber et al. [ 117 ] conducted studies on breast self examination and health beliefs of Turkish women and stated that physical illnesses and early death can be prevented by early diagnosis of breast cancer. He further stated that one out of seven patients with breast cancer is diagnosed in time. Beydag and Karaoglan [ 118 ] investigated the awareness about breast self examination in 1st and 4th years students and concluded that 4th years students have more knowledge about breast examination than the 1st years students.

Ultrasound breast imaging

There are numerous researches behind the application of adjunctive screening ultrasound in elevated hazard women with thick breast tissue, which reveals a significant but established figure of false positives [ 119 , 120 ]. There is no randomized clinical study conducted for investigation of impact of screening ultrasonography on mortality rates of breast cancer. Entire breast ultrasound might permit the Physicians to display for breast tumors not measured by long-established mammography, particularly in thick breasts wherever mammography sensitivity is lesser [ 121 ]. Ultrasound breast imaging shows the size and position of tumour whether it is filled with fluid or is solid and needs to be biopsied to rule out cancer. This examination is quickly becoming a routine procedure for diagnosing lumps in young women [ 122 , 123 ].

Nuclear medicine

It is a type of molecular imaging wherever a radioactive substance (radiopharmaceutical) is introduced to an individual and the radiation from the radiopharmaceutical is displayed by perceptive emission detectors including gamma cameras and PET detectors and gamma Cameras located exterior to the body of patient. Combination of CT and gamma camera and the combination of CT and PET is a main progress in enhancing recognition and vicinity of disease.

Single photon emission computerised tomography (SPECT)

This procedure utilizes solitary photon radionuclides including gallium-67, iodine-131 and technicium-99 m that discharge gamma rays. It is a efficient scan and is precise for organ of curiosity. It can also be employed to the entire body, is comparatively secure in expressions of radiation quantity and is fine in recognition of primary and metastatic cancers. Iodine-131 is together indicative and remedial for cancer of thyroid [ 124 ].

Positron emission tomography (PET/CT)

In expressions of radiation quantity, PET/CT is also comparatively secure and utilizes positron emitting radionuclides including oxygen-15, flouoride-18 and carbon-11. The frequently utilized tracer in positron emission tomography is a radioactive type of glucose such as [18F]fluoro-2-deoxy- d -glucose. Tissues with enhanced metabolic requirements including developing cancer cells, demonstrate increased uptake of the tracer and displays on the scan. With combination of CT and PET, significant information regarding numerous situations affecting the different organs of the body is simply mapped. PET/CT is extremely perceptive and precise for predicating occult and different areas of loco-regional lymph nodal extent and/or far-away metastases not obvious by regular imaging, therefore altering staging in up to 25% of the patients. This procedure is employed for the management planning by describing spread of primary illness. It is also employed in re-staging after management ailment relapse and treatment follow up [ 125 ].

Tumor markers

Porika et al. [ 126 ] stated that tumour markers should be measured in all stages of the breast cancer including metastasis prediction, treatment, diagnosis and screening. Thirteen verities of tumor markers of breast cancer are measured, six out of 13 are novel for the guideline. The different varieties displayed proof of clinical use and are suggested for utilization in practice [ 127 ]. It is particularly significant that the comparative autonomy of the markers in reference to other accessible markers to demonstrated so as to evade the gratuitous price and expenditure of redundancy [ 128 ]. Furthermore, it is significant that the physician be attentive of the restrictions in together specificity and sensitivity of every marker so because not to specificity and sensitivity of every marker so since not to over- or under-interpret the prognostic worth of a few investigation. With these caveats in intelligence, trial submission of tissue, germ-line and soluble tumor markers can recover medical care of individuals at threat for and with breast cancer.

It can be employed for monitoring of patients with breast cancer. High blood levels are seen in <10% of patients in the beginning of breast cancer and in approximately 70% of patients with advanced stage of breast cancer. The levels of CA 15-3 typically fall after successful management. However CA 15-3 can also be high in other types of cancers and in few non-cancerous conditions including hepatitis and benign breast conditions.

It is another marker for monitoring of patients with breast cancer. This test does not seem to be any better to identify early or advanced stage of breast cancer. This tumor marker is seen in other types of cancers and in few non-cancerous disorders.

Estrogen and progesterone receptors

For the identification of breast cancer, breast cancer tissues are investigated for estrogen and progesterone receptors including HER2 antigen. These tests give information regarding the aggressiveness of cancer and response of certain drugs used for treatment of breast cancer.

Immunohistochemistry

Immunohistochemistry (IHC) has grown to be an essential component of pathology. Although eosin and hematoxylin stain is the primary foundation for diagnostic pathology of the breast, Immunohistochemistry stains give valuable and sometimes very important information. Furthermore, taking into consideration the part of hormonal treatment in hormone receptor–positive breast tumors, as well as the accessibility of targeted chemotherapeutic drugs for HER2-positive patients, Immunohistochemistry knowledge indicates a key element of workups. Careful use of Immunohistochemistry stains in combination with E & H test assists determine mainly diagnostic matters encountered by clinicians during their routine practice. Clinicians should be well-known to utilize the each immunostain and its restrictions to evade errors in interpretation. Immunohistochemistry stains assists in differential diagnosis of challenging epithelial disorders of the breast. They should be selectively and sensibly utilized and their results must be understood with the differential diagnoses in consideration and with an understanding of potential drawback [ 129 ].

MRI and breast cancer

Mammography has been considered as an appropriate screening method for breast cancer detection for many years [ 130 ] but it can’t distinguish between the solid and cystic masses and can miss up to 10–15% of the cases however MRI provides more accurate results and clear benefit to the women who are developing breast cancer due to the BRCA1 and BRAC2 genetic mutation and are present with the axillary lymph adenopathy [ 131 ].

Breast biopsy

Breast biopsy is the simply best technique for diagnosing breast cancer [ 132 ]. There are numerous different types of breast biopsies. To enhance diagnostic precision and get rid of as many false negative results as possible, breast imaging, clinical breast examination and biopsy are performed concurrently (triple test).

Fine needle aspiration

A thin prickle is employed to get cells from the abnormal area or a breast lump [ 133 ]. Ultrasound can be used to assist direct the prickle. A restricted anesthetic might be used to anesthetize the region where the prickle will be inserted [ 134 ].

Core biopsy

A wider prickle is to get a portion of tissue (a core) from the abnormal area or breast lump [ 135 ]. It is typically made under restricted anesthetic, thus breast is insensitive, while patient may experience little hurt or uneasiness at what time the anesthetic is given [ 136 ]. MRI, ultrasound and mammogram can be used to guide the prickle for the duration of core biopsy [ 137 ].

Vacuum-assisted stereotactic core biopsy

In this core biopsy, different tiny tissue samples are taken via single tiny incision in the skin with a prickle and a suction-type device [ 138 ]. It is carried out using local anaesthetic. MRI, ultrasound or a mammogram may be employed to direct the prickle into position. The patient may experience little uneasiness during the process [ 139 ].

Surgical biopsy

If the abnormal vicinity is too minute to be biopsied by another procedure or the biopsy outcome is not apparent, a surgical biopsy is carried out. Prior to the biopsy, a guide wire may be placed into the breast to assist the medical doctor locate the abnormal tissue. Local anesthetic can be used and the physician may use MRI, ultrasound and mammogram to direct the wire into position. The biopsy is after that carried out under a general anesthetic. Little area close to breast tissue and lump are detached, alongside the wire [ 140 , 141 ].

Digital mammography

It helps to find lumps in dense tissue. The image can also be easily stored and transmitted to another radiologist for a second opinion [ 142 – 144 ]. Tarhan et al. [ 12 ] stated mammography may give false negative and false positive results in patients with dense breast tissues. Kanaga et al. [ 145 ] stated that the practice of mammography is 19% in Malaysian women as compared to other study which was 10.5%. Lack of health insurance coverage, low income and embracement were the main barriers to mammography as mentioned in earlier studies. Mammography is considered as the gold standard test for early detection of breast cancer [ 146 ] but in case of scarce resources in some areas in breast health awareness program should be promoted for the early detection of breast cancers and the staff should also gets the training of clinical breast examination so that the patient get diagnosed at earlier stage especially in those areas where mammography is unavailable [ 147 ].

