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American Journal of  Medical 
Science and Innovation (AJMSI) 

Breast Cancer in Elderly Females
Mona Mahmoud Abasher1*, Amal Abdelhakam Sidahmed1, Asjad Abdelmoniem1, Hyffa Osman Mohamed Ahmed1

Volume 2 Issue 2, Year 2023
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v2i2.1711
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: May 28, 2023

Accepted: June 20, 2023

Published: June 29, 2023

Breast cancer develops when the breast’s cells multiply uncontrollably. Breast cancer ranks 
as the second leading cause of  cancer-related mortality among women. Breast cancer risk 
increases with age. Almost 1 in 7 women will experience the onset of  breast cancer during 
their lifetime. Breast cancer is a malignant or cancerous tumour that develops from cells 
in breast tissue. Although they are non-life-threatening and confined to the breast,  some 
women develop benevolent or non-cancerous breast lumps. Many people are unaware they 
have breast cancer since the early stages of  the disease are frequently benign. Early discovery 
provides more time for evaluation and treatment, which can help prevent negative effects. 
Self-examination and several diagnostic tools as mammography, ultrasound, and nuclear 
medicine, are used to evaluate invasive and non-invasive breast cancer. Several therapies 
associated with breast cancer treatments include chemotherapy, radiation therapy, hormone 
therapy, and bone-directed therapy. Surgeries can also effectively treat breast cancer, such 
as lumpectomy and mastectomy. This suggests that effective therapies are progressing. 
This review aims to determine breast cancer’s causes, prevalence, and treatments in elderly 
women. The authors have discussed the disease’s treatment criteria and protocols, such as 
pharmacological therapies, herbal treatment, lifestyle modifications, and physical activities

Keywords
Breast Cancer, Chemotherapy, 
Herbal Treatment, Lumps, 
Mammography, Mastectomy, 
Nuclear Medicine, Tamoxifen

1 Port Sudan Oncology Centre P.O.C, Sudan
* Corresponding author’s e-mail: monamahmoud582@outlook.com

INTRODUCTION 
Breast cancer progression arises from the uncontrolled 
growth of  cells within the breast tissue. Breast cancer 
manifests in multiple forms, with the specific type 
determined by the origin of  cancerous growth in the breast 
cells (Fahad Ullah, 2019). The second most common 
cancer in women to be diagnosed in the US is breast 
cancer (Mojisola, 2023). Although breast cancer can also 
affect men, it predominantly affects women (Akram et al., 
2017). Breast cancer is a life-threatening disease affecting 
women of  any age, although those over 50 comprise 
most of  those diagnosed. Breast cancer affects about 1 
in 7 women throughout their lifetime (Fahad Ullah, 2019; 
Ferlay et al., 2015; Shannon & Smith, 2003). Adolescents 
and young women rarely develop breast cancer (Shannon 
& Smith, 2003). Among postmenopausal women, breast 
cancer contributes to approximately 23% of  all cancer-
related deaths, making it one of  the most prevalent 
malignant diseases. Furthermore, studies indicate that 
unmarried women are more likely to develop breast 
cancer than their married counterparts (Shamsi et al., 
2013). In women over 40 and 50, the incidence of  breast 
cancer was higher, with a reported rate of  2 cases per 
1000 individuals.
Furthermore, epidemiological research has shown that 
women with more children tend to have a reduced risk of  
developing breast cancer compared to those with fewer 
children. Among all types of  cancers, breast cancer has 
an incidence rate of  10.04% and predominantly affects 
women in their 40s and 50s. The average age of  Iranian 
women diagnosed with breast cancer is 48 years (Donnelly 
et al., 2013). Breast cancer is less common before age 20, 
but its risk increases with age (Zheng et al., 2023). Despite 

