A significant study on the survival rate for breast cancer patients

Breast cancer is the most significant cause of carcinoma  death amongst women globally. Cancer is also the origin of untimely mortality as measured by potential years of life lost. The natural history of breast cancer is largely unknown, therefore there is no definite primary prevention strategy yet established. The main preventive strategy is focussing on the early detection and early intervention to improve the survival rate of breast cancer patients.

Increasing consciousness of the natural history of breast carcinoma and survival rate of breast cancer patients has had two crucial consequences on the presentation of survival data. Firstly it has led to the recognition that conventional fixed time survival at 5 or 10 years is not synonymous with cure and as a result there has been increasing use of life-table analysis. Secondly, the fact that relapse can occur many years after initial treatment makes it necessary not only to continue follow-up for 20 years or more but also to allow for the normal mortality experience in the general population.

Warning Breast Cancer Symptoms 

1.  Breast Lumps

Most of the lumps in breast are non cancerous. The most common causes are cysts which might be one of the reasons Benign lesions of the breast are the most common lesions which accounts for 90% of the clinical presentation related to breast.The most common breast cancer symptoms include palpable painful breast lump is the major breast disorder. It is crucial to notice the appearance of a breast with a large lump in the armpit or bumpy area that does not disappear after 6 weeks.

2. Breast Colour and Texture Changes

The colour and texture of the skin around the breast changes. It  becomes hollowed, irritated, flaky, or reddish. Underlying conditions should quickly report to the doctor for further diagnosis — like mammogram, FNAC or Biopsy as recommended by the doctor.

3. Breast Rash

The breast skin appears like an orange peel with reddish colour and irritation. The appears to be flaky or a rash that’s itchy, painful with blisters. A carcinoma breast appears to be these kind of alarming breast cancer symptoms that should not be neglected and reported to the doctor immediately.

A carcinoma breast has these kinds of breast rashes. Causes for these include:

• An abscess
• Mammary duct ectasia (when milk ducts beneath the nipple get wider)
• Mastitis (a breast tissue infection usually tied to breastfeeding)
• Nipple eczema (dermatitis)

A rash on the nipple can also be a contrasting  type of breast cancer symptoms. One rare form, Paget’s disease of the breast, starts on the nipple and spreads to the skin around it known as areola. The other, inflammatory breast cancer, makes the breast reddish, swollen, and itchy with pain. It happens when cancer cells block lymphatic vessels in your breast.

4. Nipple Discharge

Nipple discharges with watery blood and fluid. In normal cases fluid or milk comes out during pregnancy and breastfeeding that continues up to 2 years of nursing. Sometimes the hormonal changes associated with menopause can also cause some leakage which is not to be worried about. Transgender women who use hormone therapy can have nipple discharge too. But abnormalities lie when nipple discharge happens with pain and watery blood comes out from. The nipple with other symptoms.

The nipple discharge is:

• Bloody
• Coming from just one breast
• Happening without touching or squeezing the breast
• Accompanied with breast pain, redness, swelling, or nipple changes.

The cause could be an infection, a sac filled with fluid called a cyst, other lumps that aren’t cancer (such as fibroadenomas), or cancer, should report to the doctor in any of these conditions.

5. Nipple Pain

The  nipples are sensitive, and could be painful for many reasons, like tight  clothes that are poorly fitted might cause pain in the breast area. Skin conditions such as dermatitis, contact dermatitis, and eczema can cause pain in the nipples.During  pregnancy or breastfeeding time excessive milk forms that might cause pain. During the time of menstrual cycle hormonal changes happen and that causes pain which is a sign that period is drawing soon.

Infections such as mastitis and thrush can also aggravate the nipples.

Sore nipples may make us worry about breast cancer. 

6. Soreness and Tenderness in Breasts

During periods, that’s always a possible cause of soreness in the breasts. The breast soreness can start before or after the bleeding starts. This is a normal cycle  and usually, the pain goes away on its own. But if the pain gets worse, from one area of the chest, or if it affects the daily routine like working out, lifting anything, muscles strain, lifting the kids. When these symptoms arise it is a matter of concern.

