What is cancer (malignant neoplasm)?

From the Guidelines

Breast cancer diagnosis should always involve a thorough clinical breast examination followed by imaging evaluation, as physical examination alone can be unreliable in distinguishing between benign and malignant masses. According to the study by 1, breast cancer is the most common female malignancy and the second leading cause of female cancer death in the United States, with 249,260 new cases estimated to be diagnosed in 2016. The study highlights that although the majority of palpable lumps are benign, a new palpable breast mass is a common presenting sign of breast cancer.

Some key characteristics of breast masses that may indicate cancer include:

• Asymmetry in relation to the other breast
• Distinctness from the surrounding tissues
• A 3-D shape
• Firmness
• Indistinct borders
• Attachments to the skin or deep fascia with dimpling or nipple retraction However, these characteristics are not always reliable, and imaging evaluation is necessary in almost all cases to characterize the palpable lesion, as noted in the study by 1.

The negative predictive value of mammography with ultrasound (US) in the context of a palpable mass ranges from 97.4% to 100%, as reported in studies cited by 1. Any highly suspicious breast mass detected by imaging or palpation should undergo biopsy unless there are exceptional clinical circumstances. It is essential to prioritize imaging evaluation before biopsy, as changes related to the biopsy may confuse or alter image interpretation, as emphasized by 1.

In clinical practice, it is crucial to remember that negative imaging evaluation should never overrule a strongly suspicious finding on physical examination or vice versa. By combining thorough clinical breast examination with imaging evaluation and biopsy when necessary, healthcare providers can improve the accuracy of breast cancer diagnosis and ultimately reduce morbidity and mortality.

From the Research

Definition and Overview of Cancer

• Cancer is a global health problem responsible for one in six deaths worldwide 2
• It is a complex process where human cells are recruited and transformed into pathological organisms or the building blocks of tumors 3

Cancer Treatment

• Conventional treatment approaches include surgery, chemotherapy, and radiotherapy 2
• New approaches and procedures for cancer treatment are being developed, such as:
  • Stem cell therapy to regenerate and repair diseased or damaged tissues 2
  • Targeted therapy to inhibit the growth and spread of specific cancer cells 2
  • Ablation therapy as a minimally invasive procedure to burn or freeze cancers 2
  • Nanoparticles for new diagnostic and therapeutic options 2

Cancer Prevention

• Cancer prevention encompasses a broad spectrum of strategies to lower the chance of developing cancer and reduce the morbidity of established cancer 4
• There are three levels of cancer prevention:
  • Primary prevention: eliminating or mitigating cancer risk factors by adopting healthy behaviors and lifestyles 4
  • Secondary prevention: screening to identify precancerous lesions and taking intervention measures to prevent disease progression to malignancy 4
  • Tertiary prevention: reducing or controlling the symptoms and morbidity of established cancer or the morbidity caused by cancer therapy 4
• Chemopreventive agents and immunoprevention using vaccines have shown clear clinical benefits of reducing cancer incidences in high-risk populations 4

Sequencing of Chemotherapy and Radiation Therapy

• The optimal integration of chemotherapy with radiation for patients with early-stage breast cancer remains uncertain 5
• A prospective randomized trial found no significant differences between giving radiation therapy before or after adjuvant chemotherapy in terms of time to any event, distant metastasis, or death 5