Breast Cancer: A Multifactorial Disease with Emerging Precision Medicine Approaches

Authors

  • Ruchi Rana Research Intern, Rapture Biotech International Pvt. Ltd, Mohali, Chandigarh 160059, Punjab, India Author
  • Puneet Senior Scientist, Rapture Biotech International Pvt. Ltd, Mohali, Chandigarh 160059, Punjab, India Author
  • Gurinder Singh Research Associate, Rapture Biotech International Pvt. Ltd, Mohali, Chandigarh 160059, Punjab, India Author
  • Harpreet Kaur Centre Director, Rapture Biotech International Pvt. Ltd, Mohali, Chandigarh 160059, Punjab, India Author

DOI:

https://doi.org/10.32628/IJSRST251271

Keywords:

Breast cancer, Risk factors, HER2, Hormone receptor, Diagnosis, Treatment strategies, Quality of life, Cancer biomarkers

Abstract

Breast cancer remains the most prevalent malignancy among women worldwide and continues to be a leading cause of cancer-related mortality. This review highlights the multifactorial etiology of breast cancer, encompassing genetic predispositions, hormonal influences, environmental exposures, and lifestyle choices. Key emphasis is placed on the role of BRCA gene mutations, hormonal replacement therapy, reproductive factors, and obesity in modulating breast cancer risk. The molecular classification of breast cancer into subtypes—Luminal A, Luminal B, HER2-enriched, and Triple-Negative Breast Cancer (TNBC)—has profound implications for prognosis and personalized treatment. The review explores diagnostic modalities such as mammography, ultrasound, biopsy, and immunohistochemistry for precise subtype identification. It also delves into modern therapeutic strategies, including endocrine therapy, chemotherapy, HER2-targeted therapy, and emerging approaches like immunotherapy and precision medicine. Additionally, the impact of treatment-related side effects on patients’ quality of life is examined. Understanding the diverse clinical behavior and biology of breast cancer subtypes is critical to improving outcomes and advancing individualized care.

📊 Article Downloads

References

Obeagu EI, Babar Q, Vincent CC, et al. Therapeutic targets in breast cancer signaling: a review. J Pharm Res Int. 2021;33:82–99. DOI: https://doi.org/10.9734/jpri/2021/v33i56A33889

Aizaz M, Khan M, Khan FI, et al. Burden of breast cancer: developing countries perspective. Int J Innov Appl Res. 2023;11:31–7.

Ibekwe AM, Obeagu EI, Ibekwe CE, et al. Challenges of exclusive breastfeeding among working class women in a teaching hospital South East, Nigeria. J Pharm Res Int. 2022;34:1. DOI: https://doi.org/10.9734/jpri/2022/v34i46A36371

Sun YS, Zhao Z, Yang ZN, et al. Risk factors and preventions of breast cancer. Int J Biol Sci. 2017;13:1387–97. DOI: https://doi.org/10.7150/ijbs.21635

Jagsi R, Mason G, Overmoyer BA, et al. Inflammatory breast cancer defined: proposed common diagnostic criteria to guide treatment and research. Breast Cancer Res Treat. 2022;192:235–4 DOI: https://doi.org/10.1007/s10549-021-06434-x

Edward U, Obeagu EI, Okorie HM, et al. Studies of serum calcium, inorganic phosphate, and magnesium levels in lactating mothers in Owerri. J Pharm Res Int. 2021;33:209–16. DOI: https://doi.org/10.9734/jpri/2021/v33i41B32360

Obeagu EI, Ahmed YA, Obeagu GU, et al. Biomarkers of breast cancer: overview. Int J Curr Res Biol Med. 2023;8:8–16. DOI: https://doi.org/10.22270/ijmspr.v10i4.117

Buist DSM, Abraham L, Lee CI, et al. Breast biopsy intensity and findings following breast cancer screening in women with and without a personal history of breast cancer. JAMA Intern Med. 2018;178:458–68 DOI: https://doi.org/10.1001/jamainternmed.2017.8549

Maio F, Tari DU, Granata V, et al. Breast cancer screening during COVID-19 emergency: patients and department management in a local experience. J Pers Med. 2021;11:380.

