Introducción al cáncer de mama

El cáncer de mama es una realidad ineludible para millones de mujeres. Esta guía contiene información sobre la detección temprana, el diagnóstico, el tratamiento y el pronóstico del cáncer de mama; datos que debe conocer para tomar decisiones informadas sobre su atención.

 

¿Qué es el cáncer de mama?

El cáncer de mama es el cáncer más común en las mujeres de todo el mundo. En los Estados Unidos, alrededor de 287.850 mujeres serán diagnosticadas con nuevos casos de cáncer de mama invasivo este año. (Alrededor del uno por ciento de los casos de cáncer de mama se producen en hombres). Este tipo de cáncer aparece cuando las células que conforman el tejido mamario se dividen y crecen incontrolablemente, lo que las hace capaces de propagarse a otras partes del cuerpo. El cáncer de mama a menudo se diagnostica en un estadio temprano, cuando hay muchas probabilidades de cura, aunque algunos tipos de este cáncer son más agresivos y se propagan (o metastatizan) rápidamente.  El cáncer de mama puede aparecer en ambos senos al mismo tiempo, aunque es más habitual que se desarrolle solo en uno.

 

Tipos de cáncer de mama

El cáncer de mama se divide en dos grupos principales: invasivos y no invasivos.

• Tipos de cáncer de mama invasivos: se trata de tipos de cáncer que pueden diseminarse a otros tejidos y órganos.
  • Cáncer de mama ductal invasivo: también llamado «carcinoma ductal invasivo de mama», es el tipo más común de cáncer de mama; representa entre el 70 y el 80 por ciento de los casos. Este cáncer comienza en las células de los conductos lácteos y se disemina al tejido mamario circundante. En el cáncer de mama ductal invasivo, las células pueden migrar desde los conductos y diseminarse a los ganglios linfáticos u otros tejidos y órganos.
  • Cáncer de mama lobular invasivo: también llamado «carcinoma lobular invasivo de mama», esta neoplasia maligna representa aproximadamente uno de cada 10 casos de cáncer de mama invasivo. Se diagnostica frecuentemente en mujeres de entre 45 y 55 años. Este cáncer comienza en las células de los lóbulos mamarios y puede diseminarse al tejido mamario circundante.

 

• Tipos de cáncer de mama no invasivos: estos tipos de cáncer permanecen en el tejido donde se formaron y no se diseminan.
  • Carcinoma ductal in situ (DCIS): este cáncer aparece cuando las células de los conductos lácteos comienzan a aumentar incontrolablemente. Si bien el DCIS no pone en peligro la vida, recibir este diagnóstico implica que usted tiene un mayor riesgo de padecer un cáncer de mama invasivo en el futuro.
  • Carcinoma lobulillar in situ (LCIS): este cáncer se produce cuando las células dentro de los lóbulos mamarios comienzan a aumentar incontrolablemente. Si bien los médicos consideran que el LCIS no es canceroso, recibir este diagnóstico implica que usted tiene un mayor riesgo de padecer un cáncer de mama en el futuro.
  • Hiperplasia lobulillar atípica: es similar al LCIS, aunque presenta menos células anormales y conlleva un riesgo algo menor de padecer un cáncer de mama invasivo en el futuro.

 

 

Fuente: Sociedad Estadounidense contra el Cáncer, Breastcancer.org

Breast Cancer Symptoms and Signs 

Breast cancer occurs when cells in the breast tissue begin to grow uncontrollably and form a tumor. This process may go unnoticed, at least initially. However, the gradual development of breast cancer can produce physical changes in the breast and even in other tissues that may result in a variety of symptoms and signs, which can differ from one patient to another.  

 

It’s important to keep in mind that the symptoms and signs listed below can arise due to other conditions, so if you notice any of these changes, don’t assume you have breast cancer. For example, one of the most common signs of breast cancer is a lump in the breast tissue, which in most cases turn out to be cysts or other benign (harmless) formations. Still, if you notice any of these symptoms and signs, see a doctor soon.  

 

• A new lump in the breast or underarm. 
• Thickening or swelling of the breast. 
• Breast skin that appears irritated. 
• Breast skin that appears dimpled, like an orange peel. 

• Redness or flaking around the nipple. 
• An inverted nipple. 
• Pain anywhere in the breast, including the nipple 
• Nipple discharge other than breast milk, especially blood. 
• A change in size or shape of the breast. 

