18^th International Conference on Breast Pathology and Cancer Diagnosis July 27-28, 2020 Madrid, Spain

Breast Cancer pathology

There are trillions of cells in the body. These cells have controlled cell cycle that controls their development, development, division, and demise. When they attain adulthood, the cells replicate to replace exhausted cells and to repair wounds. Cancer initiate when cells in a part of the body start to grow out of control. All types of cancer, irrespective of their origin, occur due to this uncontrollable growth of cells that leads to the formation of tumours and lesions. Cancer that develops from breast cells is known as Breast Cancer. Tumour formed by these cells can be seen on an x-ray or felt as a lump. When tumour cells grow into surrounding tissues or spread to distant areas of the body it become malignant. Breast cancer mainly occurs in women but man can also develop breast cancer, too. Breast cancer can develop from different parts of the breast. But most of the time the ducts that carry milk to nipple act as site for breast cancer. It may also start from the glands that make breast milk. Sarcomas and lymphomas are not really considered as breast cancer but they can also start from other tissues in the breast. Lump in the breast are not cancer but they are benign means they will not spread out, they are abnormal growths. But they can increase the risk for woman of getting breast cancer. When breast cancer cells enter blood or lymph system can spread the cancer and carry to the other part of the body. If the breast cancerous cells enter the lymph nodes it increases the chance of getting to spread to the other part of the body.

Breast Diseases

There are several categories of breast diseases which may cause infections, cysts and lumps with or without pain. Some of the breast diseases are benign (harmless) and some are malignant (which can spread). Most common breast diseases are mastitis (a bacterial infection), cysts, benign lumps and cancer. Women mostly are affected by the breast diseases where they are encouraged to start breast self-examination early in the life and to have regular mammography, if found suspicious they are generally offered with a combination of ultrasound and needle biopsy to work out the cause. Men are affected by breast diseases too, although not as often.

Breast Cancer Grading and Staging

Staging and grading are ways in which healthcare professionals describe the size of your breast cancer, whether and how far it has spread, and how fast it may grow. Grading is Assess by evaluating acinar formation, nuclear size/pleomorphism and mitotic activity. An attempt should be made to grade the pre-operative core biopsy as there is acceptable concordance with excision grade.

Grading:

Grade 1 – the cancer cells look small and uniform like normal cells, and are usually slow-growing compared to other grades of breast cancer

Grade 2 – the cancer cells are slightly bigger than normal cells, varying in shape and are growing faster than normal cells

Grade 3 – the cancer cells look different to normal cells, and are usually faster-growing than normal cells

Staging: Staging is used to assess the size of a tumour, whether it has spread and how far it has spread. Understanding the stage of the cancer helps doctors to predict the likely outcome and design a treatment plan for individual patients.

Stage 1: Usually means that a cancer is relatively small and contained within the breast.

Stage 2 usually means the cancer has not started to spread into surrounding tissue but the tumour is larger than in Stage 1. Sometimes Stage 2 means that cancer cells have spread into lymph nodes close to the tumour.

Stage 3 usually means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.

Stage 4 means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.

Recurrent Breast Cancer: The cancer does return after treatment for early-stage disease, it is called recurrent cancer. When breast cancer recurs, it may come back in the following parts of the body, same place as the original cancer, chest wall, lymph node, bones, lungs, liver and brain.

Screening, Monitoring and Diagnosis

Breast Cancer can be detected through screening tests. Screening earlier can improve the chances of survival. Clinical breast exam, Biopsy and mammography are breast cancer screening tests.  At higher risk of breast cancer breast MRI can also be used for some women. Powerful magnetic field and radio waves are used during Magnetic resonance imaging (MRI), which produces detailed images of structures within the breast. If breast cancer gets detected either by screening tests or from symptoms diagnostic tests are given to the woman who is suspected of having breast cancer.

Diagnostic tests includes Mammogram (X-ray of breast), Breast ultrasound (uses sound waves to produce pictures of structures), Removing a sample of breast cells for testing (biopsy), Breast magnetic resonance imaging (MRI).These diagnostic tests confirm the presence or absence of breast cancer and give more information about breast cancer like whether it has travelled outside the breast or not. Many tests are used to monitor how well therapies are working after the diagnosis of breast cancer.