7. Armpit Pain

Lump in the armpit region and a dense pain might occur. If there is pain in the armpit region and couldn’t detect the source of pain, one should consult a doctor immediately.While it could be something as simple as a muscle strain or swollen lymph nodes caused by a viral infection, it could also be a breast cancer symptom. Diagnosing the source of pain a patient is referred to an Oncologist for further screening.

There might not be any symptoms of cancer in the breast. But underarm pain and swelling is a warning sign that the cancer has spread into the lymph nodes.

When to Worry About Breast Pain

Temporary breast pain occurs during the day 1 of the menstrual cycle or before that and continues till day 3 and after that the pain disappears, some hormonal changes might cause pain in the breast and other causes like tight fit bras are clearly no cause for concern. But, if the pain with other underlying conditions exists more than six weeks, it is a matter of concern.

Breast Cancer Stages

Breast cancer is  classified according to its characteristics. After someone is diagnosed with breast cancer, doctors will  figure out how much the cancer is spread and this process is called staging. The stage of a cancer describes how much cancer is in the body and  determines its stage. Oncologists diagnose the stage and try to give the best treatment for a quality life. These include how sensitive it is to the hormones estrogen and progesterone as well as to the level of certain proteins that play a role in breast cancer growth, such as HER2, and it has a great impact on the survival rate of breast cancer patients.

Determining the stage  of cancer, doctors move forward with the  best possible treatment to give a quality life to breast cancer patients.

Breast cancer staging involves the TNM system, which provides specific details about:

T: the size of the tumour

N: lymph node involvement

M: whether the cancer has spread (metastasized)

Breast Cancer Stages:

There are five breast cancer stages, The earliest stage breast cancers are stage 0 (carcinoma in situ). It then ranges from stage I (1) through IV (4). There are several variables within some stages.

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:

Stage IV breast cancer

Metastatic breast cancer, referred to as stage IV breast cancer, is a late-stage and advanced  form of breast cancer in which the cancerous cells have spread (metastasized) beyond the breast.

Stage IV is the most advanced stage of breast Cancer that has spread to nearby lymph nodes and to distant parts of the body beyond the breast. These breast cancer cells travel through the bloodstream or lymphatic system.

In the advanced stage of breast cancer it spreads to bone first lymph nodes lungs, liver, and  then in the brain. There is no known cure for metastatic breast cancer.as the cancerous cells have spread to other parts of the body and affected different organs and it is not possible to remove those organs. Therefore, an oncologist may choose to focus on the treatment of shrinking tumours, slowing their growth and relieving symptoms and improving the survival rate of breast cancer patients with a quality of life. 

Stage III breast cancer

Stage 3 breast cancer is also known as locally advanced breast cancer, where the cancer is invasive and has spread out in the local area in the breast and into the lymph nodes or muscles close to the breast. The cancerous tumour is likely larger than the tumour in stage 1 and stage 2. In stage III breast cancer, the cancer has spread further into the breast or the tumour is a larger size than earlier stages. It is divided into three sub categories 

Stage IIIA is based on one of the following:

• The tumour may or may not present in the breast, cancer is detected in four to nine nearby regions of lymph nodes.
• The tumour is larger than 50 millimetres, and the cancer has spread to between one and three nearby lymph nodes under the arm or near the breastbone.

In stage IIIB,  the invasive cancer or we can say the tumour has spread beyond the breast tissue and lymph nodes and chest wall aside the breast and also spread to the skin of the breast.

• Cancer may also have spread to the skin, causing swelling or inflammation.The tumour can be any size and has spread to the chest wall
• It may have broken through the skin, causing an ulcerated area or wound.
• It may have spread to as many as nine underarm (axillary) lymph nodes or to nodes near the breastbone.