being a global issue, many women still neglect to perform 
self-examinations and seek clinical breast examinations, 
leading to the detection of  the disease at advanced stages 
(Akram et al., 2017). 
DNA damage causes cells to develop into cancerous cells. 
However, hormones also play a vital role in many cases of  
breast cancer.  In a normal cell, when DNA is damaged, 
the cell has mechanisms to either repair the damage or 
undergo programmed cell death. However, the damaged 
DNA is not repaired in cancer cells, yet the cell does not 
undergo cell death as it should. Instead, it continues to 
replicate and generate new cells that are unnecessary for 
the body. The damaged DNA from the original cells is 
passed on to these new cells.  A new lump or tumour is 
the most frequent indicator of  breast cancer (Girish et 
al., 2014). The risk of  malignancy increases with a firm, 
asymptomatic lump with uneven edges, but breast cancer 
might be soft, spherical, or sensitive. They might even 
cause pain. Since breast conditions can be difficult to 
diagnose, it is crucial to get any new breast tumour, lump, 
or alteration examined by a medical specialist (Girish 
et al., 2014). Breast cancer can present with additional 
symptoms, including skin irritation, dimpling, swelling 
of  the entire breast or a portion of  it (with or without 
a lump), nipple pain, breast pain, nipple retraction, and 
nipple discharge unrelated to breastfeeding.
This review aims to determine breast cancer’s causes, 
prevalence, and treatments in elderly women. 
Abbreviations: National Cancer Institute (NCI); 
Surveillance Epidemiology and End-Results (SEER); 
Ductal Carcinoma in Situ (DIC); Lobular Carcinoma in 
Situ (LCIS); Invasive Lobular Carcinoma (ILC); Infiltrating 
Ductal Carcinoma (IDC); Primary Care Physician (PCP); 

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Progesterone Receptor (PR); Estrogen Receptor (ER); 
Ductal Cell Carcinoma in Situ (DCIS); Single Photon 
Emission Computerized Tomography (SPECT); Positron 
Emission Tomography (PET); Magnetic Resonance 
Imaging (MRI); World Health Organization (WHO); 
Computed Tomography (CT); Hormone Replacement 
Therapy (HRT), Circulating Tumor Cells (CTCs). 

LITERATURE REVIEW
Breast Cancer Prevalence and Mortality
The prevalence is anticipated to be less than 0.1 per 
100,000 women under 20, 1.4 for women aged 20 to 24, 
8.1 for women aged 25 to 29, and 24.8 for women aged 
30-34. Childhood breast cancer comprises less than 1% 
of  all cancers diagnosed in children and accounts for 
less than 0.1% of  all breast cancer cases in the general 
population. According to data from the National Cancer 
Institute’s (NIC) Surveillance Epidemiology and End-
Results (SEER) database, in the United States, fewer than 
1% and 2.7% of  breast cancer patients are under the age 
of  35, respectively (Shannon & Smith, 2003). Compared 
to the global statistics, the United States exhibits a higher 
mortality rate and breast cancer prevalence according to 
age. In Poland, 17% of  sickness cases and 14% of  fatalities 
are brought on by malignant alterations. In 2004, there 
were 519,000 breast cancer-related deaths worldwide. 
Each year, approximately 1,208,000 new cancer cases are 
diagnosed in the United States, leading to the unfortunate 
demise of  538,000 individuals in the early stages of  the 
disease. These fatalities account for roughly one-fifth of  
all annual deaths across various causes (Shaukat et al., 
2013). 

Breast Anatomy
The breast primarily comprises adipose tissue, a type of  
fatty tissue. Compared to males, female breasts typically 
contain a higher proportion of  glandular tissue (Aronson 
et al., 2000). The female breasts comprise 12 to 20 lobes, 
subdivided into smaller lobules. Through milk ducts, 
these lobes and lobules are joined together. An intricate 
network of  nerves, blood vessels, lymphatic vessels, 
lymph nodes, fibrous connective tissue, and ligaments 
aligns with the breast, which nourishes and supports 
the adipose tissue within the breast (Tanis et al., 2001). 
The primary purpose of  the female breast is to provide 
optimal nutrition to newborns (Akram et al., 2017). 
Nipples and breasts exhibit a wide range of  sizes and 
shapes among individuals. It is common for most women 
to have one breast that is considerably smaller than the 
other (Brayboy et al., 2017). 