 

Source: Centers for Disease Control and Prevention 

Breast Cancer Treatment Options 

Finding out you have breast cancer is alarming, but patients can take some comfort in the fact that doctors have an ever-expanding array of treatments to offer. The treatment plan that’s right for you will depend on a variety of factors, including the type of breast cancer you have, whether it has spread (metastasized), your age and overall health, your preferences, and others. Below are the most common treatments for breast cancer. Many patients require more than one form of treatment, such as surgery with radiation. 

  

  

• Surgery: There are two primary forms of surgery for breast cancer. Women who undergo surgery to treat their cancer may elect to have breast reconstruction surgery. 

• Lumpectomy: Often-called breast-conserving surgery, this procedure involves the removal the tumor and a small area of healthy tissue surrounding it (called a margin).  
• Mastectomy: In this procedure, the surgeon removes the entire affected breast.  

• Radiotherapy: Also called radiation therapy, this treatment uses high-energy waves to kill cancer cells. There are several forms of radiation therapy. The most common is external-beam radiation therapy, which is administered with a machine from outside the body. Patients typically receive radiation treatments five days a week for three to six weeks. Side effects can include fatigue, swelling and pain in the breast, and skin tenderness, though they eventually go away.  

• Chemotherapy: Chemotherapy is the delivery of drugs that are toxic to cancer cells, which causes tumors to shrink. Some forms of chemotherapy can be taken orally, though often it must be administered intravenously at a healthcare facility. Chemotherapy is typically given over the course of several months and may cause a wide variety of side effects, including fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, constipation, and others.  
• Hormonal therapy: The growth of some—though not all—breast tumors is fueled by hormones. A patient whose tumor tests positive for the presence of estrogen or progesterone receptors may be a candidate for hormonal therapy, which blocks these hormones. Tamoxifen is a well-known form of hormonal therapy for breast cancer, but there are several others. Possible side effects include hot flashes, vaginal dryness, and bone thinning, depending on the drug used.  
• Targeted therapy: A targeted therapy is designed to identify and attack cancer cells that have certain genetic mutations or produce cancer-promoting proteins. Because these cutting-edge treatments are designed to strike only a specific target, they may be less likely than chemotherapy to harm healthy tissue and cause side effects, though all medicines in this class are capable of producing some ill effects. One widely used targeted therapy for breast cancer is the drug Herceptin (trastuzumab), which blocks a cancer-promoting protein called HER2.  
• Immunotherapy: The goal of immunotherapy is to strengthen the body’s immune system and make it better able to fight cancer. Women with a type of malignancy known as triple-negative breast cancer may be candidates for a form of immunotherapy called Keytruda (pembrolizumab). Possible side effects include skin rashes, flu-like symptoms, thyroid problems, diarrhea, and weight changes. 
• Neo-adjuvant therapy: This term describes any treatment given in advance of surgery with the goal of making the tumor smaller. Chemotherapy, hormonal therapy, targeted therapy, and immunotherapy are all used as neo-adjuvant therapy.  
• Clinical trials: If you have breast cancer that has advanced, it’s important to consider all of your treatment options. That includes participating in a clinical trial, in which researchers evaluate the benefits and safety of new, potentially life-saving therapies. At Massive Bio, our dedicated team of oncology nurses and patient advocates are experts at matching breast cancer patients to clinical trials. With SYNERGY-AI, our proprietary technology platform that uses artificial intelligence to scan thousands of clinical studies in seconds, we can identify the trial that’s right for you. 

Living With Breast Cancer 

Whether you’re a survivor or still battling the disease, breast cancer changes your life in myriad ways. Here’s a look at some issues that breast cancer patients may face, with strategies for how to cope with them.  

 

Fear of Breast Cancer Recurrence 

It’s an unfortunate reality: Even if your treatment for breast cancer is successful, there’s a chance that it can return, known as a recurrence. What’s more, having breast cancer increases your risk for developing a new breast tumor, as well as certain other types of cancer. Knowing about these risks may leave you feeling depressed or anxious. Rest assured that you have plenty of company, as many breast cancer survivors experience these difficult emotions. If you find yourself struggling with fear or sadness, taking the following steps can help: 

 

• Don’t suffer in silence: Be open with family and friends about your feelings. Sometimes simply talking can be the best medicine for emotional angst.  
• See a counselor: Talking about your fears and worries with a healthcare worker such as a licensed social worker or psychotherapist may be even more effective. A trained mental-health counselor can help you identify and address unhealthy thinking patterns, which can help you cope with your concerns more effectively.  
• Don’t miss routine checkups: Seeing your doctor for all scheduled office visits, getting mammograms as recommended, and following all follow-up care instructions can give you the confidence that if a recurrence happens, it’s caught early.  