PEM and MRI in breast cancer patients

Hence both the positron emission mammography and magnetic resonance imaging have proven breast cancer detection sensitivity, however hormone replacement therapy, post menopausal status and breast tissue density has no influence on the sensitivity of PEM and MRI. Positron emission mammography can be used as an alternative of MRI in patients who don’t want to have an MRI due to multiple reasons such as time issues, limited budgets, lack of interest, claustrophobia (fear of being kept in as small space) [ 148 ]. However, both have the similar sensitivity to detect cancerous lesions comprehending invasive and ductal carcinoma in SITU [ 149 ].

In the management of breast cancer, aim is to preserve quality of life with prolonged life expectancy. The use of bioflavonoids may inhibit estrogen formation [ 150 ]. Effective communication between doctors and patients plays an important role to improve clinical outcome. Oshima et al. [ 151 ] reported that effective communication between doctors and patients is effective. A study conducted in Japan indicates that this communication helps the patients to cope with adverse effects. Doctor patient communication enhances the quality of life of breast cancer patients [ 152 ]. Previous studies have shown that less exposure from radiations, higher family monthly income, long years after diagnosis, higher education, initial stage cancer and younger age were considerably related with better quality of life (QOL) in patients with breast cancer [ 153 ]. Breast cancer is less common in breast feeding women, but the protective effect of this factor is not clearly investigated [ 154 ]. Cancer is a fatal disease affecting humankind in every country. Vinblastine and vincristine was introduced in 1961 as anti cancer drugs. CIPLA has improved the process of isolating vinblastine and vincristine in the World [ 155 ], and India is exporting these alkaloids to European countries and the demand is steadily increasing. The main forms of treatment for cancer in humans are surgery, radiation and chemotherapeutic agents. The drugs can often provide temporary relief of symptoms, lengthening of life and occasionally cures the disease. Many hundreds of chemical drugs of known classes of cancer chemotherapeutic agents have been synthesized [ 156 ]. The activity of these compounds is based on their capacity for biological alkylation. The effective dose of such alkylating agents was almost the same as the toxic dose. Multi-targeted therapy could be more effective, because the recurrence rate of cancer is high and death occurs due to metastasis. Deng et al. [ 157 ] reported that Pemetrexed and Lobaplatin is prescribed in metastatic breast cancer. Huang and Cao [ 158 ] reported that cantharidin sodium injection is effective in the management of breast cancer. Cantharidinate sodium injection is herbal origin and is prepared in China for treatment of breast cancer. Breast cancer management strategies differ depending on the step of the cancer—its mass, place, whether it has extended to other organs of the body and the physical condition of the individual. Present management for breast cancer includes targeted therapies, hormonal treatment, radiation therapy and surgery.

Psychological adjustment to breast cancer

Breast cancer is extremely common and very worrying experience for numerous females every year in developing and developed countries [ 159 ]. Psychological research has given an image of the emotional and community impact of breast cancer on females’ lives, and of factors linked with better versus worse amendment. Psychosocial mediations have been helpful in reducing patients’ grief and improving their life quality. Current study also recommends that psychological aspects might be associated with potentially significant biological ailment linked processes. Additionally, to giving an idea of the psychological aspects in breast cancer, investigation in this vicinity has given a foundation for further studies on adjustment to health-related nervous tension in common [ 160 ].

This is the foremost management strategy for individuals whose breast cancer has not extended to further areas of the body and is also a choice for further complex stages of the illness [ 161 – 163 ]. The kinds of breast cancer surgery vary in the quantity of tissue that is excised with the cancer; this depends on the cancer’s characteristics, whether it has extended, and the patient’s special feelings. A few of the most familiar kinds of surgery include:

Lumpectomy (breast conserving surgery)

Some patients diagnosed with breast cancer undergo some type of surgery [ 164 ]. According to American cancer society, lumpectomy or partial mastectomy is the procedure of removing the part of the breast that contains malignant tumor along with some healthy tissues and surrounding lymph nodes leaving the major part of the breast intact as possible [ 165 ]. This practice generally experienced in women that are in their initial phase of cancer, however the patient also requires another type of treatment such as radiation therapy, chemotherapy or hormone replacement therapy along with this procedure. Most surgeons and patients prefer lumpectomy initially rather than having the complete breast removal, especially if the patient is more concerned about losing her breast [ 166 ]. However, adverse effects of lumpectomy are tenderness, temporary inflammation, sclerosis and changed appearance of breast, etc [ 167 ].

Mastectomy is done to decrease the risk of development of breast cancer [ 168 ]. Bilateral prophylactic mastectomy decreases the chances of development of breast cancer but does not eliminate the risk of developing cancer completely [ 169 ]. Aromatase and tamoxifen decreases the risk of contra-lateral breast cancer and it is considered more effective than contra lateral prophylactic mastectomy [ 170 ]. Mastectomy is considered the most effective method of dealing with an already diffused case of breast cancer, for which a lumpectomy was not decisive enough. Nevertheless, the loss of breast leads to feeling of asexuality and loss of self-image and consequent depression in most women [ 171 ].

Reconstructive surgery

Females who have a mastectomy might as well have breast renovation, either immediate reconstruction or delayed reconstruction. It is performed to get better the look of the breast following tumor surgery. All females having a mastectomy must be presented the option to converse reconstructive surgical treatment [ 172 ]. Mastectomy is a comparatively simple surgical practice that typically results in stay in hospital for 1–2 days. Deficiency of the breast mass changes the patient’s special look and can create wearing a few forms of clothing difficult. The utilization of an exterior prosthesis to tackle these problems can be awkward and scratchy, particularly for females with huge breasts. Though, the most significant issue of mastectomy is the psychosocial effect of the physical and aesthetic distortion, which can comprise nervousness, sadness, and negative impacts on body figure and on sexual activity [ 173 ]. Breast reconstruction is commonly requested by females with breast cancer who are unable for breast-conserving treatment and females with an increased hereditary danger for breast cancer. Existing breast reconstruction procedures are miscellaneous and might engage the utilization of prosthetic implant or an autologous tissue flap, or both. Despite of the method employed, cancer might relapse in the reconstructed breast; additionally, in autologous tissue flaps reconstructed breasts, little complexity such as fat necrosis may take place. Researches recommend that breast reconstruction restores body representation, proves vigor, femaleness, and sexuality; and optimistically influences the patient’s feelings of comfort and life quality [ 174 ].

Ovarian ablation as adjuvant therapy for breast cancer

Ovarian ablation has been employed as management for breast cancer [ 175 ]. There are numerous techniques of ovarian ablation such as radiation induced ablation, surgical removal of ovaries and chronic utilization of luteinizing hormone-releasing hormone (LHRH) analogs. Additionally, there are few proposals that cytotoxic chemotherapy might perform by inducing ovarian ablation in premenopausal females with breast cancer. Of the abundant case series and clinical studies of ovarian ablation conducted in the earlier period, numerous have been laden with methodologic issues. Meta-analysis of randomized clinical studies demonstrates a momentous enhancement in overall survival and disease-free survival for females whose ovarian ablation were performed as adjuvant treatment compared to those females who did not. Literature review indicates that ovarian ablation may be employed an alternative therapy for breast cancer [ 176 ].

Role of estrogen and progesterone receptors in the management of breast cancer

The estrogen receptor assay has developed into a typical practice in the treatment of complex breast cancer [ 177 ]. Tumors missing estrogen receptor react occasionally to endocrine treatment, while improvement proportions of 50–60% are seen in estrogen receptor positive tumors. Current researches demonstrate that the estrogen receptor condition of the principal cancer is a superior interpreter of the endocrine reliance of metastatic cancers at the moment of clinical deterioration. Additionally, the deficiency of estrogen receptor in the primary cancer is an significant self-regulating predictive display of higher incidence of relapse and shorter survival. Quantitative investigation of estrogen receptor and an analysis for progesterone receptor are two procedures for enhancing the precision of selecting or rejecting individuals for hormonal treatment; cancers with a elevated quantitative estrogen receptor amount or those with a positive progesterone receptor show the maximum response. Initial investigation demonstrates that the existence of progesterone receptor might be a improved indicator of tumor hormone dependence than quantitative estrogen receptor [ 178 ].