Breast Cancer and Types
Breast cancer originates from the abnormal growth 
of  breast tissue cells, leading to malignant tumours. 
However, it is important to note that some women may 
also develop benign or non-cancerous breast lumps, 
which are not life-threatening and do not spread beyond 
the breast. Nevertheless, they enhance a person’s risk of  

breast cancer (Ely & Vioral, 2007). The intrinsic growth 
rate of  the tumour, age at diagnosis, and various other 
factors now significantly impact survival.  Two types of  
breast cancers are categorized as invasive and non-invasive 
(Chinweike-Umeh et al., 2023). One in eight women may 
develop invasive breast cancer, and one in 33 will die. 
Although cancer incidence has increased, the death rates 
have decreased, most likely due to earlier detection and 
better therapies. Over 2 million women in the United States 
have received breast cancer treatment (Society, 2007). 

Non-Invasive Breast Cancer
Breast cancer confined to the lobules or ducts where it 
originated is classified as non-invasive.
Ductal Carcinoma In Situ: In this condition, abnormal 
cells develop within the milk ducts but do not spread to 
surrounding tissues or outside the body (Akram et al., 
2017; Hang et al., 2017). Mammography is the best tool 
for finding cancer at this stage when nearly all affected 
women can be treated (Ely & Vioral, 2007). An example 
of  DCIS is ductal comedocarcinoma (Parikh et al., 2018).
Lobular Carcinoma In Situ: When breast cancer originates 
in the breast lobules, it is called Lobular Carcinoma in Situ 
(LCIS). Breast cancer has not invaded the breast tissue 
lobules (Clauser et al., 2016). Although it starts in the milk-
producing glands, LCIS does not penetrate the lobules’ 
walls (Inoue et al., 2017). While LCIS is not considered 
invasive, it elevates a woman’s risk of  developing cancer 
later in life (Akram et al., 2017; Ely & Vioral, 2007). 

Invasive Breast Cancer
Conversely, invasive breast cancer occurs when abnormal 
cells originating from the milk ducts or lobules extend 
beyond their original location and invade the surrounding 
breast tissue (Ziperstein et al., 2016). Cancer cells can 
metastasize from the breast to various body parts through 
the immune or circulatory systems. This can occur at an 
early stage when the tumour is small or later when it has 
grown larger. Invasive breast cancer is the most prevalent 
type of  carcinoma affecting women (Harris et al., 2016). 
With increasing years, the risk of  breast cancer increases 
quickly. 

Metastatic Breast Cancer
Metastatic breast cancer is disseminated to other organs in 
the body (Page et al., 2017). The organs most commonly 
affected by the spread of  these cells are the brain, bones, 
lungs, and liver. As these cells separate and proliferate, 
they create new tumours in these locations (Prabhakaran 
et al., 2017). 

Invasive Lobular Carcinoma
It is also known as Invasive Lobular Carcinoma (ILC), a 
term used to describe a specific type of  breast cancer. It 
originates in the breast’s milk-producing glands (lobules) 
but spreads to other body parts. ILC accounts for 
approximately 10% of  all invasive breast cancers (DeVita, 
2005). 

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Infiltrating Ductal Carcinoma
Invasive ductal carcinoma is another name for infiltrating 
ductal carcinoma. It originates in a milk tube or duct, 
penetrates the duct wall, and invades the breast tissue, 
from where it can spread to other body regions. 
Approximately 80% of  breast cancers are caused by IDC 
(Somiari et al., 2003). 

Medullary Carcinoma 
Medullary carcinoma of  the breast is characterized by 
forming a well-defined boundary between the normal 
breast tissue and the medullary tumour tissue (Mateo et 
al., 2017). 

Mutinous Carcinoma
The mucus-producing cancer cells that cause mutinous 
or colloid carcinoma are uncommon breast cancers 
(Anuradha & Lakshmi, 2014). 

Tubular Carcinoma
Women diagnosed with tubular carcinoma generally have 
a more favourable prognosis compared to those with 
other types of  invasive breast cancer (Priya & Prasaad, 
2017).

