Confronting Breast Cancer: Exploring Incidence, Survival Rates, and Treatment Approaches

Introduction

Breast cancer is the form of cancer which affects breast tissue, specifically the inner side of milk ducts and lobules which plays the role of supplying milk to the ducts (Sharma, et al, 2010). It can be considered to be the most common cancer affecting women worldwide which shows its impact upon 2.1 million women every year and is responsible for the huge number of deaths related to cancer among women. A prospective study based on the data obtained from UK Biobank consisting of 273,467 females were analyzed for about 9 years and after the follow up it was observed that the total number of cases suffering from breast cancer were 14,231 showing 3,378 (23.7%) incident cases and the incidence rate is 2.09 per 1000 person-years (Al-Ajmi, et al, 2018). It can be said that the breast cancer rates are rising among women residing in the fast-developing region, the rates are found to be constantly rising throughout every part globally. Chances of getting cured of the jaws of breast cancer and its outcomes on survival depend upon the early detection of the disease and it is a critical aspect of the treatment. Unfortunately, the five-year mortality report showing as high as 50% due to diagnosis of the disease at a later stage can be considered as an unacceptable fact (Torre, et al, 2015). Therefore, to address the growing problem, the present topic was chosen for the degree programme with a lot of inquisitiveness to know about the current treatment available, the survival rates and the barriers that need to be curbed down to achieve the targeted goal of success.

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Key Research

Malignancy of breast is broadly categorised into two major types: invasive carcinoma and in situ carcinoma. The in situ carcinoma is further subdivided into ductal (DCIS) and lobular carcinoma (LCIS) (Logan, et al, 2015). The factor that mostly affects the survival rate is the stage of cancer when the patients present symptoms and in the UK nearly one fifth of cancer are diagnosed at an emergency stage. The late detection of cancer shows impact on the treatment options due to the progressive advancement in the stage of disease resulting in metastasis. The early detection programme is also based on symptomatic presentations of the patient (Sledge, et al, 2014).

The presenting symptoms of breast cancer are breast lump, nipple discharge, irritation of skin and retraction of nipple. The level of cancer is determined by the size of tumour and the area of spread. Therefore clinicians diagnose these two factors for choosing the treatment modality (Koo, et al, 2017). The stages of breast cancer that affects its prognosis are status of lymph node, size of tumour, presence of metastases, tumour grade, status of estrogen and progesterone receptor, HER2 status (Bloom, et al, 1957). The existing treatment options for breast cancer according to the UK practice guidelines are chemotherapy, radiotherapy, surgery, targeted cancer drugs. For localised breast cancer the preferred mode of treatment is conservation strategy followed by adjuvant therapy to minimise the chances of metastases and also ensures full recovery (Dhankhar, et al, 2010). Due to the adverse effects of conventional therapies such as gastrointestinal disturbances, loss of hair, neutropenia and compromised immunity which potentially impacts the quality of life some novel techniques of drug delivery based on nanotechnology have come into play (Nounou, et al, 2015). The most critical part for accurate prognosis of breast cancer is the identification of the disease at an early stage. Therefore, developing a technique that will be highly sensitive and can detect the early stage rapidly is urgent for the present situation. Among the existing techniques available such as contrast-enhanced digital mammography, magnetic resonance imaging, ultrasound and Positron emission tomography, the last one is the preferred method as the other techniques have some limitations. Apart from these, microwave imaging (MI) is also considered as a low cost and safe approach for diagnosis (Nounou, et al, 2015; Sledge, et al, 2014). The detection of breast biomarkers to assess the growth of tumour for early detection is still at immature stage. Specifically protein biomarkers can be classified as prognostic and predictive biomarkers for breast cancer such as RS/DJ-1, heat shock protein 60 and 90, mucin 1, and human epidermal growth factor receptor 2 antigens for clinical studies even though many of them are not specific for breast cancer. Moreover, evidences are also very restricted for biomarkers to be used as early diagnostic tools for breast cancer. Though researchers have considered MI as an effective technology for early diagnosis, there are some limitations associated with this technique such as imaging structures of breast, selection of suitable working frequency range and spatial resolution. Therefore, with the recent advances in technology based on molecular biology, the use and feasibility of biomarkers can be considered for clinical trials, analysis of epidemiology and also for the proper management of the disease (Wang, 2017; Levenson, 2007; Vale, 2005; Opstal-van Winden, 2012) .