In stage IIIC, there may be a tumour of any size in the breast, or no tumour present at all. But either way, the cancer has spread to one of the following places:

Stage 3C breast cancer is an invasive cancer, where a tumour of any size may be in the breast There may be no actual tumour found in the breast but the skin of the breast is affected with evidence of swelling, inflammation, or ulcers (such as with cases of inflammatory breast cancer)

 But, the cancer has spread beyond the breast tissue and lymph nodes and into the chest wall and also to the skin of the breast. In Stage 3B breast cancer, the cancer has spread into more lymph nodes than in breast cancer stage 3B

• ten or more underarm (axillary) lymph nodes detected
• the cancer spread in the  lymph nodes near the collarbone
• The cancer cells spread in some underarm lymph nodes and lymph nodes near the breastbone and the skin.

Stage II Breast Cancer

Stage II describes an early stage of breast cancer in which the cancer has not spread beyond the breast tissue or surrounding lymph nodes.that is in a limited region of the breast but has grown larger. Cancer hasn’t spread beyond the breast tissue or nearby lymph nodes.This stage is divided into two sub categories.

Stage IIA is based on one of the following:

• Either there is no tumour in the breast or there is a breast tumour up to 20 millimetres, which is just the size of a grape, and the  cancer has spread to the lymph nodes under the arm.
• A tumour of 20 to 50 millimetres is present in the breast, but cancer has not spread to the lymph nodes.

Stage IIB is based on one of these criteria:

• A tumour of 20 to 50 millimetres is present in the breast, along with cancer that has spread to between one and three nearby regions of lymph nodes.
• A tumour in the breast is larger than 50 millimetres, but cancer has not spread to any of the lymph nodes.

Stage I Breast Cancer

Stage I describes a very early breast cancer stage of invasive cancer. Breast cancer has spread from its original location (in the ducts or lobules) to the surrounding tissue but it is still contained in a relatively small area. At this point, tumour cells have spread to normal surrounding breast tissue but are still contained in a small area. Stage I is divided into two subcategories:

In stage IA, the tumour is less than 2 centimetres in size. No cancer cells have been found in the lymph nodes or the nearby areas like armpit, collarbone and chest. As, it is a early stage therefore cancer is not spread in the other parts of the body

Stage IB can be described as either:

• a small tumour in the breast that is less than 20 millimetres with small clusters of cancer cells found in the lymph nodes.
• There is no  tumour in the breast but small clusters of cancer cells found in the lymph nodes.

Stage 0 Breast Cancer

This is the very beginning of the scale. Breast cancer Stage 0 is not invasive, though it could be later. It’s less advanced than stage I cancer. This includes the most common form of noninvasive cancer called ductal carcinoma in situ (DCIS). Within stage 0, there is no evidence that cancer cells or other abnormal cells have invaded neighbouring normal tissue.

The abnormal cells are still in your milk ducts and haven’t affected the fatty tissue that makes up most of your breast. There’s no known cause, and most people don’t have any symptoms, though a lump in the breast and bloody discharge from the nipple may be noticed. The abnormal cells may or may not become invasive and start to spread. 

Diagnosing Breast Cancer

Breast exam

Diagnosing during a clinical breast exam, a healthcare professional checks the breasts to detect any abnormalities. This might include changes in the texture of the skin or discharge from the nipple. Then the health professional feels the breasts by pressing the breast to detect lumps. The health professional also feels along the collarbones and around the armpits to find out the lumps.

Mammogram

A mammogram is an X-ray of the breast tissue. Mammograms are the most common procedure for screening the image to detect breast cancer stages. Doctors  recommend mammography on the concerned breast but sometimes both the breasts are done. It depends upon the patient’s symptoms.

Breast ultrasound

Ultrasound is a sound wave used to make pictures of structures inside the body. A breast ultrasound done by the medical team to detect the breast lump. The results in ultrasound might show the type of lump  whether it is a solid mass or a fluid-filled cyst. After the result the healthcare team uses this information for the next test to be done for further diagnosis.

Breast MRI

MRI machines use a high frequency magnetic field and radio waves to create images inside the body. A breast MRI gives more-detailed images of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. Before the procedure starts the  nurse injects a dye in the vein and makes the patient wait for 45 minutes to an hour so that the dye evenly spreads inside the body which helps  to have a clear image of the tissue.