Inflammatory Breast Cancer
A highly uncommon and aggressive form of  breast 
cancer known as inflammatory breast cancer manifests as 
a reddish, swollen breast with dimples and broad ridges 
because the cancer cells have blocked the lymphatic 
channels or capillaries in the skin around the breast 
(Joglekar-Javadekar et al., 2017). When a woman visits 
her Primary Care Physician (PCP) for medical guidance, 
she is often prescribed antibiotic medication (Ely & 
Vioral, 2007). In addition to having ductal or lobular 
histology, these breast tumours also feature cancer cells 
that are visible in the skin’s lymphatics, which results in 
an inflamed appearance. 
Consequently, certain types of  cancer, such as Paget’s 
disease of  the breast, Phyllodes tumour, and Triple-
negative breast cancer, are comparatively uncommon.

Paget’s Breast Disease
A rare type of  breast cancer often presents with noticeable 
changes to the nipple. Symptoms include the presence of  
red, itchy rashes around the nipple, which may sometimes 
extend to the surrounding skin (Merrill et al., 2017). Even 
though it resembles other skin conditions like psoriasis 
and eczema, it can be distinguished because those 
conditions typically affect both breasts. This particular 
type of  breast cancer can initiate from the areola, the 
pigmented area surrounding the nipple, rather than 
originating directly from the nipple itself. This condition 
typically only affects one breast and begins at the nipple 
of  the breast. Paget’s illness, which can afflict both men 
and women, accounts for about 1-3% of  all breast cancer 
cases (Errichetti et al., 2017). 

Phyllodes Tumours
Phyllodes tumours can exhibit benign and malignant 
characteristics (Sera et al., 2017). In cases where Phyllodes 
tumours develop in the breast’s connective tissues, they 
can be surgically excised. Phyllodes tumours are highly 
uncommon and result in fewer than 10 annual deaths 
among girls in the United States (Strode et al., 2017). 

Triple-Negative Breast Cancer
Triple-negative breast cancer is characterized by the 
absence of  progesterone receptors, human epidermal 
growth factor receptor 2 (HER2), and estrogen 
receptor expression. This aggressive subtype is found in 
approximately 10-15% of  cases, predominantly affecting 
premenopausal women. It is more prevalent in white 
females and is associated with a lack of  ER, PR, and 
ERBB2 protein expression in cancer cells (Foulkes et al., 
2010; Waks & Winer, 2019b). 

Hormone Receptor-Positive Breast Cancer 
Around 70% of  breast cancer cases are classified as 
hormone receptor-positive, indicating the presence of  
either Progesterone Receptor (PR) or Estrogen Receptor 
(ER) proteins within the cancer cells (Waks & Winer, 
2019b). 

ERBB2-Positive Breast Cancer 
Around 15% to 20% of  breast cancer cases are classified 
as ERBB2-positive, commonly called HER2-positive 
breast cancer. These cases exhibit elevated levels of  the 
ERBB2 protein on the surface of  cancer cells.

Stages of  Breast Cancer
Breast cancer can be detected in various locations during 
diagnosis, including the breast tissue, axillary lymph 
nodes, or distant sites. The staging of  breast cancer, 
categorized from I to IV, depends on the extent of  its 
spread. Metastatic breast cancer is another name for 
stage IV breast cancer, which signifies that the disease 
has metastasized to other body parts beyond the breast 
and axillary lymph nodes (Waks & Winer, 2019a). Based 
on a breast cancer report, the stage of  breast cancer is 
determined by various factors, including tumour size, 
type, and depth of  infiltration into breast tissues. Non-
invasive tumours are categorized as stage 0, while invasive 
tumours are classified as stage 4.

Stage 0
Ductal Carcinoma in Situ (DCIS), which denotes that 
both cancerous and non-cancerous cells are contained 
inside the borders of  the initial spot in the breast where 
the tumour formed, is a typical example of  this tumour 
stage.  Notably, there is no evidence of  invasive growth 
into the surrounding tissues (Akram et al., 2017). 

Stage 1
It refers to invasive breast cancer, where a microscopic 

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invasion of  surrounding tissues is still possible. It is 
further divided into two categories: stage 1A and stage 
1B. Stage 1A encompasses tumours up to 2 cm in size 
without any involvement of  lymph nodes, while stage 1B 
involves the presence of  a small cluster of  cancer cells 
larger than 0.2 mm detected in a lymph node (Akram et 
al., 2017). 