Li MR, Liu MZ, Ge YQ, et al. Assistance by routine CT features combined with 3D texture analysis in the diagnosis of BRCA gene mutation status in advanced epithelial ovarian cancer. Front Oncol. 2021;11:696780. DOI: https://doi.org/10.3389/fonc.2021.696780

Hu X, Zhang Q, Xing W, et al. Role of microRNA/lncRNA intertwined with the Wnt/β-Catenin axis in regulating the pathogenesis of triple-negative breast cancer. Front Pharmacol. 2022;13:814971. DOI: https://doi.org/10.3389/fphar.2022.814971

Thigpen D, Kappler A, Brem R. The role of ultrasound in screening dense breasts—a review of the literature and practical solutions for implementation. Diagnostics. 2018;8:20 DOI: https://doi.org/10.3390/diagnostics8010020

Vatankhah H, Khalili P, Vatanparast M, et al. Prevalence of early and late menopause and its determinants in Rafsanjan cohort study. Sci Rep. 2023;13:1847. DOI: https://doi.org/10.1038/s41598-023-28526-y

Garnæs KK, Elvebakk T, Salvesen O, et al. Dietary intake in early pregnancy and glycemia in late pregnancy among women with obesity. Nutrients. 2022;14:105. DOI: https://doi.org/10.3390/nu14010105

Mills ZB, Faull RLM, Kwakowsky A. Is hormone replacement therapy a risk factor or a therapeutic option for Alzheimer’s disease? Int J Mol Sci. 2023;24:3205. DOI: https://doi.org/10.3390/ijms24043205

Kunyahamu MS, Daud A, Jusoh N. Obesity among health-care workers: which occupations are at higher risk of being obese? Int J Environ Res Public Health. 2021;18:4381. DOI: https://doi.org/10.3390/ijerph18084381

Belachew EB, Sewasew DT. Molecular mechanisms of endocrine resistance in estrogen-positive breast cancer. Front Endocrinol. 2021;12:689705. DOI: https://doi.org/10.3389/fendo.2021.599586

Cheang, M. C. U. et al. Defining breast cancer intrinsic subtypes by quantitative receptor expression. Oncologist 20, 474–482 (2015). DOI: https://doi.org/10.1634/theoncologist.2014-0372

Britt, K., Ashworth, A. & Smalley, M. Pregnancy and the risk of breast cancer. Endocr. Relat. Cancer 14, 907–933 DOI: https://doi.org/10.1677/ERC-07-0137

Shaath H, Elango R, Alajez NM. Molecular Classification of Breast Cancer Utilizing Long Non-Coding RNA (lncRNA) Transcriptomes Identifies Novel Diagnostic lncRNA Panel for Triple-Negative Breast Cancer. Cancers. 2021;13(21):5350. DOI: https://doi.org/10.3390/cancers13215350

Zhang MH, Man HT, Zhao XD, Dong N, Ma SL. Estrogen receptor-positive breast cancer molecular signatures and therapeutic potentials (Review). Biomed Rep. 2013;2:41–52. DOI: https://doi.org/10.3892/br.2013.187

Miah S, Bagu E, Goel R, Ogunbolude, Dai C, Ward A, et al. Estrogen receptor signaling regulates the expression of the breast tumor kinase in breast cancer cells. BMC Cancer. 2019;19:78. DOI: https://doi.org/10.1186/s12885-018-5186-8

Hicks DG, Lester SC. Hormone Receptors (ER/PR). Diagn Pathol. 2016:430–439. DOI: https://doi.org/10.1016/B978-0-323-37712-6.50067-3

Nicolini A, Ferrari P, Duffy MJ. Prognostic and predictive biomarkers in breast cancer: Past, present and future. Semin Cancer Biol. 2018;52(1):56–73 DOI: https://doi.org/10.1016/j.semcancer.2017.08.010

Purdie CA, Quinlan P, Jordan LB, Ashfield A, Ogston S, Dewar JA, et al. Progesterone receptor expression is an independent prognostic variable in early breast cancer: a population-based study. Br J Cancer.