 

Life After Breast Cancer Surgery 

Women who have undergone a mastectomy or other surgical procedures for breast cancer often experience complex emotions. Their bodies have changed, requiring them to accept their new appearance, which can be challenging and take time. Some women struggle with loss of self esteem and confidence. Partners of women who have had breast cancer surgery may also harbor their own difficult emotions. Their instinct may be to offer unconditional support, but a partner may also struggle to adjust to the new reality, while coping with fears of a recurrence, which can affect intimacy. Children of patients who have had breast cancer surgery may experience worry and stress, which can be manifested in behavioral changes. Mental health counseling, including individual, couples, or family therapy, can help during this difficult time of adjustment.  

 

Dealing With Menopause Symptoms 

Some treatments for breast cancer may cause younger women with the disease to experience premature menopause. Menopause occurs when a woman stops having menstrual periods for at least one year, which normally happens between the ages 45 and 55. During this transitional time, many women develop symptoms such as hot flashes, night sweats, trouble sleeping, pain during sex, moodiness and irritability, depression, and others. These symptoms are related to a drop in levels of the female hormone estrogen during menopause. Hormone replacement therapy (HRT) can improve these symptoms in many women. However, HRT is usually not recommended for women who have or had breast cancer, due to concern that increasing estrogen levels could promote the growth of existing tumors or a recurrence. Ask your doctor about strategies for coping with menopause symptoms. Some non-hormonal medications may help, as can simple lifestyle changes, such as dressing in layers (which can be removed one at a time to cool off a hot flash) or avoiding certain foods (such as spicy dishes, which may trigger a flash). 

 

Breast Cancer and Pregnancy 

Women of child-bearing age who develop breast cancer may wonder if having the disease will affect their ability to become pregnant. In fact, while many women who have breast cancer are able to have children, it’s true that some treatments for this malignancy can alter fertility, or the ability to conceive a child. For this reason, women who are diagnosed with breast cancer and hope to become pregnant should let their doctors and care team know before starting treatment. Women who have completed treatment for breast cancer should ask their doctors how long they should wait before attempting to conceive.  

 

Breast cancer survivors may also wonder if becoming pregnant will make them more likely to experience a recurrence of the disease. That’s an understandable concern, since some forms of breast cancer are sensitive to the hormone estrogen, which rises during pregnancy. However, according to the American Cancer Society, there is no evidence that becoming pregnant can cause cancer to return. Depending on the type of treatment you received, you may or may not be able to breastfeed an infant.  

 

Women with breast cancer who become pregnant can face difficult choices. While surgery to remove a tumor is generally considered to be safe, treating breast cancer with certain medications could harm the fetus, so options are limited. Making decisions about treating breast cancer during pregnancy can be challenging, so a woman may want to consult a mental health counselor for emotional support during these discussions with her care team.   

 

 

Sources: American Cancer Society, Breast Care 

Diagnóstico del cáncer de mama

El cáncer de mama a menudo se descubre a través de pruebas de detección de rutina, aunque en ocasiones las pacientes notan cambios físicos que llevan a un diagnóstico. Los médicos utilizan diversos tipos de pruebas para diagnosticar el cáncer de mama. Además, existen varios tipos de cáncer de mama, por lo que un diagnóstico preciso es esencial para elegir el plan de tratamiento para cada paciente.

 

¿Cómo se diagnostica el cáncer de mama?

Algunos casos de cáncer de mama se descubren cuando una paciente o su médico notan un cambio en una mama, generalmente en forma de bulto. Otros cambios que pueden indicar la presencia de cáncer de mama son:

 

• La aparición de un bulto en la axila.
• Secreción del pezón que no es leche (como sangre).
• Cambio en la forma o en el tono de la piel de la mama.
• Hinchazón o irritación en la piel de las mamas.
• Hoyuelos en la piel.
• Costra de piel alrededor del pezón.
• Retracción del pezón.

 

Tenga en cuenta que todos estos síntomas, incluidos los bultos en los senos, pueden ser causados por muchas otras afecciones y, por lo general, no son señales de un cáncer de mama. Aún así, es importante que su médico examine cualquier cambio que note en sus senos.