Breast Pathology Treatment and Drugs

Breast cancer treatment team mainly includes Breast surgeon, surgical oncologist, radiation oncologist, medical oncologist, plastic surgeon. It also includes a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counsellors, nutritionists, and others. The biology and behaviour of a breast cancer affects the treatment plan. Treatment options and recommendations are very personalized and depend on several factors, including: stage of tumour, tumour subtypes, genomic maker, patient age, and patient menopausal status, mutations in inherited breast cancer genes, such as BRCA1 or BRCA2. For both DCIS and early-stage invasive breast cancer, doctors generally perform surgery to remove the tumour. For larger cancers, or those that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant therapy.

Breast Cancer Surgery

Breast surgery may be done for many causes, depending on the condition of the patient. Most women with breast cancer have some type of surgery as part of their treatment. Surgery may be done to remove the maximum cancer cells as possible (breast-conserving surgery or mastectomy) and to find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary lymph node dissection) and/or restore the breast’s shape after the cancer is removed (breast reconstruction) and to relieve symptoms of advanced cancer.

Breast Cancer Pathology in Pregnancy

Breast cancer is found in about 1 in every 3,000 pregnant women. Breast cancer is the most common type of cancer found during pregnancy, while breastfeeding, or within the first year of delivery. You may hear this called gestational breast cancer or pregnancy-associated breast cancer (PABC). Sometimes due to hormonal changes in pregnancy, cancer may spread to lymph nodes. Pregnancy and breast feeding can also make breast tissue denser. Breast cancer may occur during the pregnancy and after the birth of child although the chances are less. Woman who is previously diagnosed with breast cancer and is now pregnant should take advice of consultant. Pregnancy is not a reason of breast cancer, but chances can be there in the women who are diagnosed from breast cancer. Treatment of breast cancer during the pregnancy depends upon size of tumour. Decisions should there between the consultant, surgeon and oncologist. And family support is also required at the same time.

Latest Advances and Innovative Therapeutic Approaches

Breast Pathology 2019 will be a chief interdisciplinary stage for the introduction of new advances and research results in the fields of Breast Cancer and Cancer Science. The meeting will unite driving scholastic researchers, analysts and researchers in the space of enthusiasm from around the globe. Topics of interest for submission include, but are not limited to:

Male Breast cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. Man, and women, girls and boys all have breast tissues. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels. In 2018, about 2,550 men are expected to be diagnosed with the disease. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.

Breast Cancer Prevention

Women may reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children. Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer: Older age, A personal history of breast cancer or benign (no cancer) breast disease, A family history of breast cancer, Inherited gene changes, Dense breasts, Exposure of breast tissue to oestrogen, made in the body, Taking hormone, therapy for symptoms of menopause, Radiation therapy to the breast or chest, Obesity, Drinking alcohol.

Breast Cancer and Genetics

The two most common genetic risk factors for breast cancer are the BRCA1 & BRCA2 genes. Approximately 5% of all breast cancers are caused by a recognised specific genetic predisposition due to germ line mutations of one of two different genes: BRCA1 located on Chromosome 17q, BRCA2 located on Chromosome 13q. BRCA1 mutations also predispose to carcinoma of the ovary and possibly carcinoma of the Fallopian tube. The risk of developing breast cancer among carriers is around 55% by age 70. BRCA2: The product of BRCA2 is involved in controlling gene function and DNA repair. Gene function involves in transcriptional activation and completion of cell division by cytokinesis.  Majority of BRCA2-associated tumours are invasive ductal, no special-type tumours.

Breast Pathology and Immunohistochemistry

Immunohistochemistry is a special staining process performed on fresh or frozen breast cancer tissue removed during biopsy. IHC is used to show whether or not the cancer cells have HER2 receptors and/or hormone receptors on their surface. This information plays a critical role in treatment planning. Immunohistochemistry (IHC) is used to characterize intracellular proteins or various cell surfaces in all tissues. Individual markers, or more often panels of various marker proteins, can be used to characterize various tumor subtypes, confirm tissue of origin, distinguish metastatic from primary tumor, and provide additional information which may be important for prognosis, predicting response to therapy, or evaluating residual tumor post-treatment. There is a growing list of available antibodies, which contribute to the broader utility of immunohistochemistry for solving diagnostic problems or for determining prognosis and response to therapy in breast pathology.