Anti-estrogen therapy

It can be used in such types of cancers that are affected by hormones and the tumor has hormone receptors such as estrogen receptors. Clarke et al. [ 179 ] stated that the most common category of drugs that are used in breast cancer is anti estrogen, which includes the agents that are (tamoxifen, raloxifene, toremifene etc). Tamoxifen inhibits the hormone oestrogen from entering into cells of the breast cancer. This mechanism inhibits the breast cancer cells from developing. Tamoxifen can be suggested to treat female of any age group. However tamoxifen is considered as the drug of choice in women that have positive estrogen receptor breast carcinoma. Tamoxifen is a selective estrogen receptor modulator (SERMS) and acts like estrogen on other parts of the body such as uterus. However, it demonstrates anti estrogen properties of breast tissues and competes with estrogen for binding to the estrogen receptors in the breast [ 180 ]. If we have to discuss about the toxic effects of anti estrogen therapy, comparatively there is very least toxicity found in it as compared to other cytotoxic drugs [ 181 ]. While some patients withdraw the treatment before completing the course of drug due to the side effects such as hot flushes, gastro intestinal problems and vaginitis etc. Though, the medical indications for discontinuing antiestrogen therapy include adeno carcinoma, sarcoma and thrombo embolic diseases etc. Any how the American society of clinical oncology recommends Tamoxifen as standard adjuvant therapy for patients with Estrogen positive breast carcinoma [ 182 ]. On the other hand Fulvestrant; Faslodex has entirely anti estrogenic action and is considered as estrogen antagonist it demonstrates anti neo plastic activities in breast tissues without having a positive effect on the uterus and bones, which may lead to certain side effects if taken for a long period of time such as osteoporosis [ 183 ]. Tamoxifen and raloxifene are selective estrogen receptor modulators (SERMs), a set of medicine that selectively prevents or motivates oestrogen-like activity in different tissues, affecting the estrogen receptors [ 184 ]. Tamoxifen exhibits its oestrogen antagonist action in numerous tissues such as uterus, liver, bone and breast [ 185 ]. It was used as adjuvant treatment in estrogen receptor positive patients and tamoxifen was accepted by the United States Food and Drug Administration (FDA) in 1998 for the impediment of breast cancer for females at elevated danger [ 186 ]. This verdict was based on the outcome of a experiment carried out by the United States National Cancer Institute that was interrupted premature as an intervening study indicated that tamoxifen decreased breast cancer prevalence by approximately one half [ 187 , 188 ]. Four big prospective studies have investigated the efficacy of tamoxifen versus placebo for breast cancer danger decline for females at elevated danger of breast cancer [ 189 ]. A summary of these studies demonstrated a 38% general decline in breast cancer occurrence for females at increased danger of breast cancer who administered tamoxifen for the period of 5 years and also indicated that tamoxifen inhibits only estrogen receptor positive breast cancers (RR ~ 50%) with no influence on estrogen receptor negative breast cancer [ 190 ]. A variety of adverse effects have been reported for females taking tamoxifen, such as venous thrombosis, cataract, endometrial cancer, menstrual disorders and hot flushes. A study indicated that the risk decreasing activity of tamoxifen expands beyond the vigorous management phase of 5 years, and remains for minimum 10 years, whereas the majority of adverse reactions do not carry on behind the 5 year management duration [ 191 ]. Raloxifene, has also been revealed to decrease danger of breast cancer, however seems to exert some adverse reactions [ 192 ]. During the precedent periods, clinical studies carried out to investigated the efficacy of raloxifen on fracture and osteoporosis, showed a 44–76% risk decline of breast cancer prevalence in the raloxifen treated patients as compared to the placebo group [ 193 ]. A randomized clinical study of Raloxifen and Tamoxifen was planned for comparing the efficacies of raloxifen and tamoxifen on postmenopausal females with an enhanced 5-year threat of breast cancer as expected by the Gail model [ 194 , 189 ]. The study demonstrated that raloxifen was comparable to the tamoxifen in decreasing the threat of invasive breast cancer and was linked with a minor danger of cataract and thromboembolism than tamoxifen. In 2007, approximately 10 years following the endorsement of tamoxifen, the FDA permitted raloxifen for the impediment of breast cancer for postmenopausal females with osteoporosis and for postmenopausal females at increased danger for breast cancer. In Australia, tamoxifen is prescribed for the treatment of breast cancer and osteoporosis.

Aromatase inhibitors

These are compound designed for decreasing oestrogen formation by targeting aromatase, the enzyme complex accountable for the last stair in the formation of estrogen [ 195 ]. The third-generation aromatase inhibitors including letrozole, exemastane and anastrozole are in present utilization [ 196 ]. Randomized clinical trial conducted for investigation of these agents in the treatment of breast cancer has indicated that these compounds contain an outstanding effectiveness in treating females with advanced disorder. Clinical study indicated that females managed with aromatase inhibitors had a superior contra lateral breast cancer threat decline than females managed with tamoxifen [ 131 ].

Radiation therapy

It is useful for reducing the necessity of mastectomies. A combination of a lumpectomy and radiation therapy is being increasingly used over a mastectomy in the early stages of breast cancer [ 197 ]. A study was conducted in India. For this study 135 women were selected, most of them had undergone mastectomy. At the time of analysis, there was no local recurrence after hypo fractioned radiation therapy and metastatic disease developed in only four patients [ 198 ]. Zhou et al. [ 199 ] reported that radiation therapy is effective in early breast cancer patients. This study was conducted on 143 women who underwent either routine or intra operative radiation therapy after breast conserving surgery. At 54 months of follow up, there was a significant local control of the tumour. High-energy rays from radiation therapy kill cancer cells. This therapy affects only the cells that are treated. Use of radiation therapy may be done after breast cancer surgery to destroy the remaining cells in the chest area.

Brachytherapy

It is a kind of radiotherapy [ 200 ]. It might be recognized as accelerated partial breast irradiation. It directs radiation merely to the area around the vicinity wherever the cancer was. This might replace the requirement to provide radiation to the whole breast. It also decreases the number of management sessions [ 201 ].

Chemotherapy

The process of killing cancer cells by using certain medicines is termed as chemotherapy [ 202 , 203 ]. It can be given in both situations, before and after surgery, depending upon the condition of the patient. According to the American cancer society the medicines include in chemotherapy are Docetaxel, Paclitaxel, Platinum agents (cisplatin, carboplatin), Vinorelbine (Navelbine), Capecitabine (Xeloda), Liposomal doxorubicin (Doxil), Cyclophosphamide (Cytoxan), Carboplatin (Paraplatin) etc [ 204 ]. However it has various side effects [ 205 ]. Metastatic or secondary breast can is difficult to treat but it can be controlled and sometime for various years [ 206 ]. Chemotherapy can be prescribed to manage metastatic breast cancer to minimize or sluggish its development. It can also be administered to decrease some manifestations. Other treatment option can be initiated prior or alongside chemotherapy.

Taxol is used clinically in the treatment of ovarian cancers and is undergoing clinical trials against metastatic breast cancers [ 207 ]. It may also have potential value for lung, head and neck cancers. Taxotere is a side chain analogue of taxol, which has also been produced by semi synthesis from 10-deacetyl-baccatin III [ 208 ]. It has improved water solubility, and is being clinically tested against ovarian, and breast cancers. It can be used in those where resistance to cisplatin has been observed [ 209 ].

Anthracyclines

Anthracycline are commonly prescribed in the treatment of breast cancer [ 210 ]. They impede with enzymes associated the DNA copying, which is desired for cells to separate to create new cells. Epirubicin and doxorubicin are the most commonly used medicines in breast cancers. There is proof that anthracyclines functions better than various other chemotherapy medicines [ 211 ]. However these have adverse reactions such as damage to the heart and loss of hair [ 212 , 213 ]. Prior to start of medicines, patient should converse with clinician any probable adverse reactions of drugs used and how these medicines might influence life quality.

Thermochemotherapy

Medifocus heat management in combination with chemotherapy enhanced the shrinkage of median cancer in the thermochemotherapy arm to 88.4%, whereas for chemotherapy alone the shrinkage of median cancer was 58.8%. For the thermo-chemotherapy management arm, approximately 80% of breast cancers had a cancer size decrease of 80% or more, compared to merely 20% for the chemotherapy alone [ 214 ].

Complementary therapies

Women with breast cancer occasionally desire to use complementary therapies along with their medical therapy [ 215 ]. These therapies are usually not investigated in randomized clinical trials [ 216 ]. Some female believe that they have benefited from a number of these treatments [ 217 ]. Vitamins, nutritional supplements, yoga, meditation, visualization, traditional medicines and acupuncture are included in complementary therapies.