Vaz-Luis I, Winer EP, Lin NU. Human epidermal growth factor receptor-2-positive breast cancer: does estrogen receptor status define two distinct subtypes? Ann Oncol. 2013;24(2):283–291 DOI: https://doi.org/10.1093/annonc/mds286

Iqbal N, Iqbal N. Human Epidermal Growth Factor Receptor 2 (HER2) in Cancers: Overexpression and Therapeutic Implications. Mol Biol Int. 2014:852748 DOI: https://doi.org/10.1155/2014/852748

Krishnamurti U, Hammers J, Atem F, Storto P, Silverman J. Poor prognostic significance of unamplified chromosome 17 polysomy in invasive breast carcinoma. Mod Pathol. 2009:1044–1048 DOI: https://doi.org/10.1038/modpathol.2009.61

Higgins MJ, Stearns V. Understanding Resistance to Tamoxifen in Hormone Receptor-Positive Breast Cancer. Clini Chem. 2009;55(8):1453–1455 DOI: https://doi.org/10.1373/clinchem.2009.125377

Zhou G-Q, Lv J-W, Tang L-l, Mao Y-P, Guo R, Ma J, Sun Y. Evaluation of the National Comprehensive Cancer Network and European Society for Medical Oncology Nasopharyngeal Carcinoma Surveillance Guidelines. Front. Oncol. 2020 DOI: https://doi.org/10.3389/fonc.2020.00119

Paluch-Shimon S, Chemy NI, G E de Vries E, Dafni U, Piccart MJ, Latino NJ, et al. Application of the ESMO-Magnitude of Clinical Benefit Scale (V.1.1) to the field of early breast cancer therapies. ESMO Open. 2020;5(5):e000743 DOI: https://doi.org/10.1136/esmoopen-2020-000743

Matro JM, Li T, Cristofanilli M, Hughes ME, Ottesen RA, Weeks JC, Wong Y-N. Inflammatory Breast Cancer Management in the National Comprehensive Cancer Network: The Disease, Recurrence Pattern, and Outcome. Clin Breast Cancer. 2015;15(1):1–7 DOI: https://doi.org/10.1016/j.clbc.2014.05.005

Inic Z, Zegarac M, Inic M, Markovic I, Kozomara Z, Djurisic I, et al. Difference between luminal A and luminal B subtypes according to Ki-67, tumor size, and progesterone receptor negativity providing prognostic information. Clin Med Insights Oncol. 2014;8:CMO-S18006. DOI: https://doi.org/10.4137/CMO.S18006

Lafci O, Celepli P, Oztekin PS, Kosar PN. DCE-MRI Radiomics Analysis in Differentiating Luminal A and Luminal B Breast Cancer Molecular Subtypes. Acad Radiol. 2022. DOI: https://doi.org/10.1016/j.acra.2022.04.004

Usman A. The Survival of Patients with Triple Negative Breast Cancer with Chemotherapy Along with Lifestyle Change Interventions in Survivors. Arch Cancer Res. 2022;10(1) DOI: https://doi.org/10.32768/abc.202310166-73

Park S, Koo JA, Kim MS, Park HS, Lee JS, Lee JS, et al. Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry. Breast. 2012;21(1):50–57. DOI: https://doi.org/10.1016/j.breast.2011.07.008

Krishnamurti U, Silverman JF. HER2 in breast cancer: a review and update. Adv Anat Pathol. 2014;21(2):100–107 DOI: https://doi.org/10.1097/PAP.0000000000000015

Figueroa-Magalhães MC, Jelovac D, Connolly RM, Wolff AC. Treatment of HER2-positive breast cancer. Breast. 2014;23(2):128–136. DOI: https://doi.org/10.1016/j.breast.2013.11.011

Wang J, Xu B. Targeted therapeutic options and future perspectives for HER2-positive breast cancer. Signal Transduct Target Ther. 2019;4:34. DOI: https://doi.org/10.1038/s41392-019-0069-2

Pulido C, Vendrell I, Ferreira AR, Casimiro S, Mansinho A, Alho I, et al. Bone metastasis risk factors in breast cancer. Ecancermedicalscience. 2017;11:715. DOI: https://doi.org/10.3332/ecancer.2017.715

Grassini D, Cascardi E, Sarotto I, Annaratone L, Sapino A, Berrino E, et al. Unusual Patterns of HER2 Expression in Breast Cancer: Insights and Perspectives. Pathobiol. 2022. DOI: https://doi.org/10.1159/000524227

Kumar P, Aggarwal R. An overview of triple-negative breast cancer. Arch Obstet Gynaecol. 2016;293(2):247–269. DOI: https://doi.org/10.1007/s00404-015-3859-y