 

También es importante tener en cuenta que el cáncer de mama a menudo no causa síntomas, especialmente en las primeras etapas, que es precisamente cuando es más fácil de tratar. Es por eso que la Sociedad Estadounidense contra el Cáncer (ACS) recomienda seguir una rutina de detección con mamografías u otras pruebas de diagnóstico por imágenes que permitan detectar el cáncer de mama tempranamente. La ACS y otras autoridades siguen recomendando a las mujeres que presten atención a la aparición de cualquier cambio en sus senos y, además, su médico puede revisarlos. Pero no confíe solo en estos exámenes: las pruebas de diagnóstico por imágenes son fundamentales. Estos son los exámenes más utilizados para diagnosticar el cáncer de mama:

 

• Mamografía. Las mamografías son un tipo de radiografía que está diseñada para examinar los tejidos que se encuentran dentro de la mama. Las mamografías pueden detectar tumores de mama en sus inicios, antes de que se puedan sentir. Si una mamografía muestra una masa sospechosa, necesitará realizarse más pruebas para confirmar un diagnóstico de cáncer de mama. Las mamografías pueden no detectar algunos tumores y detectar tejidos benignos (o inofensivos) que no son cáncer, pero que requieren pruebas adicionales de todos modos. Sin embargo, los estudios revelan que las mujeres que se someten a mamografías de rutina tienen menos probabilidades de requerir un tratamiento agresivo si se les diagnostica un cáncer de mama. Si bien las mamografías son la herramienta más utilizada para la detección temprana del cáncer de mama, cuando el médico sospecha que una paciente puede tener un tumor en la mama puede usar una variante de esta prueba llamada mamografía de diagnóstico. Pregunte a su médico con qué frecuencia debe hacerse una mamografía de detección.
• Mamografías tridimensionales. Esta tecnología, a veces llamada tomosíntesis mamaria, utiliza una gran cantidad de radiografías para crear imágenes tridimensionales de los tejidos que se encuentran dentro de la mama. Los estudios indican que las mamografías tridimensionales reducen la posibilidad de que las pacientes tengan que regresar a hacerse una segunda mamografía a causa de que la primera no fue concluyente. También es posible que sean más efectivas para la detección de tumores. Sin embargo, muchas clínicas no ofrecen mamografías tridimensionales, que además pueden no estar cubiertas por los seguros de salud.
• Cuando una mamografía u otra prueba de diagnóstico por imágenes detecta una masa sospechosa, es probable que se realice una biopsia para confirmar el diagnóstico. Durante una biopsia, el médico inserta una aguja u otro dispositivo similar (o usa un bisturí) para extraer un fragmento de tejido de la masa. Esta muestra de tejido se envía a un laboratorio, donde se la analiza para detectar la presencia de células cancerosas.
• Ecografía de mama. Por lo general, esta tecnología no se utiliza para la detección del cáncer de mama, sin embargo, en algunas circunstancias el médico puede solicitarle una ecografía de mama. Específicamente, esta ecografía puede ayudar a distinguir entre quistes benignos (que no necesitan tratamiento) y masas sospechosas que requieren la realización de pruebas adicionales.
• Imágenes por resonancia magnética (IRM) de mamas. Los médicos a menudo recomiendan realizar una resonancia magnética junto con la mamografía en aquellas mujeres con un alto riesgo de padecer cáncer de mama debido a antecedentes familiares o una mutación genética conocida. Las resonancias magnéticas también se utilizan para medir la extensión del cáncer de mama en pacientes que ya han sido diagnosticadas.

 

 

 

¿Cuáles son los estadios del cáncer de mama?

Para describir la extensión del cáncer de un paciente, los médicos usan un sistema llamado estadificación. Para cada tipo de cáncer se utilizan sistemas de estadificación únicos. Para el cáncer de mama, los médicos utilizan dos sistemas. Uno se llama estadificación TMN.

• La T indica el diámetro del tumor. La letra T puede ir seguida de un número (de 0 a 4) o de letras. Cuanto mayor es el número, más grande es el tumor. Si hay letras, indican otros datos sobre el tumor. (Una X indica que el tumor no se puede estudiar).
• La N indica la cantidad de ganglios linfáticos axilares enfermos que tiene la paciente. La N va seguida por un número (de 0 a 3) que indica cuántos ganglios linfáticos dieron positivo de cáncer. Cuanto mayor sea el número, más ganglios linfáticos estarán involucrados. (Una X indica que los ganglios linfáticos no se pueden estudiar).
• La letra M se refiere a la metástasis, o qué tan lejos se ha diseminado el cáncer a otras partes del cuerpo. La M puede ir seguida por un 0 (sin metástasis) o 1 (se ha detectado metástasis a otros órganos o tejidos). cM0(i+) indica que se ha encontrado una pequeña cantidad de células cancerosas en la sangre o los ganglios linfáticos.