Justification of Proposal

Based on evidence significant progress have been made in the field of treatment and prevention which had positively impacted the mortality rate of breast cancer though report of new cases could not be arrested. It is also reported that the physicians failed to diagnose the early symptoms of cancer and therefore did not progress for further investigation towards its detection due to which the condition had worsened and became out of reach for the existing clinical treatment (Levenson, 2007). Therefore, the most crucial gap is remaining in the early diagnosis of the disease which can modulate the treatment options. Researchers all over the world are evaluating the significance of biological markers which are defined as cellular, biological and biochemical substances that can be measured and evaluated in correlation with pathogenic, normal and pharmacological processes. It is evident that biosensors such as electronic transducers have been applied for the detection of biomarkers for neurological cancer, immune disorders and cardiovascular diseases (Tobore, 2019). The human epidermal growth factor receptor 2 (HER 2) has been considered as prognostic factor but only as a response predictor to HER 2 target therapy. Moreover, researchers are also targeting multigene as signatures in comparison to traditional biomarkers. The genetic mapping of BRCA1 and BRCA2 strongly indicated about the inherited risk of breast cancer which resulted due to the genetic alteration of chromosome 17q21 (Levenson, 2007). Therefore, immense research is needed in this field to detect the specific blood based biomarkers that can predict the pre invasive or early stage of breast cancer. The specific barriers should be addressed by the researchers sequentially which may act as challenges to achieve the target goal (Bensalah, et al, 2007). Therefore extensive literature based review will be conducted on this field to assess the progress of research and to understand the crucial barriers.

Aim

To identify the potential biomarkers reported till date for the early stage identification of breast cancer based on literature review

To correlate the biomarkers with the presenting symptoms of breast cancer

To conduct a nested case control study for the detection of potential biomarkers based on literature review involving participants and laboratory based detection methods.

Proposed Plan of Action

The extensive literature based review for the detection of blood based biomarkers till date in association with the early detection of breast cancer will be conducted. Information will be collected based randomised controlled trials, crossover trials, case studies, cohort studies, clinical audits, clinical outcome studies, surveys, interviews and systematic review. The research papers which will be used for literature review of the dissertation will involve animal model study and humans based clinical trial results till date. The data will be analysed in form of the literature review for the determination of crucial barrier and all these data will be documented.

To conduct the nested case control study a minimum number of 50 breast cancer patients will be included and 50 matched cancer-free controls. The blood sample of all the participants will be collected maintaining standard procedures of UK practice clinical guidelines and will be screened by enzyme-linked immunosorbent assay ELISA method for the detection of selected biomarkers for the study. After the collection the serum will be separated and stored in a cryopreservation repository for long term storage during the study. Univariate and multivariate analyses will be conducted to detect the association with clinical pathological features in between the two groups. The participants for the experimental group will be recruited via query on the Health and Social Care Information Centre (HSCIC) on cancer and death patient registries with the International Classification of Diseases code C50 concerning the malignant status of tumour of breast. The notifications of cancer will be confirmed by telephonic survey of treating clinicians and the clinical and histological data of the confirmed cases will be retrieved. The control group will include patients who are matching with age, gender (women only) and had no previous medical records of cancer (Kazarian, et al, 2017).

Ethical Issues

Members will be included for the assessment in the wake of accepting the educated consent and they will be taught about their benefits of withdrawal at any movement of the examination with no charge, about the purpose of the assessment, the strategies that will be incorporated inside the examination. The scientist will keep up the privacy of the personal information of the individuals by using code to recognize the character of results which will keep up the system of lack of clarity and regarding their security. The information will be put away in an encrypted gadget with secret phrase insurance framework. The printed copies of the information will be put away inside a safe bureau in a bolted space to keep up the legitimate guidelines. The devastation method of the gathered information will be perpetual and irreversible. It might incorporate the overwriting of the information with a progression of characters or destruction of the hard disks (Nardini, 2014).

