Mesenchymal stem cells have been described as localized to breast carcinomas, however their involvement in tumor pathophysiology has not fully been examined (Karnoub et al., 2007). One study demonstrated that human bone-marrow-derived mesenchymal cells cause cancer cells to increase their metastatic potential (Karnoub et al., 2007).
Clinical Manifestations and Diagnostic Findings
Initially, breast cancer may not cause any clinically apparent symptoms (Eberl et al., 2008). For many women, the first sign of breast cancer is a breast mass of lump that is either discovered upon self-examination, or after a physician's examination (Eberl et al., 2008). Symptoms are generally localized to the breast and can include breast swelling or breast pain. Breast cancer may also become first clinically apparent during preventative mammogram screenings, in which abnormal growth is observed and additional testing is needed (Eberl et al., 2008). Following a biopsy of the tissue, pathology reports can confirm the diagnosis and stage of breast cancer. One study has expressed the need to assess female patients with breast systems with urgency, regardless of their age (Eberl et al., 2008). There is an overall lack of medical urgency when a younger female patient presents with breast symptoms, and several weeks have been documented to pass between the physician's initial assessment and subsequent medical testing (Eberl et al., 2008). This has the potential to impact the survival of younger breast cancer patients.
Social Support and Psychological Effects
Many life threatening disease are associated with various psychological effects and compel patients to seek social support. Studies indicate that strong social-emotional support is a contributor to improved survival and protection against disability from breast cancer (Kroenke et al., 2006). Improved survival by means of social support has been explained as patients receiving this support tend to have better assistance in getting to medical appointments or to the pharmacy, reminders to take medication, and help with nutritional needs and mobility (Kroenke et al., 2006). In addition to social support, social-emotional support helps breast cancer patients reduce stress and cope with the anxiety associated with the disease; social-emotional support has been indicated as more critical than instrumental support for breast cancer survival (Kroenke et al., 2006). The progression of breast cancer calls for a patient to continuously adhere to the psychosocial adaptation of their illness (Heim et al., 1997). While there are pathological stages of breast cancer, there are also stages of psychologically coping with the disease. Studies have shown one's ability to cope with breast cancer relies on such factors as age, time elapsed since diagnosis, and time as a distance from death or survival (Heim et al., 1997).
Treatment and Management of Breast Cancer
Although there is not a cure for breast cancer, there are both invasive and alternative treatment options for the disease. Patients with early-stage breast cancer typically undergo radiation therapy and surgical intervention, but may be at risk for later disease relapse and metastasis (Perez, 2011). Surgical interventions include lumpectomy, mastectomy, and lymph node dissection. Hormonal and drug therapies are also available to breast cancer patients. Chemotherapy is used to treat late-stage breast cancer to reduce cancer cells as much as possible, and to treat early-stage invasive cancer and to reduce the risk of metastasis (Perez, 2011). The use of chemotherapy in both late-stage and early-stage patients is evidence of widespread treatment for two pathologically different stages of cancer. Targeted treatment strategies are utilized by clinicians to eliminate unnecessary treatment, provide better timing for introduction of medications, and to adjust treatments as quickly as possible (Perez, 2011). Current literature demonstrates the effective use of genomic targeted therapy; meaning the expression of certain proteins and genes, such as ER, PR, and HER-2, has been indicated as useful for the prediction of therapeutic benefit with specific agents (Perez, 2011).
Complementary and alternative medicine (CAM) has also been used with breast cancer patients (Shaharudin et al., 2011). CAM is broadly defined as medical treatments that are not widely taught in medical schools or are not commonly available in hospitals (Shaharudin et al., 2011). CAM utilizes biological-based therapy, physical, psychological, and spiritual therapeutic techniques. Biological-based therapies work on the evidentiary link between diet and breast cancer incidence, and involves patients taking dietary supplements and herbal products to promote breast cancer survival (Shaharudin et al., 2011). Physical CAM practices include massage, acupuncture, and exercise (Shaharudin et al., 2011).
The Future of Breast Cancer Treatment
The genomic era of targeted therapy is allowing for more tailored treatment for clinical trials (Perez, 2011). Researchers are aiming to develop new treatment agents as well as optimizing the utilization of currently available treatment methods. Under the cancer stem cell pathophysiological model, the identification of biomarkers that indicate cancer stem cells offers a new strategy of cancer treatment. Verifying certain biomarkers as indicators of cancer stem cells, such as the cell surface glycoprotein CD44, would allow for the creation of preventative drug therapies (Charafe-Jauffret et al., 2009). Preventing the spread, if not the genesis, of cancer cells has mounting potential for the future of cancer treatment.
Breast cancer is the most frequently diagnosed cancer for women worldwide and is the leading cause of death among women 35-54 years of age (Edwards et al., 2009). The cause of breast cancer has been attributed to three general elements: family history, environmental factors, and hormonal factors. Risk factors reflect etiological evidence, and include such influences as personal history, age, BMI, alcohol consumption, family history, exposure to pollutants, exposure to radiation therapy, and use of estrogen hormone replacement therapy (Edwards et al., 2009). The pathophysiology of breast cancer has been understood within the context of sporadic clonal evolution and cancer stem cell models. There is pathological evidence of breast cancer progression through stages 0 to IV by order of increasing invasiveness. The molecular composition of metastatic events is not fully understood, however studies are emerging that highlight the metastatic properties of mesenchymal cells (Karnoub et al., 2007).
The presence of breast cancer is typically not clinically apparent until a lump or breast mass has formed, or abnormal tissue is evident following a mammogram (Eberl et al., 2008). Social support is a component of breast cancer survival and patients will typically progress through various psychological stages of disease acceptance. There is no cure for breast cancer, however several treatment options are available, including surgical intervention, radiation therapy, hormone therapy, chemotherapy, and alternative therapies. The future of breast cancer treatment is focused on genomic targeted therapies and the identification of cancer stem cell biomarkers to develop preventative drug therapies. Breast cancer is a major health problem for many women, and continuing education and awareness about risk factors and prevention is critical for the reduction of breast cancer incidence until more specific, targeted, treatments are available.
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