Loibl S, Gianni L. HER2-positive breast cancer. Lancet. 2017;389(10087):2415–2429. DOI: https://doi.org/10.1016/S0140-6736(16)32417-5

Collignon J, Lousberg L, Schroeder H, Jerusalem G. Triple-negative breast cancer: treatment challenges and solutions. Breast Cancer (Dove Med Press). 2016;8:93 DOI: https://doi.org/10.2147/BCTT.S69488

Cardoso, F. et al. 4th ESO–ESMO international consensus guidelines for advanced breast cancer (ABC 4)†. Ann. Oncol. 29, 1634–1657 (2018)

Kim M, Jung MS. Effects of chemotherapy-induced peripheral neuropathy in women with breast cancer: a structural equation approach with the theory of unpleasant symptoms. Cancer Nurs. 2021;44:145–53. DOI: https://doi.org/10.1097/NCC.0000000000000764

Golse, N. & Adam, R. Liver metastases from breast cancer: what role for surgery? Indications and results. Clin. Breast Cancer 17, 256–265 (2017). DOI: https://doi.org/10.1016/j.clbc.2016.12.012

Xie, Y. et al. Surgery of the primary tumor improves survival in women with stage IV breast cancer in southwest China: a retrospective analysis. Medicine 96, e7048 (2017) DOI: https://doi.org/10.1097/MD.0000000000007048

Shien, T. & Doihara, H. Resection of the primary tumor in stage IV breast cancer. World J. Clin. Oncol. 5, 82–85 (2014). DOI: https://doi.org/10.5306/wjco.v5.i2.82

Badwe, R. et al. Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial. Lancet Oncol. 16, 1380–1388 (2015). DOI: https://doi.org/10.1016/S1470-2045(15)00135-7

Fitzal, F. et al. Impact of breast surgery in primary metastasized breast cancer: outcomes of the prospective randomized phase III ABCSG-28 POSYTIVE Trial. Ann. Surg. https://doi.org/10.1097/ SLA.0000000000002771 (2018).

Dare, A. J. et al. Surgical Services for Cancer Care. in Cancer: Disease Control Priorities, Third Edition (Volume 3) (eds. Gelband, H., Jha, P., Sankaranarayanan, R. & Horton, S.) (The International Bank for Reconstruction and Development/The World Bank, 2015).

Phillips, C., Jeffree, R. & Khasraw, M. Management of breast cancer brain metastases: a practical review. Breast 31, 90–98 (2017). DOI: https://doi.org/10.1016/j.breast.2016.10.006

Thavarajah, N. et al. Continued success in providing timely palliative radiation therapy at the rapid response radiotherapy program: a review of 2008–2012. Curr. Oncol. 20, e206–e211 (2013) DOI: https://doi.org/10.3747/co.20.1342

Chow, E. et al. Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial. Lancet Oncol. 15, 164–171 (2014). DOI: https://doi.org/10.1016/S1470-2045(13)70556-4

Sologuren, I., Rodríguez-Gallego, C. & Lara, P. C. Immune effects of high dose radiation treatment: implications of ionizing radiation on the development of bystander and abscopal effects. Transl Cancer Res. 3, 18-31–31 (2014).

Bernier, J. Immuno-oncology: allying forces of radioand immuno-therapy to enhance cancer cell killing. Crit. Rev. Oncol. Hematol. 108, 97–108 (2016) DOI: https://doi.org/10.1016/j.critrevonc.2016.11.001

Cardoso, F. et al. 4th ESO–ESMO international consensus guidelines for advanced breast cancer (ABC 4)†. Ann. Oncol. 29, 1634–1657 (2018).