 

 

En la estadificación del cáncer de mama también se consideran otros factores, como si el tumor tiene receptores de estrógeno o progesterona, si produce altas cantidades de una proteína llamada HER2 y cuál es la apariencia (o grado) de las células cancerosas.

 

Los médicos también usan un sistema de numeración para estadificar el cáncer de mama, generalmente con números romanos, que van de 0 a IV. El estadio 0 describe formas no invasivas de cáncer de mama tales como el DCIS. Los estadios I, II, III y IV son tipos invasivos de cáncer de mama. Dentro de cada estadio hay subcategorías (indicadas con letras, como IB) que denotan factores tales como si el tumor parece ser agresivo o no. Pero, en general, cuanto mayor es el número del estadio, más probable es que el cáncer de mama se haya diseminado a los ganglios linfáticos o, en el caso del estadio IV, a otros órganos como los huesos, el hígado o el cerebro, lo que lo hace más difícil de tratar.

 

 

 

Fuente: Sociedad Estadounidense contra el Cáncer, Breastcancer.org

What Are the Stages of Breast Cancer? 

Doctors use a system called staging to describe the extent of a patient’s cancer—that is, how big the tumor is and whether (and where) it has spread. Unique staging systems are used for different forms of cancer. In breast cancer, doctors use two systems. One is called TMN staging.  

• T is for a tumor’s diameter. T may be followed by a number (from 0 to 4) or letters. The higher the number, the larger the tumor. Letters, if present, indicate other information about the tumor. (An X indicates the tumor can’t be studied.) 
• N is for the number of diseased axillary lymph nodes a patient has. N is followed by a number (from 0 to 3) that indicates how many lymph nodes test positive for cancer. The higher the number, the more lymph nodes involved. (An X indicates the lymph nodes can’t be studied.) 

• M is for metastasis, or how far the cancer has spread to other parts of the body. M is followed by a 0 (no metastasis) or 1 (metastasis to other organs or tissues detected). cM0(i+) indicates that a small amount of cancer cells are found in the blood or lymph nodes.  

 

Other factors are considered in staging breast cancer, including whether the tumor has estrogen or progesterone receptors, makes high amounts of a protein called HER2, and the appearance (or grade) of the cancer cells.  

 

Doctors also use a numbering system to stage breast cancer, usually with roman numerals, ranging from 0 to IV. Stage 0 describes non-invasive forms of breast cancer such as DCIS. Stages I, II, III, and IV  

are invasive forms of breast cancer. Within each stage, there are subcategories (noted by letters, such as IB) that denote factors such as whether or not a tumor appears to be aggressive. But, in general, the higher the stage number, the more likely that breast cancer has spread to lymph nodes or, in the case of stage IV, to other organs such as the bones, liver, or brain, making it more challenging to treat.  

 

Source: American Cancer Society 

Follow-up Care After Breast Cancer Treatment 

Completing treatment for breast cancer may bring a sense of joy and relief, but it’s essential to keep in mind the importance of follow-up care. You will see your doctor and care team on a regular schedule to be monitored for signs that your cancer has returned (called recurrence) and evidence of long-term side effects from treatment. Your care team can also counsel you on steps to take to promote overall health and help you coordinate what care you should be receiving from other clinicians.  

 

The specifics of your follow-up care plan will depend on the type of breast cancer, treatments you received, your age, personal preferences, and other factors. However, a typical follow-up care plan for a breast cancer survivor includes the following elements.  

 

Monitoring for Recurrence and Other Cancers 

Your doctor will plan to see you for office visits frequently after you complete treatment, perhaps every few months, at first, then at longer intervals over time. In addition to performing a thorough physical examination and asking you about symptoms you may be experiencing, other tests are essential as part of follow-up cancer care. 

 

• Mammograms: Having breast cancer increases your risk for a second bout, so these imaging tests remain necessary for most women who have undergone treatment for this malignancy, according to the American Cancer Society. A woman who has had a mastectomy should have routine mammograms on her remaining breast (they are not necessary if both breasts have been removed). Women who undergo lumpectomy or partial mastectomy require mammograms, too. Your doctor will recommend a schedule for mammograms, which will typically start six to 12 months following treatment, and continue annually thereafter.  

