Breast Cancer in the Era of Precision Medicine

Introduction:
Precision medicine is concerned with the diagnosis of patients according to their biological, genetic, and molecular status. As cancer is a genetic disease, its treatment comes among the first medical disciplines as an application of precision medicine. Breast cancer is a highly complex, heterogeneous, and multifactorial disease; it is also one of the most common diseases among women in the world. Usually, there are no clear symptoms, so regular screening is important for early detection. Scientists recently started using modern techniques that aid in accurate diagnosis at the genetic level and treatment.

Entering the era of precision medicine and leaving behind traditional treatment approaches may provide data-driven treatments suitable to the genetic, environmental, and lifestyle factors that contribute to each individual's uniqueness.

Keywords: breast cancer, precision medicine, genetic disease.

Literature Review: Unlike most breast cancer treatments which include surgical treatment, radiation therapy, hormone therapy, chemotherapy, and targeted therapy, and have shown risks and side effects, precision medicine has shown to be the most effective treatment for each patient.

Most breast cancers start either in the breast tissue made up of mammary glands' lobules or in the ducts that are attached to the nipple. The remainder of the breast is made up of fatty, connective, and lymphatic tissues. Breast cancer has also been reported in rare cases of men in the US, accounting for less than 1%.

Breast Cancer Risk Factors include: family history, genetic predisposition, breast density, bone mineral density, height, menstrual cycles, endogenous hormone levels, pregnancy, exposure to fertility drugs and postmenopausal hormones, breastfeeding, use of hormonal birth control, alcohol and tobacco consumption, diet, physical activity, obesity, weight gain, radiation exposure, diethylstilbestrol exposure, environmental pollutants, use of bras, breast implants, night shift work, hair dyes, relaxers, and antiperspirants.

In a randomized clinical trial of an earlier study for breast irradiation, it was shown to reduce cancer recurrence in the breast, but there was no statistically significant reduction in mortality.

In a 2005 study, an evidence-based method was used to calculate a general estimation of optimum radiotherapy utilisation of 52.3% for all notifiable cancer in Australia.

The advantage of radiotherapy over other treatment options lies in its better survival, local control, and toxicity profiles. The total estimate provides a useful tool for assisting in planning for adequate radiotherapy resources.

In a 2012 study by Yamamoto et al, it was reported that the applications of genome-wide expression profiling technologies, such as DNA microarrays, are important to better characterize the molecular features of breast cancers. The study showed that it is possible to integrate non-invasive magnetic resonance imagining (MRI) data with more comprehensive microarray genomic studies for breast cancer. The results also showed some potential ways of associating breast tumor biology to imaging descriptors recognized through routine studies and provide a palette of copy traits for future radiogenomic studies to leverage.

In a study conducted in 2017, the authors suggested new approaches that may help in improving the efficiency of the currently available cancer therapies. These approaches include optimization of drug dosage and identifying genetic changes related to cancer symptom occurrence and severity.

Besides, gene profiling studies would also help in identifying the genetic biomarkers. This can predict the risk of individuals developing common symptoms related to cancer treatment, thereby achieving a better quality of life for patients undergoing cancer treatment. More recently, a 2018 study revealed that technologies such as genomics, transcriptomics, proteomics, metabolomics, and radiogenomics have been favored in breast cancer research. They aim to assimilate several layers of data for an integrative portrait of breast cancer, recognizing precision medicine in the process. Radiogenomics not only represents the progress of radiology-pathology correlation from the anatomic histologic level to the genetic level, but it also describes the interface of biological systems methodologies and imaging. More research is needed to study the importance of follow-up to patient survivorship. Immunotherapy with immune checkpoint inhibitors is a promising and rapidly growing field of interest in many solid tumors, including breast cancer. TILs are mononuclear immune cells that are found in and around tumor tissue. The prognostic value of TILs in primary breast cancer has been substantially evaluated using tumor samples from thousands of patients in prospective trials of adjuvant chemotherapy. Enhanced response rates and longer survival have been detected in patients with advanced TIL levels.

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