Brest cancer. Normal breast (definition-structure)and general Breast cancer specialy in Saudi Arabia
Classification of breast cancer – Morphological classification (type invasive) – Molecular classification : -ER -PR -HER2 over Expressing tumours -triple negative breast cancer (TNBC) Risk factors -modified -non modified Prognostic factors – tumour size – Tumour grade – Lymph node stage
– Distant metastasis – Receptor status
Markers to classify breast cancer Immunohistochemical markers of intrinsic subtypes (PM50)
Therapeutic every type Target therapy
Style of reference (Harvard )
Breast Cancer in Saudi Arabia: Classification, Risk Factors, and Treatment Approaches
Breast cancer is one of the most common cancers affecting women worldwide. The normal breast is composed of lobules, ducts, connective tissues, blood and lymph vessels (American Cancer Society, 2022). Carcinomas, or cancerous cells, develop in the breast tissues and can spread to other areas of the body through the lymphatic system and bloodstream (National Cancer Institute, 2022). This paper will explore breast cancer classification, associated risk factors, and current therapeutic approaches, with a focus on the disease in Saudi Arabia.
Classification of Breast Cancer
Breast cancers are classified based on their histological features and molecular characteristics. Histologically, breast cancers are categorized as either invasive (infiltrating) carcinomas or in situ carcinomas. Invasive carcinomas have the ability to spread beyond the layer of cells where they developed, while in situ carcinomas involve abnormal cells that have not spread (American Cancer Society, 2022).
At the molecular level, breast cancers are classified into intrinsic subtypes based on the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The major subtypes include luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), HER2-enriched (ER-, PR-, HER2+), and triple-negative breast cancer (TNBC; ER-, PR-, HER2-) (Perou et al., 2000).
Risk Factors for Breast Cancer
Several factors have been shown to increase a woman’s risk of developing breast cancer. These include age, family history, genetic mutations (e.g. BRCA1 and BRCA2), reproductive history, obesity, and lifestyle factors like alcohol consumption (American Cancer Society, 2022). Studies conducted in Saudi Arabia have identified additional risk factors prevalent in the region, such as a lack of formal education, large family size, late age at first birth, and nulliparity (Althubiti & Nour Eldein, 2018; Al-Eid et al., 2016).
Prognostic Factors and Markers
Prognostic factors that influence breast cancer outcomes include tumor size and grade, lymph node involvement, and distant metastasis at time of diagnosis. The expression of ER, PR and HER2 receptors also provides important prognostic information, as receptor-positive tumors generally have a more favorable prognosis (National Cancer Institute, 2022). Immunohistochemical markers like progesterone receptor modulator 50 (PM50) help further classify breast cancer intrinsic subtypes with prognostic significance (Cheang et al., 2009).
Therapeutic Approaches for Breast Cancer
Treatment for breast cancer may involve surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, or some combination depending on the cancer type and stage. Targeted therapies that block the growth and spread of cancer by interfering with specific molecular targets have improved outcomes for patients with HER2-positive and hormone receptor-positive disease (American Cancer Society, 2022). Examples of targeted therapies approved for breast cancer include trastuzumab (Herceptin) for HER2-positive tumors (Smith et al., 2007) and CDK4/6 inhibitors like palbociclib (Ibrance) for advanced ER-positive disease (Finn et al., 2015). Ongoing research continues to develop new targeted agents and immunotherapy approaches for difficult-to-treat subtypes like triple-negative breast cancer.
In conclusion, breast cancer classification systems provide important information to guide prognostic Assessment and personalized treatment selection. While risk factors vary between populations, therapeutic advances hold promise for improving outcomes across diverse patient groups in Saudi Arabia and worldwide.
American Cancer Society. (2022). Breast Cancer Facts & Figures 2021-2022. American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2021-2022.pdf
Althubiti, M., & Nour Eldein, M. (2018). Trends in the incidence and mortality of cancer in Saudi Arabia. Saudi medical journal, 39(12), 1259–1262. https://doi.org/10.15537/smj.2018.12.23348 write my thesis paper.
Al-Eid, H. M., Khayat, M. H., Al-Mulhim, F. A., Al-Sheikh, A. A., Al-Swailem, A. R., & Noorwali, A. A. (2016). Breast cancer in Saudi Arabia: patient characteristics and survival analysis of 2,375 cases from a single institution. Asian Pacific journal of cancer prevention : APJCP, 17(9), 4353–4357. https://doi.org/10.7314/apjcp.2016.17.9.4353
Cheang, M. C., Chia, S. K., Voduc, D., Gao, D., Leung, S., Snider, J., Watson, M., Davies, S., Bernard, P. S., Parker, J. S., Perou, C. M., Ellis, M. J., & Nielsen, T. O. (2009). Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. Journal of the National Cancer Institute, 101(10), 736–750. https://doi.org/10.1093/jnci/djp082
Finn, R. S., Martin, M., Rugo, H. S., Jones, S., Im, S. A., Gelmon, K., Harbeck, N., Lipatov, O. N., Walshe, J. M., Moulder, S., Gauthier, E., Lu, D. R., Randolph, S., Dieras, V., & O’Shaughnessy, J. (2015). Palbociclib and Letrozole in Advanced Breast Cancer. The New England journal of medicine, 373(18), 1925–1936. https://doi.org/10.1056/NEJMoa1505270
Perou, C. M., Sørlie, T., Eisen, M. B., van de Rijn, M., Jeffrey, S. S., Rees, C. A., Pollack, J. R., Ross, D. T., Johnsen, H., Akslen, L. A., Fluge, O., Pergamenschikov, A., Williams, C., Zhu, S. X., Lønning, P. E., Børresen-Dale, A. L., Brown, P. O., & Botstein, D. (2000). Molecular portraits of human breast tumours. Nature, 406(6797), 747–752. https://doi.org/10.1038/35021093
Smith, I., Procter, M., Gelber, R. D., Guillaume, S., Feyereislova, A., Dowsett, M., Goldhirsch, A., Untch, M., Mariani, G., Baselga, J., Kaufmann, M., Cameron, D., Bell, R., Bergh, J., Coleman, R., Wardley, A., Harbeck, N., Lopez, D., Mallmann, P., … Piccart-Gebhart, M. (2007). 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet (London, England), 369(9555), 29–36. https://doi.org/10.1016/S0140-6736(07)60028-2