Stage 2
Stage 2 is divided into 2A and 2B. In stage 2A, the tumour 
is found in the sentinel or axillary lymph nodes but not 
in the breast. The tumour size can vary, ranging from less 
than 2 cm to more than 5 cm. On the other hand, stage 
2B indicates that the tumour may exceed 5 cm in size, but 
it has not spread to the axillary lymph nodes. (Moran et 
al., 2014). 

Stage 3 
The classification of  this stage has been subdivided 
into three categories: 3A, 3B, and 3C. Notably, Stage 3B 
encompasses a type known as inflammatory breast cancer, 
characterized by symptoms such as redness, warmth, and 
swelling of  the breast skin. Stage 3 breast cancer has three 
subcategories: 3A, 3B, and 3C. In stage 3A, no tumour is 
present in the breast, but it can be detected in 4-9 axillary 
lymph nodes or the sentinel lymph nodes. Stage 3B is 
characterized by a tumour of  any size that has caused 
swelling or ulceration on the skin of  the breast. It can also 
involve the spread to up to 9 axillary lymph nodes or the 
sentinel lymph nodes. Stage 3C refers to the spread of  the 
tumour to 10 or more axillary lymph nodes and lymph 
nodes located above and below the collarbone (Akram 
et al., 2017). 

Stage 4 
The significant spread of  the disease to several body 
organs is evident in this advanced and metastatic stage of  
cancer, including but not limited to the lungs, bones, liver, 
brain, and other locations (Neuman et al., 2010).

METHODOLOGY
In order to execute this review, recent research and 
review articles/publications based on breast cancer 
in elderly women were considered. The focus of  the 
investigation revolved around the effectiveness of  
managing breast cancer in preventing the development 
of  related conditions, such as metastasis, recurrence, and 
other comorbidities. Data was gathered from electronic 
databases; Google Scholar, PubMed, Publon, Web of  
Science, NCBI, Hindawi, National Library of  Medicine, 
ResearchGate, MEDLINE, EMBASE database, Science 
Direct, Scopus, Cochrane Central Register of  Controlled 
Trials (CENTRAL), and BioMed.
For this study, we searched the literature for articles 
addressing the causes, prevalence, and treatments for 
breast cancer in women. Studies were selected from 
different years ranging between  2017 to 2022 using 
keywords’ ‘breast cancer,’ ‘breast cancer types,’ ‘breast 

cancer and mortality,’ ‘breast cancer treatments,’ ‘invasive 
and non-invasive breast cancer,’ ‘breast cancer stages,’ 
‘chemotherapy in breast cancer,’ ‘herbal medicine 
effectiveness.’ Search keywords were combined using 
proximity operators (NEAR, NEXT, WITHIN) and 
boolean (AND, OR) operators.
First, text words included in the article’s title, abstract, 
and index keywords were examined after databases were 
searched for relevant papers. Then, across all databases, 
a second search was conducted using all the discovered 
keywords, index terms, and MeSH terms for MEDLINE. 
Third, new studies were found by searching the reference 
lists of  all the studies, reports, and articles. Fourth, 
databases were searched to identify all related articles and 
reports in LMICs: PubMed, Google Scholar, and Google. 
Titles and abstracts were examined for the search terms. 
Access was made to the whole texts of  the articles that 
were found. This article serves as a review. Therefore, not 
all information about preventing breast cancer through 
management strategies has been comprehensively 
presented in its contents. In contrast, efforts were focused 
on including the most significant and relevant research. 

Inclusion Criteria
The following addition and omission criteria were 
used to filter the titles rather than study relevance. We 
only selected those studies submitted to peer-reviewed 
journals for approval that were already published. These 
studies were taken into consideration to understand the 
research criteria better. 

* All English-language research published in peer-
reviewed publications was included for review.

* Studies describing the importance of  self-examination 
for breast cancer were included.