Medicinal plants

Screening of plant extracts for anticancer activity started in 1961 by National cancer institute in the USA, and up to 1981 (20 years) about 1,14,045 plants had been screened of which only 3.4% (representing about 3400 different species) have been observed to be active in one or more biological systems.

Ganoderma lucidum (Polyporaceae)

It contains ganoderic acid, ganoderic acid G, ergosta, ergosterol peroxide ganoderic acid G, ergosta, ergosterol peroxide, methyl ganoderate A, B, ganoderic acid C2. It is an anticancer [ 218 ]. Jiang et al. [ 219 ] reported that the Ganoderma lucidum suppresses growth of breast cancer cells through the inhibition of Akt/NF-kappa B signaling. It is used to treat cancer cells. It inhibits the transcription factor NF-kappa B and inhibits the invasive behavior of breast cancer cells. The exact mechanism for inhibition of cancer cells is not understood. The study showed that the proliferation of breast cancer MDA-MB-231 cells is inhibited and Akt/NF-kappa B signaling is suppressed. Phosphorylation of Akt at Ser473 is suppressed by this plant and expression of Akt is suppressed, as a result NF-kappa B activity in MDA-MB-231 cells is inhibited.

Momordica charantia (Cucurbitaceae)

The parts used are fruits, leaves and seeds. It contains glucoside, albuminoids, fatty acids, non polar lipid, linolinic acid, palmitic acid, myrtenol, hexenol, benzyl alcohol, acylglycosylsterols and glycoproteins [ 220 ]. It is hepatoprotective, tonic, stimulant, emetic, laxative, stomachic and cancer [ 221 ]. It is used to treat gout and rheumatism. Ray et al. [ 222 ] reported that Momordica charantia extract inhibits breast cancer by modulating cell cycle regulatory genes. This study was conducted in vitro models. An extract of this plant was investigated in human breast cancer cells, MCF-7 and MDA-MB-231, and primary human mammary epithelial cells. This extract was able to decrease cell proliferation and apoptotic cell death was induced. Survivin and claspin expression was inhibited by this extract.

Carthamus tinctorius (Asteraceae)

The parts used are flowers and seeds. It contains palmitic acid, hexadecanolenin, coumaric acid, daucosterol, apigenin, kaempferol, trans-3-tridecene-5, 7, 9, 11-tetrayne-1, 2-diol, trans-trans-3, 11-tridecadiene -5, 7, 9-triyne -1, 2-diol [ 223 ]. It is used in colds, flu, fevers, hysteria, anemia, and diabetes mellitus. It is an antioxidant [ 224 ] and alpha glucosidase inhibitor [ 225 ]. Loo et al. [ 226 ] reported the efficacy of this plant in breast cancer. MDA-MB-231 breast cancer cell and normal human mammary gland cell were treated with a compound that contains Carthamus tinctorius. This compound observed inhibition of cell proliferation. Inhibition of cell proliferation was dose dependent. Its cytotoxic activity was more than commonly used cytotoxic drugs.

Viscum album (Viscaceae)

Part used are leaves and stem. It contains sinapylflavanone, glucopyranoside, flavanone, hydroxy flavanone and viscin [ 227 ]. It is antioxidant, cardiac tonic, and anti-cancer [ 228 ]. It is used in palpitation, vascular spasms, asthma, dizziness, vertigo and headaches. Gunver et al. [ 229 ] reported the efficacy of this plant in breast cancer.

Calendula officinalis (Asteraceae)

The parts used are leaves. It contains triterpene, calendula glycoside, butyl ester, flavonol glycosides, and carotenoids [ 230 ]. It is anti-inflammatory and anti-cancer [ 231 ]. It is used in carcinoma of the vagina, and cervix. Pommier et al. [ 232 ] reported the efficacy of Calendula officinalis for the prevention of acute dermatitis during irradiation for breast cancer.

Citrullus colocynthis (Cucurbitaceae)

The parts used are seeds and fruit. It contains phytosterol, flavones C-glycosides, saponins, aspartic acid, arginine, colocynthin, colocynthitin and cucurbitacin glycosides [ 233 ]. It is used in constipation and carcinoma of the breast [ 234 ]. It is an emmenagogue, ecbolic, cathartic, hydragogue and antioxidant [ 235 ]. This plant has growth inhibitory activity. Cucurbitacin glucosides have been isolated from this plant. These glycosides prevent human breast cancer cells [ 234 ].

Indole-3-Carbinol (13C)

A compound known as indole-3-carbinol, which is a plant chemical derived from cruciferous vegetables such as Brussels sprouts and cabbage, changes the way estrogen is metabolized. This compound predictably alters the endogenous estrogen metabolism towards increased catechol estrogen production and may thereby provide a novel dietary means for decreasing risk of breast cancer [ 236 ].

Silibinin and Chrysin

Previous research indicates that chrysin and silibinin function synergistically and possess significant anti-cancer activities against T47D breast cells [ 187 , 188 ]. It shows potential that the synergistic efficacy is based, at least in part, by down-regulation of hTERT and cyclin D1. Their potential activities in the established synergism among Chrysin and Silibinin should be verified by additional in vitro or in vivo researches. Study demonstrates that Chrysin and Silibinin combined might come out as an eye-catching approach based on herbal medicine for the management of breast cancer [ 237 ].

Lactobacillus acidophilus

Breast cancer and hyperestrogenism may be decreased by the inclusion of lactobacillus acidophilus in the diet. This useful bacterium helps to metabolize estrogen properly in the bowel. Clinicians can prescribe lactobacillus acidophilus that is available in different forms, including capsules in patients with breast cancer [ 238 ].

Women with breast cancer have been shown to possess selenium levels that are lower than those of women without cancer. Selenium is a trace mineral that is often lacking in refined food diets. A contrary association exists among the prevalence of human breast cancer and concentration of dietary selenium. The adding of Selenium to the food has been revealed to reduce the occurrence of breast cancer [ 239 ].

Targeted therapies

These are drugs prescribed to manage some types of breast cancer. The mainly familiar targeted treatment is the drug Herceptin [ 240 ]. It is prescribed to manage HER2 positive breast cancer. It functions by preventing the cancer cells from developing and progressing [ 241 ].

Gene therapy for carcinoma of the breast

Gene therapy is a remedial strategy that is considered to correct particular molecular deformities associated with the progression or development of breast cancer [ 242 ]. Mutated BRCA1 and p53 genes recognized as cancer susceptibility gene are involved in progression of cancer [ 243 ]. Since mutational inactivation of gene activity is reserved to cancer cells in these contexts, cancer gene modification techniques may give an opening for selective targeting without major hazards of normal, non-cancer cells [ 244 , 245 ]. Both BRCA1 and p53 emerge to restrain tumor cells that lack mutations in these genes, indicating that the so-called gene modification techniques may contain broader efficacy than previously considered. Raising awareness of cancer genetics has recognized these and new genes as possible targets for gene substitute treatment [ 246 ]. Early patient study of BRCA1 and p53 gene therapy have given a number of indications of possible effectiveness, but have also recognized areas of clinical trials that are wanted prior to these therapeutic strategies may be broadly employed in patients with breast cancer [ 247 ].

Oncogenes inactivation

Numerous oncogenic proteins have been recognized and linked with a variety of cancers [ 248 ]. The frequently practical strategy in clinical studies is the employment of antisense options. Oncogenes transcription also can be prevented by means of adenoviral gene E1A, which hinder erbB-2 transcription, an option helpful in managing cancer that over express this oncogenic protein [ 249 ].

Augmentation of cancer suppressor genes

The mutations in tumor suppressor genes are linked with the development of numerous cancers. Some clinical studies are being conducted to deliver p53 via adenoviral vectors to different cancers. Likewise, viral vectors have been used to administer a breast cancer gene BRCA1 and retinoblastoma gene into ovarian cancer and bladder, correspondingly. In various circumstances, this strategy will fall short, as the mutant gene indicates dominant negative activity of the normal gene. To avoid this difficulty for p53 gene therapy, a genetic repair approach rather than a gene augmentation strategy might be more successful [ 250 ].

