Breast Cancer screening

Table of Contents

Introduction

Breast cancer is the most common malignancy in female patients. [1]

Breast cancer is the most common cancer in American women. As of 2018, 1 in 8 women in the United States will be diagnosed with invasive breast cancer during her lifetime. This risk has been increasing since 1975. [2]
Globally, female breast cancer ranks fifth in terms of cancer mortality. [3]
From 2014 to 2018, the average age of women found to be diagnosed with breast cancer was 63. [2]

The treatment of breast cancer is constantly evolving. Fortunately, survival rates are likely to continue to improve due to improvements in individualized treatment and earlier detection [4].

The increase in the number of breast cancer survivors has led to more research and care towards developing interventions that will help improve the overall quality of life of breast cancer survivors. [5]

Physiotherapists play an important role in the rehabilitation process and in the care of survivors during and after a breast cancer diagnosis.
Physical activity and physical therapy have been shown to reduce the incidence of musculoskeletal disorders after cancer [6].
Breast cancer requires an interdisciplinary team to achieve optimal outcomes. The team includes oncology and plastic surgeons, medical oncology, radiation oncology, pathology, physical therapy, radiology, nurses, navigators, and multiple others to discuss each patient and formulate treatment plan. Multiple retrospective studies have demonstrated that breast cancer patient outcomes continue to improve with the increased use of interprofessional teams [4].

Pathophysiology

Breast cancer is a malignant tumor originating from breast cells. As with other cancers, there are a variety of factors that increase the risk of breast cancer.

DNA damage and genetic mutations that lead to breast cancer have been experimentally linked to estrogen exposure.
Some people inherit DNA and genetic defects such as BRCA1 BRCA2 and P53, among others. Therefore, those with a family history of ovarian or breast cancer have an increased risk of developing breast cancer.
The immune system normally seeks out cancer cells and cells with damaged DNA and destroys them. Breast cancer may be the result of failure of this effective immune defense and surveillance.
These are several signaling systems of growth factors and other mediators that interact between stromal cells and epithelial cells. Disruption of these may also lead to breast cancer [7].

Classification

The vast majority of breast cancers are adenocarcinomas (99%). The most common types are:

Invasive carcinoma not otherwise specified (ductal carcinoma not otherwise specified): 40-75%
Ductal carcinoma in situ: 20-25% (non-invasive in ducts or lobules)
Invasive lobular carcinoma: 5-15%[8]

Terminology

Grade – “score” of cancer cell appearance and growth pattern: Grade 1 (also sometimes called well-differentiated); Grade 2 (moderately differentiated); Grade 3 high-grade (poorly differentiated).
Tumor necrosis – if present, this means that dead breast cancer cells are seen in the tissue sample. Tumor necrosis is usually limited to a small area within the sample. Its presence indicates more aggressive breast cancer.
Vascular or Lymphatic Invasion:- These types of invasion describe whether the cancer cells are evident in the blood vessels and lymph vessels that supply the breast tissue.
Hormone receptor status: – To test whether breast cancer cells removed during biopsy or surgery have receptors for estrogen or progesterone. When estrogen and progesterone bind to these receptors, they promote cancer growth. The cancer is called hormone receptor positive or Hormone receptor negativity depends on whether they have these receptors [9]. Hormone receptor status determines whether hormone therapy is appropriate.
HER2 Status:- HER2 is a gene that, when dysfunctional, plays a role in the development of breast cancer. HER2-positive breast cancers tend to grow faster and spread more easily than HER2-negative breast cancers. [10]

Staging[11][12]

Stage is the most basic way to classify how far a cancer has spread from its point of origin [13]. The phase is the number zero and the Roman numerals I II III or IV (usually followed by A B or C). In general, the higher the number, the more advanced the cancer. For example, the fourth stage. breast cancer cells Has spread far from the breast and lymph nodes. The most common sites are bones, lungs, liver, and brain. This stage is described as “metastatic,” meaning it has spread beyond the area of the body where it was originally found.

Breast tumors are staged using the TNM system published by the American Joint Committee on Cancer/Union for International Cancer Control (UICC): Breast Cancer (Staging).