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References

Al-Ajmi, K., Lophatananon, A., Ollier, W. and Muir, K.R., 2018. Risk of breast cancer in the UK biobank female cohort and its relationship to anthropometric and reproductive factors. PloS one, 13(7).

Bensalah, K., Montorsi, F. and Shariat, S.F., 2007. Challenges of cancer biomarker profiling. European urology, 52(6), pp.1601-1609.

Bloom, H.J.G. and Richardson, W.W., 1957. Histological grading and prognosis in breast cancer: a study of 1409 cases of which 359 have been followed for 15 years. British journal of cancer, 11(3), p.359.

Dhankhar, R., Vyas, S.P., Jain, A.K., Arora, S., Rath, G. and Goyal, A.K., 2010. Advances in novel drug delivery strategies for breast cancer therapy. Artificial Cells, Blood Substitutes, and Biotechnology, 38(5), pp.230-249.

Kazarian, A., Blyuss, O., Metodieva, G., Gentry-Maharaj, A., Ryan, A., Kiseleva, E.M., Prytomanova, O.M., Jacobs, I.J., Widschwendter, M., Menon, U. and Timms, J.F., 2017. Testing breast cancer serum biomarkers for early detection and prognosis in pre-diagnosis samples. British journal of cancer, 116(4), pp.501-508.

Koo, M.M., von Wagner, C., Abel, G.A., McPhail, S., Rubin, G.P. and Lyratzopoulos, G., 2017. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer epidemiology, 48, pp.140-146.

Levenson, V.V., 2007. Biomarkers for early detection of breast cancer: what, when, and where?. Biochimica et Biophysica Acta (BBA)-General Subjects, 1770(6), pp.847-856.

Logan, G.J., Dabbs, D.J., Lucas, P.C., Jankowitz, R.C., Brown, D.D., Clark, B.Z., Oesterreich, S. and McAuliffe, P.F., 2015. Molecular drivers of lobular carcinoma in situ. Breast Cancer Research, 17(1), p.76.

Nardini, C., The Ethics of Clinical Trials. eCancerMedicalScience. 2014.

Nounou, M.I., ElAmrawy, F., Ahmed, N., Abdelraouf, K., Goda, S. and Syed-Sha-Qhattal, H., 2015. Breast cancer: conventional diagnosis and treatment modalities and recent patents and technologies. Breast cancer: basic and clinical research, 9, pp.BCBCR-S29420.

Opstal-van Winden, A.W., Rodenburg, W., Pennings, J.L., Van Oostrom, C., Beijnen, J.H., Peeters, P.H., Van Gils, C.H. and De Vries, A., 2012. A bead-based multiplexed immunoassay to evaluate breast cancer biomarkers for early detection in pre-diagnostic serum. International journal of molecular sciences, 13(10), pp.13587-13604.

Sharma, G.N., Dave, R., Sanadya, J., Sharma, P. and Sharma, K.K., 2010. Various types and management of breast cancer: an overview. Journal of advanced pharmaceutical technology& research, 1(2), p.109.

Sledge, G.W., Mamounas, E.P., Hortobagyi, G.N., Burstein, H.J., Goodwin, P.J. and Wolff, A.C., 2014. Past, present, and future challenges in breast cancer treatment. Journal of Clinical Oncology, 32(19), p.1979.

Tobore, T.O., 2019. On the need for the development of a cancer early detection, diagnostic, prognosis, and treatment response system. Future Science OA, (0), p.FSO439.

Torre, L.A., Bray, F., Siegel, R.L., Ferlay, J., Lortet‐Tieulent, J. and Jemal, A., 2015. Global cancer statistics, 2012. CA: a cancer journal for clinicians, 65(2), pp.87-108.

Vale, C., Stewart, L. and Tierney, J., 2005. Trends in UK cancer trials: results from the UK coordinating committee for cancer research national register of cancer trials. British journal of cancer, 92(5), pp.811-814.

Wang, L., 2017. Early diagnosis of breast cancer. Sensors, 17(7), p.1572.


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