Breast Cancer

Risk for breast cancer
- genetic predisposition
- family history

Breast cancer
- types of breast cancer
- breast cancer cells

Hormones
- made by endocrine system
- female hormones are estrogen and progesterone
- breast cancer cells have hormone receptors (ER, PR)
- hormones can stop breast cancer cells from multiplying
- male hormones are androgens
- male hormones are made by the adrenal glands which are located at the top of kidneys

Menopause
- is the end of reproductive period in women
- women can't reproduce anymore
- women can't have babies anymore
- women are regarded as infertile

Aromatization
- male hormones are converted into female hormones by chemical aromatization
- aromatization occurs throughout the body in fatty tissue (including breast tissue)
- aromatization is more pronounced in women after menopause

Hormone receptors
- hormone-receptor positive:
  -- the breast cancer cells have a significant number of either ER or PR,
  -- and will respond to endocrine therapy
- endocrine receptor (estrogen or progesterone receptor)
  -- estrogen receptor (ER)
  -- progesterone receptor (PR)
  -- ER/PR = estrogen receptor/progesterone receptor
- endocrine receptor (estrogen or progesterone receptor) positive

Carcinoma
- breast carcinoma
- invasive breast carcinoma
- tumour (American, tumor)

Biomarker testing
- ER positive
- PR positive
- HER2 positive
- ER/PR/Her-2
- ER/PR/Her2
- Triple negative: not positive to receptors for estrogen, progesterone or HER2
- Triple positive: positive for estrogen receptors, progesterone receptors and HER2

Overproduction of HER2/neu protein in breast cancer
- protein
- breast cancer protein
- HER2, Her2 or Her-2
- HER2 positive
- DNA
- DNA amplification
- FISH = fluorescent in situ hybridization
  -- a technique used to assess Her2 DNA amplification

Treatment
- surgical treatment
- radiation treatment
- chemotherapy
- drug treatment
- endocrine therapy
- other medications

Surgical treatment
- the ovaries maybe removed in breast cancer as they are a source of hormones

Chemotherapy
- taxanes are used to treat breast cancer
- has a lot of side effects

Drug treatment
- Tamoxifen
  -- blocks ER
  -- is the gold standard of hormone therapy for breast cancer treatment
  -- is marketed as Nolvadex
  -- is an antiestrogen drug pill; it blocks estrogen
  -- has been used for more than 30 years (since 1984)
  -- is used to treat advanced breast cancer (metastatic or stage IV)
  -- is used to treat early breast cancer (stage I and II) after surgery in high risk patients
  -- is used to treat locally advanced cancer (stage III) after surgery in high risk patients
  -- is used in premenopausal and postmenopausal women with breast cancer
  -- is used to treat males with breast cancer
- Aromatase inhibitors
  -- eg Arimidex, Femara
  -- stop estrogen production in post-menopausal women
  -- stop the enzyme that catalyses aromatization of hormones
  -- stop the aromatization of androgens to estrogens
  -- stop the growth of breast cancer
- Herceptin
   -- reduces occurrence of HER2-positive breast cancers
   -- is given after surgical treatment, along with adjuvant chemotherapy in metastatic breast cancer
   -- has less side effects compared to chemotherapy (no nausea or hair loss)
   -- poses risk of heart and lung damage
   -- scientists are still working out how long patients should take Herceptin
- Tykerb is given for metastatic cancer if Herceptin fails
- Kadcyla is given after Herceptin and taxanes
- Perjeta (i.v.) is for late stage HER2-positive breast cancer
- Perjeta when given combined with Herceptin extends life

Endocrine therapy
- is also known as hormone therapy, hormonal therapy or hormone treatment
- is used in diabetes, menopause, and breast cancer treatment
- comes last, after surgical treatment, chemotherapy, and radiation treatment are completed
- adds, blocks or removes hormones
- is used to curb the growth of breast cancer, stop their spread, and recurrence
- blocks estrogen receptors and effects of estrogen, prevents recurrence of breast cancer
- is used to top up hormones in diabetes and menopause (low hormone levels)
- is used to block the body's natural hormones from reaching cancer cells in the body
- is used to slow down or stop cancer growth in prostate cancer and breast cancer
- side effects include infertility, blood clots, stroke, etc

Breast cancer biomarker status (ER/PR/HER2)

1. 75% of breast cancers are ER-positive. These cancers grow with more estrogen. Estrogen comes from food sources (estrogenic foods) - soybean milk (air soya, susu kacang soya), ubi keledek.
2. 65% of ER-positives are also PR-positive. These cancers grow with more progesterone.
3. 60% of breast cancers which are ER/PR-positive will respond to endocrine therapy.
4. 20%-25% breast cancers are HER2/neu positive. These are aggressive breast cancers and they grow very fast.

External links
http://pathology.jhu.edu/breast/biomarker-testing.php
http://www.webmd.com/breast-cancer/breast-cancer-types-er-positive-her2-positive
http://www.webmd.com/breast-cancer/breast-cancer-hormone-therapy-directory