Cancer stem-cell therapy for breast cancer

Current investigation in biology of breast has provided the foundation for the cancer stem-cell hypothesis [ 251 ]. Two significant aspects of this theory are that cancer arises in progenitor cells or mammary stem cells as an outcome of dysregulation of the normally strongly regulated method of self-renewal. As a consequence, cancers posses and are obtained by a cellular subcomponent that keeps central stem-cell functions such as self-renewal, which directs differentiation and tumorigenesis that is responsible for cellular heterogeneity. Development in the stem-cell field have guided to the recognition of stem cells in normal and malignant tissue of the breast. The investigations of these stem cells have assisted to clarify the source of the molecular complexity of breast cancer in human. The cancer stem-cell theory has significant role for timely recognition, prevention, and management of human breast cancer. Dysregulation of stem cell renewal pathways are involved in the development of both sporadic and hereditary breast cancers. These abnormal stem cells may give targets for the improvement of cancer prevention options. In addition, since breast cancer stem cells may be extremely challenging to chemotherapy and radiation, the progress of additional efficient treatments for breast cancer may need the efficient targeting of this cell population [ 252 ].

Anti-oestrogens and prevention of breast cancer

With the accomplishment of anti-oestrogens in breast tumor management, numerous studies evaluated their use as an mediator to avert breast cancer in female at high risk [ 253 , 254 ]. Tamoxifen is the antiestrogen medicine employed most commonly in the treatment of breast cancer. Administration of tamoxifen as an adjuvant treatment following surgery, normally for 5 years, decreases the risk of hormone receptor breast cancer recurrence.

Metastatic breast cancer is also managed by tamoxifen. In numerous females, tamoxifen induce the manifestations of menopause such as mood swings, vaginal discharge and hot flushes. Toremifene is one more medicine strongly related to tamoxifen. It is used an alternate drug in postmenopausal female for the treatment of metastatic breast cancer. Fulvestrant is another drug that decreases the estrogen receptor numbers. It is usually useful in postmenopausal female, even in tamoxifen resistant breast cancer. In previous studies, tamoxifen was evaluated for its efficacy in 13, 388 females at higher risk of breast cancer for the period of 5 years. The study indicated a 49% decrease in risk of increasing invasive breast cancer and as well decreased risk of opposing side breast cancer, reappearance and extended existence in the female who had tamoxifen as accessory after operation [ 187 , 188 ]. Antioestrogens are currently suggested as chemoprevention for female with atypical hyperplasia, genetic tendency to develop cancer and important family history of breast tumor. They are also prescribed because component of practice post-operative concomitant management of those with estrogen receptor positive cancers for duration of 5 years following surgery [ 255 ].

Human monoclonal antibody

Monoclonal antibodies are prepared in the laboratory [ 256 ]. These are used alone or in combination with radiation therapy and chemotherapy to locate and target cancer cells. Usually, the body’s immune system attack to foreign antigens such as infectious agents. It will then create antibodies to assist fight it off. The body does not identify cancer cells as a kind of foreign attacker. So, antibodies are then not formed. A randomized clinical trial was conducted to investigate efficacy of denosumab, a completely human monoclonal antibody against receptor activator of nuclear factor κ B (RANK) ligand, in comparison with zoledronic acid in the prevention of skeletal-related events in breast cancers individuals with bone metastases. Denosumab was found better as compared to zoledronic acid in preventing or delaying the SREs in breast cancer patients with bone metastasis. It is demonstrated that denosumab is possible therapeutic alternative for individual with bone metastases [ 257 ].

Immunotherapy

It utilizes the immune system of the body to fight against the cancer cells [ 258 ]. Cancer vaccine is one of its examples. Parts of cancer cells or cancer cells are utilized for formation of vaccines. These cells excite the body’s immune system to assist assault and destroy cancer cells [ 259 ]. Immunotherapy has turn into a significant constituent in the management of breast cancer. HER2 targeted treatment are at the present an important part of HER2 over expressing breast tumor therapy. Trastuzumab, with the new current accompaniments of pertuzumab and TDM1, encompass considerably superior breast cancer prediction. With various Federal Drug and Administration recommended antibody treatments used in together the adjuvant and metastatic settings, development progresses to be done in the area of immunotherapies. Current achievements in targeted therapies, vigorous particular immunotherapy, grasp assure for continuous success in general endurance within the adjuvant setting. The extremely precise and targeted strategy of vaccine therapy not simply avoids the adverse effects of recent standard of care therapies, active and passive immunotherapies including ipilimumab; however presents remedial strategy beyond now the HER2-overexpressing individuals. Even though vaccines for breast cancers have been mainly ineffective in precedent clinical studies, the most of these studies conducted in the location of late-stage metastatic illness, adverse surroundings for agents intended to stop, as different to manage, disease. With present clinical studies conducted on the adjuvant settings, immunogenicity is at the present indicating association with medical response.

Anti–angiogenesis drugs

Angiogenesis and inflammation are host-dependent manifestations of tumors that can be targeted with impediment strategies long prior to cancer start and develop [ 260 ]. Numerous prescription and non-prescription medicines are now accessible for utilization in angioprevention. Angioprevention can be proposed at four levels; first for the healthy people, 2nd for population at enhanced risk of tumor, 3rd for preneoplastic disease and 4th for prevention of cancer relapse. There are numerous achievements in prevention of cancer that reveal medical possibility and levels of interference, from no to slight to strong clinician participation. To evade toxicity whereas maintaining effectiveness, angioprevention desires to attain a level of angiogenesis prevention that is not extremely oppressive, such that hale and hearty vascular activity is maintained. These drugs block angiogenesis. In the absence of blood supply to cancer cells, they cannot develop and die. Various drugs are under investigation for the management of metastatic breast cancer. In initial stage of breast cancer, they are also investigate in the neoadjuvant (before surgery) setting [ 261 ]. Antiangiogenic treatment in breast cancer presents important promise, and numerous continuing investigations are trying to better describe the best management settings and mediator assortment. For patients with estrogen receptor positive aliment, researches recommend a relationship among resistance of endocrine and cancer dependence on angiogenic networks, suggesting a possible curative advantage in mixing endocrine treatment with antiVEGF mediator. Findings from randomized clinical studies emphasize the multiplicity in reaction to antiVEGF treatment and recommend the requirement for better choice of patient subsets further to be expected to advantage from these therapies. The recognition of biomarkers for therapy response is solitary part of deep attention, though mainly study to date has become unsuccessful to discover a relationship linking cancer-associated markers including cancer mutations and EGF expression and scientific response.

Surveillance and follow up

A regular assessment of the important in print literature conducted by de Bock et al. [ 262 ], revealed that 40% of recurring cancers are identified in asymptomatic individuals during routine visits. This information intensifies the significance of surveillance and follow-up. Clinical investigation such as history and physical examination is suggested each 4–6 months for 5 years, after that each year with annual mammography. Female on tamoxifen should go through a yearly gynecologic evaluation if the uterus exists. Female who suffers from ovarian failure secondary to management or on an aromatase inhibitor should have checking of bone fitness with a bone mineral thickness determination at the start and sometimes subsequently. Women should also be advised to adopt variable risk factors, including lessening alcohol use, reducing BMI and enhancing physical activity.

The increase of information on the pathophysiologic mechanisms of breast cancer has brought extensive development in the figure of biomolecular markers. In addition, the development of targeted drug design has grown quickly and more complicated, providing numerous agents that target these markers for in vivo investigation in animal models as well as clinical studies. The enthusiasm among scientists and Physicians about the growing management strategies is tempered by apprehension that resources are insufficient to carry the mainstream of these agents to advanced clinical trials. The challenges, then, are to choose the most capable agents to be investigated and the proper clinical studies for such evaluations. We have adopted a justifying strategy to unfolding the most extensively documented molecular targets in breast cancer. Drugs that amend the NRF have not been evaluated comprehensively so far, and such studies can boost the chances for true ‘endocrine’ strategies for management of breast cancer. Furthermore, agents that amend angiogenesis and apoptosis demonstrate an thrilling area of research, mostly in vigilantly chosen combination regimens.

Authors’ contributions

MA provided concept and design of the manuscript. MI wrote the draft of Manuscript. MD and AUK revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Competing interests.

The authors declare that they have no competing interests.

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No funding received from any source.

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Home > Cancer Research Catalyst > The More You Know About Cancer Prevention

The More You Know About Cancer Prevention

The World Health Organization estimates that 30% to 50% of all cancer cases are preventable.  