• Screening for other cancers: Breast cancer and its treatment can increase the risk for certain other cancers. For instance, a woman with an intact uterus who takes the hormone drugs tamoxifen or toremifene should have regular pelvic exams, since these drugs cause an increased risk for uterine cancer. Other treatments can increase the risk for additional  cancers. Women with mutations in BRCA1, BRCA2, or certain other genes should be screened for ovarian cancer.  
• Other tests: If you develop certain symptoms or preliminary tests indicate a possible recurrence of your cancer, your doctor may order imaging tests such as an X-ray, computed tomography (CT) scan, positron-emission tomography (PET) scan, magnetic-resonance imaging (MRI) scan, or a bone scan. In some cases, a biopsy may be necessary. Some women may be monitored for levels of certain tumor markers that would suggest that cancer has recurred.  
• Genetic counseling: Your doctor may recommend genetic counseling to determine if your breast cancer was associated with an inherited syndrome. Genetic counseling is often recommended for patients who fall into any of these groups:  

• You were diagnosed before age 50, especially if you’re younger than 35.  
• You have had ovarian cancer. 

• You had cancer in both breasts. 
• You have other family members who had breast or ovarian cancers. 
• One side of your family (your father’s or mother’s) had multiple cases of breast cancer. 
• You are male. 
• You are of Ashkenazi Jewish ancestry. 

 

 

Managing Long-Term Effects 

Having breast cancer, and especially receiving treatment for the disease, can have long-term effects on your body and mind in the form of increased risks for other medical conditions. Your doctor will keep an eye on the following, in particular.  

 

• Cardiovascular health: Some common cancer treatments can increase the risk for heart problems. Your doctor should check your cholesterol and other blood fats regularly, and may recommend other cardiovascular monitoring, if necessary. 
• Depression and anxiety: Many breast cancer survivors struggle with psychological distress and mood disorders. Your primary care doctor can refer you to a mental health counselor for short- or long-term therapy, as needed.  
• Osteoporosis: This common condition, which causes bones to become thin and fragile, can be caused by certain breast cancer drugs, including hormone treatments called aromatase inhibitors. Also, some therapies can promote early menopause, which is also a risk factor for osteoporosis. Your doctor may recommend routine scans to monitor your bone density. 
• Lymphedema: If you had lymph nodes removed or treated with radiation as part of treatment, you may be at risk for lymphedema. In this condition, lymph—clear liquid that circulates through the body, clearing away bacteria and waste from tissues—builds up and can cause significant swelling, pain, rash, and other symptoms. The arms and hands are most often affected, but lymphedema can occur elsewhere in the body. If you develop lymphedema, your doctor can refer you to a specialist (such as a physical therapist) who can work with you to control its symptoms.  

 

General Health Counseling 

A comprehensive breast cancer follow-up care plan should also include advice and counseling on how to maintain good all-around health, including the following: 

 

• Weight management: Breast cancer survivors who are obese have an increased risk for recurrence or being diagnosed with a different cancer, as well as other conditions associated with being overweight, such as type II diabetes. However, even modest weight loss significantly reduces those odds and can improve quality of life. Your doctor can refer you to a registered dietitian who can help you develop a healthy eating plan that controls calories while increasing cancer-fighting foods such as vegetables, fruits, whole grains, and legumes, while limiting less-healthy choices such as processed meats, red meat, and foods high in saturated fat.  
• Physical activity: Getting some form of regular exercise will not only help with weight management, but also improves cardiovascular health, mood, sleep, and overall health. Most authorities recommend getting at least 150 minutes of moderate exercise (such as walking briskly) per week.  

• Tobacco cessation: If you smoke, quitting is a must. If you can’t, studies suggest that a combination of smoking-cessation medication and counseling is most effective.  
• Alcohol: Excessive consumption of liquor, wine, or beer increases the risk for many cancers. If you consume alcohol, limit yourself to one drink per day (two for men).  

 

Pull it All Together: A Cancer Survivorship Care Plan 

Ask your doctor about developing a cancer survivorship care plan for you, which can help ensure successful follow-up care. This plan may include the following: 

 

• A recommended schedule for follow-up exams and tests to monitor you for a recurrence of breast cancer. 
• A schedule for other tests you may need in the future, such as screening tests for early detection of certain other types of cancer that occur more commonly in breast cancer survivors. 
• A list of possible late or long-term side effects from your treatment, including what to watch for and when to contact your doctor, as well as a schedule for testing to identify these effects, as necessary. 
• A list of other clinicians you may see as part of follow-up care. 

• Diet, physical activity, and other lifestyle change recommendations. 

 

 

Sources: American Cancer Society, Canadian Family Physician 

What Are the Risk Factors for Breast Cancer? 

The risk factors for breast cancer fall into two general categories: those you can’t change and those you can. Knowing the risk factors for breast cancer can help you make lifestyle changes that lower your odds of developing this disease and take steps to ensure that it’s detected early, when it’s most treatable, if you do.  