Case study and Case Reports

In medicine, a case report contains detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case report usually describes an unusual or novel occurrence. Case reports are an unexpected association between diseases or symptoms. It may results in finding the shed new light on the possible pathogenesis of a disease or an adverse effect. It may contour Unique or rare features of a disease, unique therapeutic approaches.

Special Types of Breast Cancer

20% of breast carcinomas are of special type and the majority of these are lobular carcinomas. Tubular and mucinous carcinomas occur next most frequently and thereafter the remaining special types are seen infrequently. Special types of carcinoma should be distinguished from mixed carcinomas where the special type areas occupy between 50 and 90% of the tumour area with the remaining area being usually of no special type.

Women’s Health and Fitness

Breast health begins with a sense of what's normal for your breasts (breast awareness). To promote breast health, consider doing regular breast self-exams. For many women, breast health includes concerns about breast lumps, breast pain or nipple discharge. It's also important to understand common screening and diagnostic tests for breast health, such as clinical breast exams, mammograms and breast ultrasounds.

Nursing and Palliative care rehabilitation

The treatment and the cancer itself may affect the physical functioning and energy of the body. Life after breast cancer treatment gets changed like returning to some familiar things and new choices to make. After the last steps of treatment like radiation or diagnostic procedure is not the end of fighting against breast cancer. Physical energy and functioning can also be getting affected after the breast cancer treatment. Level of oestrogen may also get lowered after the treatment which leads to the decrease in bone density. Bone density can be increased as well recurrence of breast cancer can be prevented with the help of exercise. During oncology rehabilitation physical functioning as well as sense of well-being can be improved.

Oncology nurses are critical participants in the delivery of palliative care. It is the position of oncology nurse that primary nursing should begin at the time of diagnosis and continue throughout bereavement. Physical, psychological, social, cultural, and spiritual assessments are key components to the development of a comprehensive care plan for each patient. Oncology nurses must possess knowledge and skills in certain domains to deliver safe, quality palliative care including structure and processes of care, physical aspects of care, psychological care, and social aspects for care, cultural aspects of care, care of the imminently dying patient, ethical and legal aspects of care and, spiritual, religious, and existential aspects of care of a cancer patient. Oncology nurses have a responsibility to engage the public and provide fact-based information about care of people with advanced serious illness to encourage advance care planning and informed choices based on the needs and values of individuals.

Breast Cancer: Challenges, Breakthroughs

Breast cancer is the second most common cancer diagnosed after lung cancer and is the main cause of cancer demise in women. The heterogeneity of breast cancer such as ductal carcinoma in situ, triple negative breast cancer, HER2 negative among the women makes it difficult for the doctors to provide ideal medications for the cure. The major treatment methods are chemotherapy, radiation therapy, targeted drug therapy, oncoplastic surgery etc. Recent oncology research lead to the developments in neoadjuvant therapies, have also been benefited in treatment of breast cancer. Complete cure through Ayurveda was another major breakthrough in breast cancer treatment.

Breast Implants

There are three general types of breast implant devices, defined by their filler material saline solution silicone, silicone gel and composite filler. The saline implant has an elastomer silicones shell filled with sterile saline  solution during surgery the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel and the alternative composition implant featured miscellaneous fillers such as soy oil, polypropylene string etc.

The global breast cancer therapy market is expected to register a CAGR of 8.5% during the forecast period 2018-2023. The high incidence rate of breast cancer is now becoming a concern, and several pharmaceutical companies are increasingly investing in research on breast cancer. Thus, the market is expected to grow. Statistics say that around 50% of breast cancer cases and more than 58% of deaths occur in less developed countries. The National Cancer Institute has estimated that 246,660 cases of breast cancer were diagnosed in 2016. The high incidence and prevalence rate show that the breast cancer therapeutics market will boost over the forecast period. Today, an increasing number of countries are adopting early cancer detection programs, around the world. If these initiatives continue, the demand for breast cancer therapeutics is bound to increase, with most of the cases being detected in the early stages. Along with the other factors, such as high investments on R&D, and the advancements in cancer biology and pharmacology promoting drug development, are driving the market. North America dominates the market for breast cancer therapy, due to the fact that the prevalence of breast cancer is on the rise in this region, along with an increase in R&D funding through public and private sectors. Asia-Pacific region is expected to grow at a significant pace, over the forecast period.