Yes, much of that can be attributed to healthy lifestyle choices, including physical activity , better nutrition , lack of smoking , and light to moderate alcohol consumption , but knowledge can also be a powerful cancer prevention tool. According to the American Association for Cancer Research (AACR) Cancer Progress Report 2023 , the United States experienced a 33% decline in overall cancer mortality between 1991 and 2020 largely thanks to public health campaigns and policy initiatives implemented to reduce smoking and increase early detection of cancers, based on study findings in CA: A Cancer Journal for Clinicians . 

Bar graph of modifiable cancer risks with tobacco smoking having the highest percentage of cancer cases in the U.S. in adults over 30 attributed to that cause followed by excess body weight, alcohol consumption, ultraviolet radiation exposure, poor diet, pathogenic infections, and physical inactivity.

As they say (or at least a series of public service announcements did in the ’90s), “The More You Know.” And in this case, the more you know about your cancer risks can be lifesaving, and what you don’t know can have negative consequences. A series of recent studies have found that some people may lack a certain level of clarity and/or awareness about some cancer prevention techniques such as screening and vaccination. This may cause gaps in ensuring benefit from available methods that can help detect cancer much earlier or outright prevent it. 

Some Stool Samples Aren’t Fit to be Tested  

One of the several initial screening options for colorectal cancer  (CRC) is a self-administered fecal immunochemical test (FIT) in which an individual provides a stool sample to be examined for hidden blood. The FIT is either administered at a health care office (often with verbal instructions) or via a mail-order program (with written and/or info-graphical instructions). But 1 in 10 FITs could not be processed due to unsatisfactory samples, according to results from a study published in  Cancer Epidemiology, Biomarkers & Prevention , a journal of the AACR. 

At least part of the issue is individuals don’t fully comprehend what is required to provide a sample that is deemed satisfactory for testing, according to Rasmi Nair, MBBS, PhD , co-first author of the paper and an assistant professor at the Peter O’Donnell Jr. School of Public Health of UT Southwestern Medical Center. That was especially true for the mail-order program, which was 2.66 times more likely to produce unsatisfactory results. 

Nair and her colleagues examined electronic health record (EHR) data of 56,980 individuals aged 50 to 74 who underwent FIT screening between 2010 and 2019 within the Dallas-based Parkland Health system. Parkland, which is considered a safety-net hospital, provides care to more than one million low-income, uninsured Dallas County residents. Overall, of the 10.2% FITs considered unsatisfactory, 51% were due to an inadequate specimen, 27% were attributed to incomplete labeling, 13% of the stool specimens were too old, and 8% had a broken or leaking container. Additionally, only 40.7% of individuals with unsatisfactory tests received follow-up FIT or colonoscopy screening within 15 months of the failed test. 

Nair suggested that minimizing language and health literacy barriers could help, and the study authors pointed to visual instructions that showed positive results in improving sample collection in other studies. The authors also suggested that testing facilities include previously affixed patient labels or barcodes to minimize labeling errors as well as policy changes to allow using the sample ordering, mailing, or receiving date as the collection date—if the date is missing on the label itself and the sample is sent within the two-week widow. Finally, the authors also want to see a better system put in place to ensure proper follow-up.   

“The fact that, in most instances, unsatisfactory FIT was not followed by a timely subsequent test highlights the need for systems to have a better, more comprehensive approach to tagging and following up unsatisfactory FIT,” said co-first author Po-Hong Liu, MD , a gastroenterology fellow at UT Southwestern Medical Center. 

The Need for More HPV Vaccine Awareness  

The vaccine for human papillomavirus (HPV) has shown tremendous results in preventing cervical cancer . In fact, a recent study examining cervical cancer cases in Scotland found zero cases among women born between 1988-1996 who were fully vaccinated against HPV between the ages of 12 and 13, according to a paper published in the Journal of the National Cancer Institute .  

The HPV vaccine, however, can benefit men and protect against other cancers as well, including anal , oral, and penile cancers. But this fact may not be properly presented to Hispanic and Latino men who identify as sexual minorities, according to results presented at the  16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved . 

Between August 2021 and August 2022, Shannon M. Christy, PhD , assistant member in the Department of Health Outcomes and Behavior at Moffitt Cancer Center in Tampa, Florida, and her colleagues surveyed individuals between the ages of 18 and 26 who were born male and were living in Florida and Puerto Rico, identified as Hispanic or Latino, had sex with a man or were attracted to men, and were able to read and understand Spanish. Among the 102 participants who said they had not received the HPV vaccine, 56% responded incorrectly or “do not know” to a question about whether most sexually active individuals are at risk for being infected with HPV; 20% responded incorrectly or “do not know” to a question assessing whether men can be infected with HPV; and more than half responded incorrectly or “do not know” to questions about the link between HPV and anal (54%), oral (61%), or penile (65%) cancers.  

Fifty-six percent did hear about the HPV vaccine, yet only 19% said a provider had recommended it to them. Currently, the Centers for Disease Control and Prevention recommends HPV vaccination for adolescents around ages 11 or 12 and even encourages the vaccination of young adults up to age 26 if they did not receive it when they were younger. The U.S. Food and Drug Administration has approved the HPV vaccine for people ages 9 to 45. 

A breakdown of the current HPV vaccination recommendations including the CDC recommending two doses given six months apart for adolescents younger than 15 and three doses for those between 15 and 26 or with weakened immune systems.

“Sexual minority men are a population group at higher risk for HPV infections and subsequent HPV-related health concerns, including anal cancer,” said Christy. “Prior research has demonstrated suboptimal HPV vaccine uptake among young adults, including sexual minority men. Additional efforts are needed to ensure that all age-eligible community members can benefit from this effective cancer prevention method.” 

One place to start would be more Spanish-language materials about HPV vaccination for young adults, as Christy and her collaborators found a lack of such education and no materials culturally adapted for Hispanic and Latino sexual and gender minority community members. “To reduce HPV-related cancer disparities, it is essential that information be relevant and actionable and available to age-eligible people in their preferred language,” said Christy. 

Your Genetics Know What You May Not about Cancer Prevention 

Whole-exome sequencing can be used as a screening technique to identify if an individual has any genes predisposed for hereditary diseases, including some cancers. The National Comprehensive Cancer Network (NCCN) has established a set of guidelines—including ones for breast, ovarian, and pancreatic cancers and colorectal cancer —to identify individuals who should undergo genetic testing, but guidelines like these might not be catching everyone who should be screened, according to  N. Jewel Samadder, MD , a professor of medicine at the Mayo Clinic College of Medicine and co-leader of the precision oncology program at the Mayo Clinic Comprehensive Cancer Center. 

“These criteria were created at a time when genetic testing was cost-prohibitive and thus aimed to identify those at the greatest chance of being a mutation carrier in the absence of population-wide whole-exome sequencing,” Samadder said. “However, these conditions are poorly identified in current practice, and many patients are not aware of their cancer risk.” 

Samadder presented results from the  Tapestry  clinical trial at the  AACR Annual Meeting 2023 that showed that 39.2% of individuals who consented to whole-exome sequencing and were identified as carriers of predisposition genes for hereditary breast and ovarian cancer (HBOC) or Lynch syndrome would not have qualified under current guidelines. At the time of data cut-off, 44,306 patients from Mayo Clinic sites in Minnesota, Arizona, and Florida had provided a saliva sample. For this part of the trial, researchers used whole-exome sequencing to evaluate samples for BRCA1 and BRCA2, denoting HBOC, and MLH1, MSH2, MSH6, PMS2, and EPCAM, denoting Lynch syndrome. 

A diagram with lines pointing to various body parts and then a list of the genes associated with potential inherited cancer risk for that body part.

Of the 387 individuals with HBOC and 163 with Lynch syndrome identified, 52.1% did not know prior to this study they had a cancer predisposition condition and 39.2% did not satisfy the existing NCCN criteria for genetic testing. Among the patients who were newly diagnosed with HBOC or Lynch syndrome during this study, 60% were ineligible for genetic testing per the current guidelines. Samadder explained that patients with HBOC have up to an 80% lifetime risk of developing  breast cancer  and a markedly increased risk, relative to the general population, of developing  ovarian cancer ,  pancreatic cancer ,  prostate cancer , and  melanoma . Meanwhile, patients with Lynch syndrome have up to an 80% lifetime risk of colorectal cancer and up to 60% lifetime risk of  endometrial cancer , plus increased risks of upper gastrointestinal, urinary tract, skin, and other cancers.  