The TNM system uses information on:

T: the size of the tumor and how far it has spread in the breast and nearby organs
N: lymph node involvement
M: Whether there is distant metastasis

Once TN and M have been determined by stage grouping, stage 0 I II III or IV is assigned. There was a positive correlation between the number of stages and how far the cancer had spread.

Metastases

Metastasis involves one or more sites that spread to other parts of the body. This occurs by directly affecting organs or by spreading through the lymphatic and/or circulatory system. [10]

The following terms can be used to classify the extent of malignant cell spread: [14]

Localized means there is no spread.
Regional means spread to lymph node tissue or organs close to where the cancer started (primary site).
Distant (also called metastatic cancer) is cancer that has spread to organs or tissues that are far from where it started. The main metastatic sites of breast cancer include bone, lung, brain and liver [15].

Epidemiology

Breast cancer is the most common non-cutaneous malignancy in women.

Six percent of women in affluent North America, Europe and Australia develop invasive breast cancer before age 75, compared with 2 percent in developing regions of Africa and Asia. This difference has been attributed to the risks associated with a Westernized lifestyle, including a high-calorie diet High in fat and protein and lack of exercise[8]
Survivors varied globally, with 5-year relative survival rates of ≥80% in the United States, Canada, and Austria, but less than 40% in Denmark, Poland, and Algeria. [16] This may be due to differences in diagnosis and treatment and lack of medical resources in some regions Country[17][18][19]
Breast cancer-related lymphedema (BCRL) is a condition that women can develop at any time for 3-20 years after treatment. [20] Incidence varies and may depend on the type of treatment received. Recent evidence suggests that one in five women will get it at some point. [twenty one]

Risk Factors

increasing age
Reproductive lifestyle factors increase unopposed estrogen load
- early menarche
- nulliparous infertility or having few children in the first delivery
- lack of breast feeding
- late menopause
- unopposed estrogen replacement therapy
Personal history of breast cancer or high-risk breast lesions
first degree relative with breast cancer
genetic mutations
- BRCA1 or BRCA2 mutation
- Li Fraumeni syndrome
- Peutz Jegher syndrome
- Cowden syndrome
- ataxia telangiectasia
thoracic radiation therapy
alcohol consumption[8]

Factors That May Lower Your Risk of Breast Cancer

Breastfeeding
Participating in moderate or vigorous activity
Maintaining a healthy body weight[22]

Clinical Presentation

Breast cancer may be asymptomatic and undetectable in its early stages.
The hallmark signs and symptoms of ductal carcinoma are breast lumps and breast tenderness (usually not pain).
The hallmark signs and symptoms of lobular carcinoma do not involve a lump. Therefore, lobular carcinoma may be more difficult to detect
Breast texture often changes. [twenty three]
Swollen lymph nodes in the armpit or difficulty breathing (metastasis) [1]

Diagnosis

Mammogram showing normal breast (left) and cancerous breast (right)
Mammogram (older ones) and ultrasound (younger ones)
Breast MRI in Challenging Cases
US/mammogram guided biopsy[1]
IR Thermography: It is a powerful tool that is also non-invasive and non-invasive, which simplifies analysis and provides safety and comfort for patients. It can be used in women of different ages and health conditions without any risk [24].
Hormone receptor testing If someone is diagnosed with breast cancer, hormone receptor testing can be used to help plan treatment. Hormone therapy is a recommended form of treatment if the cancerous tissue is positive for hormone receptors (estrogen and/or progesterone). [25][26]
HER2/neu test: HER2 is human epidermal growth factor receptor 2, a protein that can sometimes be found on cancer cells. Cancer cells that contain the HER2/neu protein tend to be more aggressive and may have a poorer prognosis. If this is the case, then a targeted approach That specific area will be used as a treatment option. [25][26][27]

Systemic Involvement

Breast cancer that has metastasized can manifest itself in a variety of ways [26][28].