Removing a sample of breast

A biopsy is a procedure to remove a sample of tissue from the affected area for testing in a lab. To collect the sample, a needle is injected inside the patient’s skin and into the breast tissue. The health professional guides the needle using images created with X-rays, ultrasound or another type of imaging. Once the needle reaches the exact region,  the health professional  draws out tissue from the breast through that needle. Then, a spot is made through a marker from where the tissue sample was taken. The small metal marker will show up on imaging tests. The marker helps the healthcare team to monitor the area of concern.

Testing cells in the lab

The biopsy sample goes to a lab for testing to detect whether the cells were carcinogenic or not. Other tests give information about the type of cancer and how rapidly it’s growing. Other tests give more details about the cancer cells. For example, tests might look for hormone receptors on the surface of the cells. The healthcare team uses the results from these tests to make a treatment plan and proceed with the best possible breast cancer treatment.

Staging of  breast cancer

Once the healthcare team is diagnosed with patient breast cancer, they proceed with further tests to figure out the extent of the cancer. This is called staging of cancer. The healthcare team follows the cancer stage to understand the prognosis.

Breast Cancer Treatment 

Breast cancer treatment often starts with surgery to remove the tumour. But before that Oncologist decides the proper treatment  like giving chemos, radiation  a patient requires before surgery in order to shrink the tumour so that it can be easily removed. Most patients with breast cancer might receive  radiation, chemotherapy after surgery, it varies on patients stage of cancer and the size of tumour.There are many options for breast cancer treatment. It can feel overwhelming to consider all the options and make complex decisions about the care. Consider seeking a second opinion from a breast specialist in a breast centre or clinic. Talk to breast cancer survivors who have faced the same decision.

Breast cancer surgery

Lumpectomy

Breast cancer surgery typically involves a procedure to remove the breast cancer and a procedure to remove some nearby lymph nodes. Operations used to treat breast cancer include:

A lumpectomy is a surgery to remove cancer or other abnormal tissue and a small amount of healthy tissue that surrounds the breast. Oncologists used to keep the breast instead of operating fully. It is also known as  breast-conserving surgery and wide local excision. 

Chemotherapy is sometimes given to shrink the tumour before Lumpectomy and it is followed  by radiation therapy to the breast for further recurrence of cancer.

Mastectomy 

Removing all the breast tissue from a breast  is called mastectomy. When a patient couldn’t go for breast conserving surgery then mastectomy might be used to remove a large cancer. When there are multiple cancerous cells in one breast  doctor recommend for mastectomy 

When patients who have a high risk of recurrence of breast cancer choose to have a double mastectomy (the removal of both breasts) with advancement of treatment the procedure of mastectomy changed.These newer operations can improve the look of the breast after surgery, but they aren’t options for everyone.

Removing a few lymph nodes. 

Depending on the stage of cancer lymph nodes dissection, lymph node removal or  lymphadenectomy is opted by the doctor. In these procedures doctors may remove some lymph nodes to remove breast cancer.

Lymph nodes and the lymphatic system are essential to a person’s general well-being, and because the body has hundreds of lymph nodes, it’s generally safe to remove some of them.

The procedure is done by the doctor to control the rapid spread of breast cancer. The lymph nodes are a part of the lymphatic system; they are  also known as the lymphoid system. It is a network of lymph vessels, similar to veins. If there is a small portion of cancerous cells then only that part of lymph nodes and also some health nodes are removed for spreading of cancer to the nearby areas.

Removing several lymph nodes.

The lab test results in a biopsy and further tests determine the stage of cancer. If it is detected cancerous cells have spread to the armpit region and rapidly spread to the nearby regions of chest bone then a surgeon does axillary lymph node dissection where many lymph nodes from the armpit are removed.

Radiation therapy

Radiation therapy treats cancer with powerful energy X rays, protons or other particles to kill cancer cells. 

Radiation therapy may be used to treat breast cancer at almost every stage.There are two kinds of radiation therapy. One is outside the body and the other is inside the body.

For breast cancer treatment the radiation is often external radiation. During this type of radiation therapy, patients lie on a table while a machine moves around them. 