 

Breast Cancer Risk Factors You Can’t Change 

Here’s a list of risk factors for breast cancer that you cannot change, according to the Centers for Disease Control and Prevention (CDC). 

 

• Age: The risk for breast cancer increases as you grow older. While young women can develop breast cancer, most cases are diagnosed in women over 50. 
• Your genes: Having mutations (alterations in DNA) in certain genes inherited from your parents (notably the BRCA1 and BRCA2 genes) increases the risk for breast cancer, as well as ovarian cancer. 
• Your reproductive history: If you had your first menstrual period prior to age 12 or began menopause after age 55, your risk is increased.  

• Dense breasts: A breast is considered dense if it has a lot of connective tissue. That doesn’t cause cancer, but it can make tumors harder to detect with mammograms. 
• Previous breast cancer or non-cancerous condition: If you have had breast cancer, your risk for a second bout with the disease is increased. The same is true if you have been diagnosed with certain non-cancerous breast diseases, such as atypical hyperplasia or lobular carcinoma in situ. 
• Family history: Your risk rises if you have a close blood relative—such as your mother, sister, or daughter—who had breast cancer; if more than one family member on either your mother’s or father’s side had breast or ovarian cancer; or you have a close male relative (father, brother, or son) who had breast cancer. 
• Prior treatment with radiation therapy: Radiation treatment is a critical tool in treating many forms of cancer, but in some cases it may increase the risk for breast cancer later in life.  
• Exposure to DES: The drug diethylstilbestrol (DES) was used to prevent miscarriage in pregnant women in the United States between 1940 and 1971. Unfortunately, DES increased the risk for breast cancer in these women and their daughters.  

 

Breast Cancer Risk Factors You Can Change 

The good news is that you have the opportunity to lower some significant breast cancer risk factors, including the following. 

 

• Inactive lifestyle: Your risk for breast cancer is reduced if you exercise or get some form of physical activity on a regular basis. Experts recommend at least 150 minutes a week of moderately intense exercise, such as brisk walking.  

• Being overweight: Carrying too much weight, especially after menopause, increases your risk for breast cancer, among other diseases.  
• Using hormone therapy: Short-term use of hormone replacement therapy that includes both estrogen and progesterone during menopause may be safe, but studies suggest that this treatment can raise risk for breast cancer if taken longer than five years. Use of certain oral contraceptives can increase risk, too.  
• Pregnancy history: Never having children, having your first pregnancy after age 30, and never breastfeeding are all associated with an increased breast cancer risk. 
• Excessive alcohol consumption: Alcohol is associated with an increased risk for breast cancer—the more you drink, the higher the risk.  

 

According to the CDC, quitting smoking may lower your risk for breast cancer, while some evidence suggests that women who work night shifts experience changes in hormones that promote breast cancer, too.  

 

Source: Centers for Disease Control and Prevention 

 

Recurrence of Breast Cancer 

Breast cancer that has been successfully treated may nonetheless return months or even years later, known as a recurrence. This happens because treatment may make cancer undetectable, but some cancer cells remain in the body. Over time, they may begin growing again, form tumors, and spread to other parts of the body. If you have been treated for breast cancer, but begin to notice changes in your breast or chest, or experience symptoms such as chronic chest pain or swollen lymph nodes, see a doctor soon.  

  

What Are the Types of Breast Cancer Recurrence? 

• Local recurrence: If a recurrence is local, that means it has not spread. Local recurrence may occur in the chest, breast, or armpit, or within a surgical scar. 
• Regional recurrence: Also called locally advanced, regional recurrence of breast cancer occurs when cancer returns in the lymph nodes in the armpit or collarbone area near where the original cancer was diagnosed. 
• Metastatic recurrence: Also called a distant recurrence, in this case cancer has returned in a part of the body far from the original site such as the liver, bones, or brain. 

  

What Are Risk Factors for Breast Cancer Recurrence? 

Your risk of cancer recurrence is influenced by several factors: 

• Age: Women who have breast cancer at a young age (before age 40) are more likely to develop breast cancer again. 
• Type of cancer: Aggressive types of cancer, such as inflammatory breast cancer and triple-negative breast cancer, are more likely to come back and spread. 
• Cancer stage: The stage of cancer at diagnosis is associated with the risk for recurrence; higher-stage cancers are more likely to recur. 

  

How Common Is Breast Cancer Recurrence? 