Bone: is the most common site of metastases in both men and women, and symptoms may include posterior hip or shoulder pain and/or weight bearing pain.
Central nervous system: Another common site of breast cancer metastasis, especially in the thoracic portion of the spinal cord. Signs and symptoms associated with neurologic involvement include unilateral upper extremity numbness and tingling (neck/chest) leg weakness or Paresis (lumbar spine) or bowel and bladder symptoms (sacrum). Other common metastatic sites are lymph nodes, lung, brain and liver, and remaining breast tissue. Nervous system involvement can also present as a paraneoplastic syndrome, a term used to describe associated signs and Symptoms away from tumor and/or metastatic sites.
Paraneoplastic syndromes often present in ways that do not appear to be cancer-related and may resemble disorders of the endocrine-metabolic hematologic or neuromuscular systems.

Management

see also Oncology Examination

Women after breast cancer treatment may develop any of the following lesions:

decreased upper body strength
Decreased shoulder mobility
Scar tightness (breast and/or armpits)
Upper extremity ache
Lymphedema of the upper extremity
Neuropathic pain
Musculoskeletal pain (breast armpits and/or neck and shoulders)
Chronic pain

Interventions Post Surgery

A physical therapist’s treatment plan should include:

Movement exercises that improve tissue extensibility and promote normal movement patterns.
Myofascial release enhances mobility and increases tissue extensibility. [31] [32] [33] [34]

Several forms of manual therapy may also be helpful:

Joint mobilization techniques
Soft tissue release techniques
Neurodynamic techniques
Muscle groups that should be targeted include the rotator cuff trapezius anterior, rhomboid biceps, and pectoralis major. [35] The exercise can start with the elastic band, 2 times a week, and repeat 2 sets of 10-15 times each. [36]

A Structured Shoulder Problems Prevention Trial (PROSPER) exercise program introduced one week after surgery improved upper extremity function postoperative pain arm symptoms and physical quality of life at 12 months compared to usual care in women at high risk for upper extremity disability After undergoing non-reconstructive surgery. [37]

Mobility exercises

Two common complications are limited arm motion and lymphedema.
Implement early rehabilitation to promote functional movement to the patient’s previous activity level.

Arm mobilization is performed on the first or second postoperative day.
Mobilization is achieved using joint rotation to tolerance, but abduction and flexion are limited to 40°.
On postoperative day 4, flexion and abduction are gradually increased to 45°, which can be further increased by 10-15° per day depending on the patient’s pain tolerance.
This technique works by keeping the patient’s arm in 45° flexion or abduction until the drain is removed.

Surface electromyography studies have shown changes in muscle range of motion and onset of each selected shoulder movement in women following breast cancer treatment, suggesting a need to develop a selective therapeutic exercise program to optimize the shoulder neuromuscular Movement of women after breast cancer treatment [38].

Secondary lymphedema is a common phenomenon after surgery in the breast cancer population and has long-term negative effects on patients’ quality of life. This can be treated with complete decongestant therapy.

Physical Activity

Exercise is increasingly used as a therapeutic tool in breast cancer patients [39]. Recently, it has become apparent that exercise plays a central role in the management and prevention of chronic disease.
Despite the well-known benefits of exercise, adherence rates among breast cancer survivors are statistically very low.
There is substantial evidence to support the benefits of physical activity during and after chemotherapy for breast cancer.
Studies have shown that physical activity and exercise are effective in improving quality of life, cardiorespiratory fitness and physical function in breast cancer patients and survivors [40].
Physical activity has been shown to be an appropriate adjunct therapy against long-term chronic disease and has been successful in reducing mortality and improving overall quality of life.

Precautions

When exercising for the postoperative population, the SEWS chart should be monitored regularly for early warning signs. Exercise should be postponed if the patient is tired or anemic.

BEAUTY (see table R)

The BEAUTY program aims to eliminate key issues associated with breast cancer patients such as fatigue lower QoL social anxiety and body conditioning. [41]
Given the enormous physiological benefits as well as the major psychological benefits, it is important that the physical therapist promotes the benefits of exercise immediately after surgery and ensures that the exercise program can be assessed at home or in the community and is tailored to the individual.
During and after breast cancer, all exercise programs should be designed according to the F.I.T.T principles.