Internal radiation (brachytherapy). Followed by surgery depending on the stage and breast cancer treatment procedure, the doctor temporarily inserted a radiation-delivery device in the breast area for a short period of time. The device works just like the radiation given to kill the cancer cells inside and control the rapid spreading of cancer in the area of Breast.

Radiation therapy is recommended by a doctor after surgery. The device works in the process to kill the cancer cells that might be left after surgery. The radiation lowers the risk of cancer recurrence.

Patients observed with certain side effects of radiation therapy like feeling tired, sunburnt rash over the skin where radiation is aimed. Some patients feel nausea and vomiting, for a short period of  time. But, it goes off automatically after the cycle of radiation ends. 

Chemotherapy

The use of cytotoxic Chemotherapy in both advanced and early stage breast cancer has made significant progress in the last 10 years treating cancer with strong medicines. Most chemo medicines are given through veins. Some are available in pill form.

The main purpose of systemic adjuvant chemotherapy treatment is to control any micrometastatic disease, reduce the recurrence rate and improve the long term overall survival rate of breast cancer patients.

There are two types of chemo given before and after breast surgery for breast cancer treatment. Chemos given before surgery is known as Neo adjuvant chemotherapy, it helps to shrink the tumour so that it can be easily removed  and control the spread of cancer in lymph nodes. Adjuvant chemotherapy is given after surgery to kill the cancer cells. It varies on patients’ breast cancer stages and treatment procedure.

Chemotherapy helps to control the rapid spreading of cancer cells in other parts of the body and relieve the symptoms of advanced and also lower down the pain a patient has to face in breast  cancer. 

The side effects of chemotherapy depend on the type of chemo medicine  provided. Common side effects include hair loss, nausea, vomiting, feeling fatigue, loss of appetite, skin rash and having an increased risk of getting an infection. Less common side effects can include premature menopause and nerve damage. 

Hormone therapy

Hormonal therapy is appropriate treatment for all stages of estrogen or progesterone- receptor containing breast cancer for which systemic therapy is indicated. 

The potential benefit of hormonal therapy was estimated using clinical criteria. A long interval between the time of original surgery and the appearance of metastases, soft tissue rather than visceral metastases, response to prior hormonal therapy and older age within the pre or post menopausal subgroups suggested a greater likelihood of responding to endocrine treatment.

The adoption of tamoxifen as the preferred hormonal breast cancer treatment was based on its excellent patient tolerance and low toxicity. Hot flashes, amenorrhea  and vaginal bleeding, drying or discharge reflect side effects of the drug attributable to its estrogenic properties.

Targeted therapy

Breast cancer is the most commonly diagnosed malignancy and one of the major causes of death among women.

Trastuzumab is the first approved targeted anti-cancer agent to show an attractive response rate and outcomes in treating HER-2 positive metastatic breast cancer patients. The promising results with trastuzumab targeted therapy encouraged further investigations in this area exploring several novel targeted agents aiming to overcome the resistance drawback of trastuzumab.

Trastuzumab (Herceptin, Genentech/ Roche, South San Francisco, CA) is the first approved anti- HER-2 targeted agent to show a highly promising response rate in the treatment of HER-2 positive metastatic breast cancer patients, as well as in combination with or after standard adjuvant chemotherapy of HER-2 positive breast cancer patients.

Trastuzumab is effective in controlling the progression and invasion of metastatic breast cancer, it is insufficient to prevent the  occurrence of brain metastases due to the molecular weight limitation for crossing the blood brain barrier. Whereas lapatinib is a small molecule that may penetrate the blood-brain barrier easily and achieve the effective concentration level in the cerebrospinal fluid, it may therefore prevent the refractory effect of brain metastasis.

Immunotherapy

Immunotherapy is the breast cancer treatment to boost up the immune system through medicine to kill cancer cells. The immune system fights off diseases by attacking foreign substances and other cells that make the immune system weak. 

Palliative care

Palliative care is opted for those breast cancer patients who are seriously ill or in the advanced stage of breast cancer. A special type of healthcare team helps patients to feel better and lessen the cancerous pain. In palliative care patients’ disease is not curable, but the goal is to increase the survival rate of breast cancer patients though the rate does not increase but a quality life is provided till the patient lives.