Local recurrence of breast cancer is most common within five years of lumpectomy, though combining surgery with radiation therapy reduces this risk to three to 15 percent over a 10-year period. Additional therapies may shrink the risk even more.  

  

For patients who have had mastectomies, recurrence rates vary. 

• If no cancer was detected in the axillary lymph nodes during the surgery, a patient has a six percent chance of recurrence over a five-year period.  

• If cancer was found in an axillary lymph node, there is a 25 percent chance of recurrence, though the rate drops to six percent if radiation therapy is administered.  

 

Source: Cleveland Clinic 

Non-Hodgkin’s Lymphoma Clinical Trials 

Clinical trials focusing on Non-Hodgkin’s Lymphoma are aiming to find safe and effective new treatments, drugs or approaches to better care for the patients suffering from the disease. For these new methods to be widely available, they first need to be tested and approved. Non-Hodgkin’s lymphoma (NHL) is one of the most frequent cancers in the US, accounting for approximately 4 percent of all cancers. According to the American Cancer Society, the overall 5-year survival rate for Non-Hodgkin’s Lymphoma is 73 percent. These numbers are possible because medical science puts an enormous effort into advancement. That is why joining a clinical trial is valuable not only for the patients themselves but also anyone who is suffering from NHL. 

According to the information provided by the clinicaltrials.gov, there are currently 469 clinical trials (either active, recruiting or enrolling by invitation) on Non-Hodgkin’s Lymphoma in the United States as of March 2022. There are various methods scientists are working on to improve: 

Immunotherapy: The research evolving around the CAR (Chimeric antigen receptor) T-cell therapy is included under the immunotherapy studies. The patient’s healthy T-cells (a type of immune cells) are collected and engineered in the laboratory to recognize, bind to and defeat the cancer cells. In addition to four approved CAR T-cell therapies that are currently available as treatment, more is expected to be approved soon. Among the ongoing studies, several are targeting CD19, and assessing the competence of the CAR T-cell therapies for treating refectory and relapsed Non-Hodgkin’s Lymphoma. 

Chemotherapy: A common treatment for all cancer patients, chemotherapy has positive results for Non-Hodgkin’s Lymphoma as well. Researchers are focusing on combining different chemotherapies and treatment methods such as immunotherapy and radiation. They are looking for ways to improve the current drugs and develop or combine new ones. 

Genetic testing: Genetics is an important element in classification and diagnosis of Non-Hodgkin’s Lymphoma subtypes. Researchers are trying to find out more about the mutations (gene changes) in the development of cancer. The expectation with these studies is to identify the specific mutations to design the best treatment for each patient. 

Vaccines: Especially for Non-Hodgkin’s Lymphoma in indolent nature, therapeutic vaccines are a wide area of study. Main goal is preventing or diminishing the chance of relapse of the disease after chemotherapy or targeted therapy, rather than prevention. 

Targeted therapies: Targeted therapy is the most prominent and promising area of clinical trials for the Non-Hodgkin’s Lymphoma studies. The targeted drugs such as proteasome inhibitors, Histone Deacetylase (HDAC) inhibitor, Bruton Tyrosine Kinase (BTK) inhibitors, Phosphoinositide 3-kinase (PI3K) inhibitors, EZH2 inhibitor, mTOR inhibitor, nuclear export inhibitor and other agents are being carefully studied to provide new options for patients. 

Bone Marrow Transplantation/Reduced-Intensity Stem Cell Transplantation (Nonmyeloablative Allogeneic Transplantation): This method is being tested both for patients that re newly diagnosed and for those already received a treatment but experienced a relapse.  Current studies are looking into the procedure to determine its effectiveness for different types of lymphoma, including some subtypes of Non-Hodgkin’s Lymphoma. For preparation, the patients first receive a low dose of chemotherapy drug/s and/or radiation therapy for a while before the reduced-intensity transplant. 

Supportive care/palliative care: The clinical trials also focus on diminishing the symptoms and side effects of Non-Hodgkin’s Lymphoma treatments that are already available, as improving the patients’ comfort and quality of life is one of the main concerns. 

How to find clinical trials for Non-Hodgkin’s Lymphoma? 

This is a question that needs to be answered in guidance of a medical team who know your medical history, your current stage and condition along with the match your case has with the requirements of a given clinical trial. Here at Massive Bio our patient advocates consist of oncology nurses, and our artificial intelligence-based clinical trial matching system can assist you to choose the best option and enroll as soon as possible. You can get a free consultation, or directly start your journey to advanced treatment options. 

 

Sources: 

cancer.org 

lls.org 

cancer.net