Breast Cancer: Survival

Survival 5 years after the diagnosis of breast cancer has increased significantly in recent years, especially thanks to the progress made by medical science both…

Common Types of Breast Cancer – Mayo Clinic – 2022

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Introduction

In Italy, breast cancer is the most common malignant tumor in the female population (29% of cancers) and is the leading cause of death from oncological diseases (17% of deaths).

Unfortunately, breast cancer initially does not manifest itself in any way and this often causes a delay in diagnosis; more generally it is possible to observe

• presence of a lump in one breast (in the advanced stage the overlying skin acquires an orange peel appearance),
• swelling of the axillary lymph nodes on the affected side (but no pain),
• breast pain (appears late),
• breast tenderness, swelling and / or changes in the size or shape of the breast,
• secretion of blood or abnormal material from only one nipple,
• nipple folded on itself.

An early diagnosis allows you to drastically increase the chances of recovery, so it is recommended to carry out regular breast self-examination; more debated is the opportunity to join the Ministerial screening campaigns (which allow you to undergo regular mammograms for free), not shared by all the authors.

Men can also suffer from breast cancer, but it is an extremely rare occurrence (less than one in 600 men in Italy).

Survival

Survival 5 years after the diagnosis of breast cancer has increased significantly in recent years, especially thanks to the progress made by medical science both in terms of diagnosis and efficacy of therapy; according to AIRC data, an early diagnosis (stage 0) allows a 5-year survival close to 100% of women, while as the progression increases, the percentage decreases proportionally.

In addition to a late diagnosis, the main factors negatively affecting the prognosis of breast cancer are:

• the number of metastatic lymph nodes, which is the most important factor. The involvement of more than 4 lymph nodes is considered a sign of considerable disease aggressiveness;
• large tumor size,
• degree of malignancy / aggressiveness of the cells (assessable with histological examination),
• age of juvenile onset (patients who get breast cancer at 20-30 years of age have a worse prognosis),
• finding of metastases at diagnosis,
• presence of a fibrous core, as a sign of chronic oxygen deficiency,
• presence of the BRCA gene (see below).

On average, survival 5 years after diagnosis is around 90%.

An important factor that can affect survival is the type of tumor: all cells in our body, including cancer cells, have receptors, which are proteins on which various substances act, including hormones.

Some breast cancer cells can be characterized by the presence of specific receptors:

• Estrogen and progesterone receptors: cells that express these receptors grow upon stimulation of these hormones. Cancers with these receptors grow more slowly and are therefore associated with a better prognosis than breast cancers that do not express them.
• HER2 receptors (Human epithelial growth factor receptor): in about 20% of breast tumors the cells express excessive quantities of these receptors and for this reason they are subject to a particularly accelerated and aggressive growth, with prognosis worse.

The characterization of the tumor also guides the specialist in planning the therapy.

Causes and risk factors

Although the underlying cause of cancer often remains unknown, science has identified numerous risk factors that can influence the likelihood of developing breast cancer, although it is not always clear how these induce its onset and growth. of cancerous cells.

The main risk factors are:

• Age: About 60% of cancers occur after age 60.
• It is more frequent in the western population than in the poorest areas of the world.
• Previous breast cancer: Women who have previously had breast cancer are more likely to develop another one in the contralateral breast.
• Family history: Women with a first degree relative with breast cancer have a higher risk.
• Hereditary factors: About 5-10% of women with breast cancer have inherited a genetic mutation. The genes most frequently involved are BRCA1 and BRCA2; these are tumor suppressor genes, ie able to regulate cell growth by inhibiting it. Patients with mutations of the BRCA1 and BRCA2 genes, where therefore the inhibition is lower, are 5-8 times more likely to develop breast cancer during their lifetime than the general population. In these patients, the tumor tends to arise at a young age and to be bilateral.
• Hormonal factors: the longer the period of exposure to female hormones, the higher the risk of developing breast cancer. Risk factors related to hormones are represented by:
  • early menarche (first menstruation at a young age),
  • late menopause,
  • advanced age at first pregnancy,
  • absence of pregnancies in the course of life,
  • taking the contraceptive pill (but with reversible effect after 10 years of suspension),
  • taking hormone replacement therapy in menopause.
• Pregnancy and breastfeeding are conditions that determine a higher risk of developing breast cancer in the years immediately following, while in the long term they involve a certain degree of protection (they are on the whole considered protective factors).
• Dietary factors. Obesity, with the consequent increase in circulating estrogen, seems to favor the onset of breast tumors; on the contrary, practicing regular physical activity plays a protective role against this pathology.
• Exposure to high insulin levels (diabetes mellitus or conditions of reduced glucose tolerance) also seems to be associated with a higher risk of developing breast cancer.
• Consumption of alcohol.
• Smoke.
• Environmental factors: Environmental or occupational exposure to specific chemicals, such as polycyclic aromatic hydrocarbons and heterocyclic amines, determines an increased risk of breast cancer.
• Exposure to radiation before the age of 30 increases the likelihood of incurring the tumor, including radiotherapy used for the tumor itself.

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