Palliative care specialists work with the patient, and with the family members to motivate them mentally and also with the patient through all kinds of treatment therapy to feel better and give a quality life. By providing an extra layer of support in the  breast cancer treatment journey that makes the patient and patient party feel better and live a quality life and increase the survival rate of breast cancer patients.

Survival Rate for breast cancer patients

Survival rate of breast cancer patients depends on many various factors.  Hence, depending on those factors an overall assumption can be made. 

• type and stage of cancer
• level of fitness
• previous treatment

Breast Cancer Stage 1

In stage 1 the survival rate of breast  cancer patients is 5 years or more after diagnosis and process of treatment. The chance of recurrence is low, medical team targets to make the treatment cancer free.

Breast Cancer Stage 2

In stage 2 breast cancer 90% of women survives for 5 years or more after the breast cancer detected 

Breast Cancer Stage 3

In stage 3 breast cancer more than 70 out of 100 women (more than 70%) survive for 5 years or more after detection of breast Cancer.

Breast Cancer Stage 4

Stage 4 is an advanced stage of breast cancer. 25% may survive between 1 to 3 years after they are diagnosed. As at stage 4  it is not curable but it could be controlled with treatment for some years.

Breast Cancer is a major health problem and one of the most common cancers among women in the world. 

Conclusion 

Breast cancer is the cancer case with the highest number of occurrences among women. Many factors influence the survivability of breast cancer patients. There are several things that are prognostic factors for the survival of breast cancer patients, one of them are the pathological stages at the first diagnosis. Besides, there are other factors such as clinical stages and other histopathological characteristics. 

Dedicated quality of the tools to evaluate metastatic disease is urgently needed.

Overall, the two important factors that independently  affect the survival rate of breast cancer patients were age and stage at diagnosis, as the survival rate was inversely correlated with a decrease in these 2 factors. The survival rate has increased in recent years owing to improvement in diagnostic methods, screening and better breast cancer treatment.

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Frequently Asked Questions (FAQ’s)

Briefly explain the survival rate for  breast cancer patients?

 five year survival rate of breast cancer patients with  following classification:

1. Localized: No sign of malignancy that has metastasized the abnormal cells found in the milk duct. 99% of 5 yrs survival rate 
2. Reginal: Breast cancer spread to nearby lymph nodes 5 years of survival rate decreases to 86%.
3. Distant: Advance stage breast cancer that spreads to different organs of the body.by lowering down the survival rate less than 5 years.

Do advanced therapies affect the survival rate for  breast cancer patients?

Yes, it is but it depends on the age and stage of breast cancer.

What are the symptoms of breast cancer?

Lump on breast, armpit region, pain, swelling of breast, dimpling of skin, nipple discharge.

How many stages of breast cancer are there? 

Stage 0 Stage 1 (A & B) Stage 2 (A &  B) Stage 3 (A B C) Stage 4 ( Advanced)

What is the diagnosis process  for breast cancer?

Screening Image- Mammography, Breast CT scan, Breast Ultrasound, FNAC, Cancer Antigen test, Needle Biopsy.

Compare between immunotherapy and targeted therapy?

Immunotherapy is given through medicine to boost up the immune system so that it can fight against foreign substances inside the body.

Targeted therapy is an anti-cancer agent to show an attractive response rate and outcomes in treating HER-2 positive metastatic breast cancer patients.

What causes breast cancer?

• Inherited changes to certain genes BRCA1 BRCA2
• Reproductive history 
• Menstruation before age of 12 and menopause after 55

Is breast cancer treatment possible?

Yes, breast cancer treatment is 100% possible.

How can we avoid breast cancer?

• Quitting smoking and alcohol consumption 
• Breastfeeding 
• Healthy lifestyle 
• Breast exercise 
• Stay a healthy weight 
• Limiting hormone therapy 

What is the survival rate of breast cancer in Stage 0 and stage 4 B patients?

Survival rate of breast cancer patients depends on several factors. There is on overall survival rate that will confirm breast cancer patients will survive within that time Factors like: 

• Age and stage of cancer 
• Treatment 
• Level of fitness