Knowing about their increased genetic risk can help patients take appropriate next steps, Samadder said. For example, patients with Lynch syndrome can undergo regular colonoscopies, blood and urine screening, and prophylactic hysterectomy, while patients with HBOC can be proactive through advanced breast imaging and prophylactic mastectomy and/or oophorectomy.  

“The knowledge that comes from genetics,” Samadder said, “can empower patients to take control of their disease risk and increase their likelihood of avoiding a deadly cancer diagnosis or catching it at an early stage when it is highly curable.”  

Like they say, the more you know.  

To see how much you know about cancer prevention, take the AACR’s Cancer Prevention Quiz .   

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Annual breast cancer screening beginning at 40 saves lives, study suggests

by Radiological Society of North America

breast cancer screening

Annual breast cancer screening beginning at age 40 and continuing to at least age 79 results in the highest reduction in mortality with minimal risks, according to a new study published in Radiology .

Breast cancer is the second most common cause of cancer death for women in the U.S. Despite research demonstrating that consistent participation in screening mammography can reduce breast cancer deaths by 40%, only 50% or less of eligible women actually participate in annual screening.

"There is an ongoing debate over the recommendations for breast cancer screening, specifically about when to start and the frequency of screening," said lead researcher Debra L. Monticciolo, M.D., professor of radiology at Dartmouth Geisel School of Medicine in Hanover, New Hampshire.

Dr. Monticciolo said a recommendation by the U.S. Preventive Services Task Force (USPSTF) in 2009 to screen every other year, or biennially, beginning at age 50 resulted in a nationwide decline in screening participation. The USPSTF drafted new recommendations in 2023, suggesting women participate in biennial screening between 40 and 74.

The American College of Radiology, the Society of Breast Imaging and the National Comprehensive Cancer Network recommend annual screening for women at average risk for breast cancer beginning at age 40 and continuing as long as the woman is in good health.

In the study, Dr. Monticciolo and colleagues performed a secondary analysis of Cancer Intervention and Surveillance Modeling Network (CISNET) 2023 median estimates of breast cancer screening outcomes. CISNET modeling data gives researchers the opportunity to estimate the outcomes of screening at various frequencies and starting ages using U.S. data.

The researchers compared the benefits of screening, including mortality reduction, life years gained, breast cancer deaths averted, and its risks—including benign, or unnecessary, biopsies and recall rates—for four different scenarios: biennial screening of women 50–74 (the longstanding USPSTF recommendation), biennial screening of women 40–74 (the task force's new draft recommendation), annual screening 40–74, and annual screening 40–79. CISNET does not offer modeling past age 79.

The review of CISNET estimates showed that annual screening of women 40–79 with either digital mammography or tomosynthesis showed a mortality reduction of 41.7%. Biennial screening of women 50–74 and 40–74 showed mortality reduction of 25.4% and 30%, respectively. Annual screening of women 40–79 years showed the lowest per mammogram false-positive screens (6.5%) and benign biopsies (0.88%) compared to other screening scenarios.

"The biggest takeaway point of our study is that annual screening beginning at 40 and continuing to at least age 79 gives the highest mortality reduction, the most cancer deaths averted, and the most years of life gained," Dr. Monticciolo said. "There's a huge benefit to screening annually until at least 79 and even more benefit if women are screened past 79."

Dr. Monticciolo said that although the USPSTF uses CISNET modeling to formulate its recommendations, it refers to recall rates and benign biopsies as harms, rather than risks.

"To balance the harms and benefits of screening mammography, they're willing to give up some mortality benefit to avoid women being recalled for additional imaging and benign biopsies," she said.

According to the researchers' analyses, the chance of a woman having a benign biopsy following annual screening is less than 1%, and all recall rates for screening mammography are under 10%. When screening is performed annually with tomosynthesis, the recall rate decreases to 6.5%.

"The risks of screening are non-lethal and manageable for most women," she said. "But advanced breast cancer is often lethal. Breast cancer is easier to treat if it's found earlier; we're able to spare women extra surgeries and chemotherapy. It's just a better idea to shift to early detection, and that's what screening does."

Dr. Monticciolo said she hopes that her study will add to the body of literature that supports annual screening beginning at age 40 as the best way to diagnose cancer early.

"This paper is important because it shows once again that there's a tremendous increase in mortality benefit by screening annually between the ages of 40–79, and that the chances of experiencing harm are low on a per-exam basis," she said.

"It comes down to valuing women's lives. I am hoping that primary care physicians see that risks of screening are manageable, and the benefits are tremendous. We need to do this for women."

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Breast Cancer Awareness Month 2022

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KNOWH Blog

October 14, 2022

Breast Cancer Awareness Month

Breast Cancer Awareness Month

October is Breast Cancer Awareness month ! Our goal throughout the month is to increase awareness of the disease and stress the importance of mammograms as the best tool to screen for breast cancer, the second most common type of cancer among women. Approximately one in eight women in the United States will get breast cancer during their lifetime and each year, more than 40,000 women die from breast cancer.  

Signs and Symptoms of Breast Cancer

Different people have different symptoms of breast cancer, while some do not have any signs or symptoms at all. It is important to know how your breasts normally look and feel to be able to recognize any changes that may occur. While knowing what to look for is important, regular mammograms and clinical breast exams are crucial, as these tests can help detect breast cancer before symptoms show.

Signs of breast cancer may include:

  • Lump in the breast or underarm (armpit)
  • Swelling or thickening of all or part of the breast
  • Dimpling or skin irritation of breast skin
  • Redness, scaliness or thickening of the nipple or breast skin
  • Nipple discharge (other than breast milk)
  • Any change in the size or shape of the breast
  • Pain in any area of the breast

BCAM_Women Pink Ribbon

Get Screened

A mammogram is a low-dose x-ray picture of the breast. Early detection of breast cancer can improve a woman’s chance of survival and mammograms are the best tool to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Women should ask their healthcare provider if and when a mammogram is right for them. 

  • Follow these tips to help you prepare for a mammogram
  • Digital Mammography FAQ’s

How Can I Lower My Risk?

There are many factors that can influence your breast cancer risk such as family history and getting older. There is no sure way to prevent breast cancer, but lifestyle changes can help lower your risk of breast cancer such as:

  • Keep a healthy weight and exercise regularly.
  • Choose not to drink alcohol, or drink alcohol in moderation.
  • If you are taking hormone replacement therapy or birth control pills, ask your doctor about the risks.
  • Breastfeed your children, if possible.
  • If you have a family history of breast cancer, be sure to talk to your doctor about ways to lower your risk.

Learn more about  breast cancer , its symptoms , risk factors , mammograms , diagnosis , and treatment for breast cancer.

Diverse Women_Workout Clothes_BCAM

Pink Ribbon Guide

A pink ribbon symbolizes breast cancer awareness. The FDA Office of Women’s Health launched the Pink Ribbon Sunday Mammography Awareness Program in 1998 to educate women about early detection of breast cancer through mammography. Pink Ribbon Sunday originally targeted African American and Hispanic churches. Over the years, the program’s outreach has expanded to connect with as many women as possible. Pink Ribbon events help educate women about the importance of mammograms and encourage them to take charge of their breast health by getting regular mammography screenings. We are pleased to share our updated mammography resource, Pink Ribbon Guide: Mammography Matters .

Take Action

This month and every month, there are many ways you can join the fight to save lives against breast cancer. Many women do not get their recommended mammography screenings due to fear, time, lack of knowledge about mammograms or concerns about cost. The Pink Ribbon Guide shares ways you can help make a difference including distributing reliable health information, providing emotional support and connecting women to local resources. In the guide, you will find:

  • Basic facts about mammography
  • Information on how to host an in-person or virtual event
  • A customizable flyer and postcard to promote your event
  • Resources on mammography and breast cancer

Search for a certified mammography facility in your area . The Centers for Disease Control and Prevention (CDC) offers free or low-cost mammograms. Find out if you qualify .

Additional Resources

Check out these resources from our office and federal partners: 

  • Get the Facts About Mammograms
  • Mammography: What You Need to Know
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IMAGES

  1. Breast Cancer Facts & Statistics for 2022

    breast cancer awareness articles 2022

  2. 2022 Breast Cancer Awareness Collection by Staples Promotional Products

    breast cancer awareness articles 2022

  3. (PDF) Breast Cancer Awareness Month 2022

    breast cancer awareness articles 2022

  4. ESMO Breast Cancer 2022

    breast cancer awareness articles 2022

  5. Breast cancer awareness month 2022

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  6. Breast Cancer Awareness Infographic

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COMMENTS

  1. Knowledge & News on Women: Breast Cancer Awareness Month 2022

    October 14, 2022 Breast Cancer Awareness Month October is Breast Cancer Awareness month! Our goal throughout the month is to increase awareness of the disease and stress the...