FITT Guidelines

Exercise adherence after cancer is very low [42] A number of factors contribute to this, such as lack of services, travel issues cost and personal reasons as well as fatigue are often responsible. Physiotherapists should be aware of barriers to exercise adherence in this specific population (see #obstacle).

FITT Principle After Breast Cancer

Warm up: 5-10 minutes to raise heart rate
Aerobic Exercise: Frequency:
- 3 x 5 times a week **Intensity: 50-70% of max intensity. heart rate
- Type: walking cycling aerobic activity
- Time: 30 minutes as a long-term maintenance routine
Resistance Training: Frequency:
- 2/3 times a week
- Intensity: 12/15 reps of 60% of 1RM
- Type: Supervised resistance program for major muscle groups
- Time: 6 weeks

Aerobic exercise such as walking, cycling or swimming has been shown to reduce cancer-related fatigue [43] [44] [45] improve quality of life [46] [47] reduce cognitive impairment associated with various cancer treatments [48] improve cardiovascular Vascular outcomes [49] and improved sleep dysfunction. [50] Research Treadmill exercise is shown to be cardioprotective against doxorubicin-induced cardiotoxicity. [51] Another study reported the positive effects of a 7-week pedometer exercise program on fatigue quality of life, bone mass, and functional capacity in breast cancer patients Receive chemotherapy. [52] It can be concluded that a supervised exercise program combining aerobic and resistance training has substantial benefits for fitness bone health and quality of life, especially in overweight or obese breast cancer survivors. [53]

Below is an 8-week multimodal physical therapy program (cardio core stability exercises and some recovery through stretching and myofascial release techniques). [54][50].

Physiotherapy Long-term Management

The role of a physical therapist is to promote a healthy lifestyle, including physical activity and proper nutrition.

Exercise

Continuing to exercise continues to foster motivation in the patient, provides the patient with a support group, and promotes social and mental health.
It can improve patients quality of life.
It allows patients to have some control over their life stability and daily routine.
It enables them to restore themselves and become active again in the community [55].

Education

Patient education is a key component of the physical therapist’s role.
Promoting independence and self-management of physical activity is important for successful rehabilitation outcomes.
Referring to the biopsychosocial model of health, physical therapists should address more than just the physical problems of their patients. All patient needs and concerns require treatment or referral to appropriate professionals.

Life After Cancer

Life after breast cancer treatment means returning to some familiar things and making some new choices.

The end of treatment does not mark the end of the breast cancer journey.
Two of the more frustrating and troublesome side effects women face after treatment are fatigue from the cumulative effects of chemotherapy and/or other treatments, and what some women call chemical brain – memory deficits and an inability to concentrate, among other things Psychological changes.

Physiotherapists can help patients plan for returning to work by assessing their physical abilities in the workplace.

Workplace assessments will also help to achieve this.
Following a workplace assessment, adjustments to duties can be recommended to patients and employers.
Knowledge of anatomical kinesiology and ergonomics and agreed workplace adjustments will allow the physical therapist to focus on the treatment of the disease and prevent injury when the patient returns to work.

Outcome Measures

LymphodemaLYMQOL is a validated lymphedema-specific outcome measure of QOL [56]. It consists of 24 questions covering 4 domains (Symptoms, Body Image, Mood and Functioning). It is measured by a Likert scale of 1-4 Cancer-Related Fatigue BFI (Brief Fatigue Inventory). BFI measures severity and Effects of fatigue over a 24-hour period. 9 item 0-10 numeric scale. [57] Functional Assessment of Cancer Therapy (FACT-F) The FACT-F measures physical fatigue and its consequences over a 7-day period. It is a 13-item unidimensional scale assessed on a 5-point scale from 0-4. [58] Shoulder Dysfunction of the arm, shoulder and hand (DASH). [59] Psychometric outcome measures Hospital Anxiety and Depression Scale (HADS). [60] European Organization for Research and Treatment of Cancer Quality of Life Breast Cancer – Quality of Life Questionnaire – Core 36 (EORTC QLQ-C36) Development Proposed by Aaronson et al. in 1987.

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