Rugo, H. S. et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology guideline. J. Clin. Oncol. 34, 3069–3103 (2016). DOI: https://doi.org/10.1200/JCO.2016.67.1487

Cardoso, F. et al. 4th ESO–ESMO international consensus guidelines for advanced breast cancer (ABC 4)†. Ann. Oncol. 29, 1634–1657 (2018) DOI: https://doi.org/10.1093/annonc/mdy192

Chang CC, Ho TC, Lien CY, et al. The effects of prior mammography screening on the performance of breast cancer detection in Taiwan. Healthcare (Basel). 2022;10:1037. DOI: https://doi.org/10.3390/healthcare10061037

Wang Y, Chen H, Li N, et al. Ultrasound for breast cancer screening in high-risk women: results from a population-based cancer screening program in China. Front Oncol. 2019;9:286 DOI: https://doi.org/10.3389/fonc.2019.00286

van der Poort EKJ, van Ravesteyn NT, van den Broek JJ, et al. The early detection of breast cancer using liquid biopsies: model estimates of the benefits, harms, and costs. Cancers. 2022;14:2951 DOI: https://doi.org/10.3390/cancers14122951

Maio F, Tari DU, Granata V, et al. Breast cancer screening during COVID-19 emergency: patients and department management in a local experience. J Pers Med. 2021;11:380. DOI: https://doi.org/10.3390/jpm11050380

Seferin MR, Pinto FR, Leite AKN, et al. The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma. Braz J Otorhinolaryngol. 2022;88:434–8. DOI: https://doi.org/10.1016/j.bjorl.2020.11.015

Wang M, Kundu U, Gong Y. Pitfalls of FNA diagnosis of thymic tumors. Cancer Cytopathol. 2020;128:57–67 DOI: https://doi.org/10.1002/cncy.22211

Pagani, O. et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N. Engl. J. Med. 371, 107–118 (2014). DOI: https://doi.org/10.1056/NEJMc1409366

Francis, P., Regan, M. & Fleming, G. Adjuvant ovarian suppression in premenopausal breast cancer. N. Engl. J. Med. 372, 1672–1673 (2015) DOI: https://doi.org/10.1056/NEJMc1502618

Mao, J. J. et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. J. Clin. Oncol. 33, 3615–3620 (2015). DOI: https://doi.org/10.1200/JCO.2015.60.9412

Loprinzi, C. L. et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 356, 2059–2063 (2000). DOI: https://doi.org/10.1016/S0140-6736(00)03403-6

Niravath, P. Aromatase inhibitor-induced arthralgia: a review. Ann. Oncol. 24, 1443–1449 (2013). DOI: https://doi.org/10.1093/annonc/mdt037

Razvi, Y. et al. ASCO, NCCN, MASCC/ESMO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in adult patients. Support. Care Cancer 27, 87–95 (2019). DOI: https://doi.org/10.1007/s00520-018-4464-y

Gulati, G. et al. Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): a 2×2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur. Heart J. 37, 1671–1680 (2016) DOI: https://doi.org/10.1093/eurheartj/ehw022

Smith, E. M. L. et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA 309, 1359–1367 (2013) DOI: https://doi.org/10.1001/jama.2013.2813

Hershman, D. L. et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J. Clin. Oncol. 32, 1941–1967 (2014).

Hanai, A. et al. Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: prospective self-controlled trial. J. Natl Cancer Inst. 110, 141–148 (2018). DOI: https://doi.org/10.1093/jnci/djx178

Hou, S., Huh, B., Kim, H. K., Kim, K.-H. & Abdi, S. Treatment of chemotherapy-induced peripheral neuropathy: systematic review and recommendations. Pain Physician 21, 571–592 (2018). DOI: https://doi.org/10.36076/ppj.2018.6.571

Ahmed, R. L., Schmitz, K. H., Prizment, A. E. & Folsom, A. R. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study. Breast Cancer Res. Treat. 130, 981–991 (2011). DOI: https://doi.org/10.1007/s10549-011-1667-z

Gillespie, T. C., Sayegh, H. E., Brunelle, C. L., Daniell, K. M. & Taghian, A. G. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments. Gland. Surg. 7, 379–403 (2018) DOI: https://doi.org/10.21037/gs.2017.11.04

Runowicz, C. D. et al. American Cancer Society/ American Society of Clinical Oncology breast cancer survivorship care guideline. J. Clin. Oncol. 34, 611–635 (2016). DOI: https://doi.org/10.1200/JCO.2015.64.3809

Velikova, G. et al. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol. 19, 1516–1529 (2018).

Downloads

Published

11-07-2025

Issue

Section

Research Articles

How to Cite

Breast Cancer: A Multifactorial Disease with Emerging Precision Medicine Approaches. (2025). International Journal of Scientific Research in Science and Technology, 12(4), 247-260. https://doi.org/10.32628/IJSRST251271