  2. Breast Cancer Awareness Feature

    Dr. Lisa Richardson explains in this video. Ask your doctor when you should get a mammogram. Other than skin cancer, breast cancer is the most common cancer among American women. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Are you worried about the cost?

  3. Advances in Breast Cancer

    Breast cancer is the second most common cancer among American women. Breast cancer death rates have been falling over the past 30 years. But nearly 13% of women are still diagnosed in their lifetime. Men can get breast cancer too, although it's rare. Cancer is caused by changes to genes that control the way our cells function.

  4. Breast Cancer Awareness Month

    In 2022, it is estimated that nearly 44,000 people in the U.S. will die from breast cancer. Know Your Risk Knowing your family history is lifesaving. Talk to a doctor about your family history and see how that history impacts your risk of breast cancer. You and your doctor can create a personalized plan to monitor for signs of the disease.

  5. Breast Cancer Research Articles

    Posted: July 5, 2022 People with metastatic breast cancer whose tumors had low levels of HER2 protein lived longer after treatment with trastuzumab deruxtecan (Enhertu) than those treated with standard chemotherapy, results of the DESTINY-Breast04 clinical trial show. NCI Study Advances Personalized Immunotherapy for Metastatic Breast Cancer

  6. Breast Cancer Awareness Month

    Collection 11 October 2022 Breast Cancer Awareness Month Breast cancer is the most common cancer in women worldwide. It is a heterogeneous disease and molecular features include...

  7. Breast Cancer Awareness Month 2022: International Journal of Cancer

    This collection, curated by the team at the International Journal of Cancer & the Union for International Cancer Control for this October 2022 Breast Cancer Awareness Month, includes a variety of both translational and clinical research articles. These articles investigate the complex epidemiology and biology of breast cancer and present novel diagnostic and therapeutic approaches.

  8. Breast Cancer Awareness Month 2022

    The International Agency for Research on Cancer (IARC) is marking Breast Cancer Awareness Month by focusing on the need for breast cancer screening worldwide and the intergenerational effects of breast cancer deaths.

  9. Breast Cancer Awareness Month

    Breast Cancer Awareness Month. ... of efficient global breast cancer screening programs and early diagnosis to reduce health disparities and promote breast cancer control worldwide. Articles. ... M., Biessy, C. et al. BMC Cancer 22, 877 (2022). Comparison of breast cancer surrogate subtyping using a closed-system RT-qPCR breast cancer assay and ...

  10. Breast Cancer Awareness Month 2022

    9 November 2023 Breast Cancer Awareness Month 2022 The International Agency for Research on Cancer (IARC) is marking Breast Cancer Awareness Month by focusing on the need for breast cancer screening worldwide and the intergenerational effects of breast cancer deaths.

  11. Breast cancer

    12 July 2023 العربية 中文 Français Русский Español Key facts Breast cancer caused 685 000 deaths globally in 2020. Roughly half of all breast cancers occur in women with no specific risk factors other than sex and age. Breast cancer occurs in every country in the world. Approximately 0.5-1% of breast cancers occur in men. Overview

  12. Breast Cancer Awareness Month 2024

    Advertisement What is Breast Cancer Awareness Month? Breast Cancer Awareness Month, held in October every year, aims to promote screening and prevention of the disease, which affects one in eight women in the United States every year and 2.3 million women worldwide.

  13. Breast Cancer Awareness Month

    Patient Navigator More Than a Statistic A breast cancer diagnosis is overwhelming. That's why we started the NBCF Patient Navigation Program—so that no one faces breast cancer alone. Read her story Natalie , Survivor Throughout my treatment, my navigator, Jennifer, kept my mind and spirit fed.

  14. Breast Cancer Facts & Figures

    The Breast Cancer Facts & Figures 2022-2024 report is an educational companion for Breast Cancer Statistics, 2022, a scientific paper published in the American Cancer Society flagship journal, CA: A Cancer Journal for Clinicians. Breast cancer is the most common cancer diagnosed among women in the United States.

  15. Breast Cancer Statistics, 2022

    Breast Cancer Statistics, 2022 Authors Angela N Giaquinto 1 , Hyuna Sung 1 , Kimberly D Miller 1 , Joan L Kramer 2 , Lisa A Newman 3 , Adair Minihan 1 , Ahmedin Jemal 1 , Rebecca L Siegel 1 Affiliations 1 Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.

  16. Breast Cancer Awareness Month 2023

    As of January 2022, there were over 4 million women living with a history of breast cancer in the US. About 9 percent of all new breast cancer cases are diagnosed in women 45 and under. Though Black women have a lower incidence of breast cancer than white women, Black women are 40 percent more likely to die of breast cancer.

  17. Breast Cancer Awareness Month 2022

    The International Agency for Research on Cancer (IARC) is marking Breast Cancer Awareness Month by focusing on the need for breast cancer screening worldwide and the intergenerational effects of breast cancer deaths. In 2020, female breast cancer became the most commonly diagnosed cancer type globally: about 2.26 million women were diagnosed ...

  18. Women's awareness of breast cancer symptoms: a national cross-sectional

    Breast cancer (BC) is the most common cancer among women worldwide with 2.26 million new cases diagnosed in 2020 accounting for 24.5% of all cancers in women [].BC was responsible for more than 600,000 deaths in 2020; making it the leading cause of cancer-related deaths among women [].High-income countries have higher incidence rates of BC than low- and middle-income countries.

  19. Articles in 2022

    Unconventional isoquinoline-based SERMs elicit fulvestrant-like transcriptional programs in ER+ breast cancer cells. G. R. Hancock. K. S. Young. S. W. Fanning. Article Open Access 14 Dec 2022.

  20. Breast Cancer Facts & Stats

    Last updated on Jan 17, 2024 Medically reviewed on Jun 15, 2023 by: Lillie D. Shockney 1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. In 2023, an estimated 297,790 women and 2,800 men will be diagnosed with invasive breast cancer.

  21. Awareness and current knowledge of breast cancer

    With one million new cases of cancers reported in the World, breast cancer is common in females and comprises 18% of all women cancer. Incidence of breast cancer is predicted to increase to 85 per 100,000 women by 2021 [ 12 ]. In 2012, 1.67 million new cases of breast cancer were diagnosed that is 25% of all cancers among women.

  22. The More You Know About Cancer Prevention

    The More You Know About Cancer Prevention. February 12, 2024 by Andrew Matthius. The World Health Organization estimates that 30% to 50% of all cancer cases are preventable. Yes, much of that can be attributed to healthy lifestyle choices, including physical activity, better nutrition, lack of smoking, and light to moderate alcohol consumption ...

  23. Annual breast cancer screening beginning at 40 saves lives, study suggests

    The researchers compared the benefits of screening, including mortality reduction, life years gained, breast cancer deaths averted, and its risks—including benign, or unnecessary, biopsies and ...

  24. Cancer cases to rise steeply by 2050: What are the causes?

    According to one of the IARC reports worldwide, the top three most common cancers in 2022 were lung, breast, and colorectal cancer. Among men and women, lung cancer accounted for 12.4% of all ...

  25. Breast Cancer Awareness Month 2022

    October 14, 2022 Breast Cancer Awareness Month October is Breast Cancer Awareness month! Our goal throughout the month is to increase awareness of the disease and stress the...

  26. Performance of artificial intelligence-based breast cancer screening in

    In resource-constrained countries where systematic screening programmes with mammography is not scalable or feasible, the portable, radiation-free Thermalytix test is a promising option for affordable and accessible breast cancer screening. This screening test is not resource-intensive and can be set up in remote locations and operated with minimal training. The Thermalytix test can be used to ...

  27. amp.cdc.gov

    amp.cdc.gov

  28. February is National Cancer Prevention Awareness Month

    But at the same time, the number of new cancer cases had ticked up to more than two million in 2023, from 1.9 million in 2022. Cancer remains the second leading cause of death in the United States ...

  29. Cancer patients share their experiences after King's diagnosis

    BBC. Bina Shah was diagnosed with breast cancer at the beginning of the Covid-19 pandemic. A woman who had breast cancer hopes the King's decision to share his diagnosis will encourage more people ...