* Studies related to care were included. 
* Reviews of  recent developments in breast cancer 

treatment were focused on. 
* Studies related to precautions during breast cancer 

were also considered.                  
* Studies evaluating the diagnosis criteria were also an 

area of  interest.       
* The study included a case report, a case report with 

review literature, a literature review, a retrospective cohort 
study, review articles, and a case-control study. 

Exclusion Criteria
The exclusion criteria involve; 

* Other than English-language papers were not 
considered.

* Studies focusing solely on the science of  breast 
cancer were excluded.

* Papers not aimed at breast cancer treatment and 
advancement in monitoring were excluded from the 
review.                                                                                                                                 

* The objective was unrelated to breast cancer.
* Duplicate studies were excluded.                                                                                                     
* Studies lacking predefined findings’ supporting data.                                                                   
* Studies whose titles were related to the study but 

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whose text was not relatable were excluded from the 
review.                                                                                                                               

DISCUSSION
Breast cancer is widely recognized as a heterogeneous 
disease comprising various subtypes that can be 
distinguished based on their clinicopathological 
characteristics, prognoses, and responses to treatment. 
Moreover, its prevalence has increased (Barrios, 2022). 
The prevalence varies across regions and populations but 
remains a global public health concern. Annually, over 
55,000 women are diagnosed with this devastating illness 
(KJ & Khamzaeva, 2023). Various factors influence the 
prevalence of  breast cancer. Efforts are made to raise 
awareness about breast cancer risk factors, promote 
early detection through regular screenings, and improve 
treatment options (Prager et al., 2018). Considering 
breast cancer’s significant impact on individuals, families, 
and societies, it is crucial to prioritize prevention, early 
diagnosis, and access to quality healthcare services 
(Basu et al., 2020). By addressing risk factors, promoting 
education, and advancing research, efforts can be made to 
decrease the occurrence of  breast cancer and enhance the 
prognosis and well-being of  individuals impacted by this 
disease (Szuhany et al., 2021).

Risk Factors
The risk of  breast cancer is increased by certain factors, 
including nutritional imbalances, smoking, chronic alcohol 
consumption, the intake of  carcinogenic beverages, 
occupational hazards, sexually transmitted infections, 
and specific characteristics related to reproductive health. 
Other factors may include; age, family history, genetic 
mutations, hormonal factors, dense breast tissue, previous 
history of  breast conditions, radiation exposure, obesity, 

lack of  physical activity, and hormonal birth control. 
The risk can also be increased by reproductive attributes 
such as early menstrual onset, delayed menopause, 
never having children, delaying having children until 
after age 30, and not breastfeeding (Kurbonov et al., 
2023). Hormonal factors such as early menstruation, 
late menopause, Hormone Replacement Therapy (HRT) 
use, and certain hormone-related conditions can also 
increase the risk of  breast cancer. Breast density can also 
increase the risk of  developing breast cancer (Cullinane et 
al., 2022). It is crucial to emphasize that one or more of  
these risk factors does not guarantee the development of  
breast cancer. Many women without known risk factors 
still develop the disease, while some with several risk 
factors never do. Regular screenings, early detection, and 
a healthy lifestyle reduce the risk and promote overall 
breast health (Tang, 2022).

Diagnosis 
As a result, the staging procedure develops into a 
challenging yet essential part of  diagnosis and treatment. 
Women should begin self-examining their breasts at age 
20, and routine health checks should include clinical 
breast inspections. It is recommended for women over 
40 to undergo breast cancer screening annually, while for 
women in their 20s and 30s, screening is typically advised 
every three years. Additionally, women should know how 
their breasts typically feel and immediately notify their 
doctor of  any changes. Cancer diagnosis and treatment 
aim to identify a malignancy before it manifests clinically. 
There are various breast cancer-specific screening and 
diagnostic procedures. A few of  them are described as 
follows: 
Other diagnosis measures may include; breast biopsy, 
Magnetic Resonance Imaging (MRI), core biopsy, fine 

Table 1: Diagnostic Procedures
Diagnostic Tools Characteristics
Breast Examination Women should begin self-checks at age 20, and routine health inspections should 

include clinical breast examinations. Every year for women over 40 and every three 
years for those in their 20s and 30s (Society, 2007). 

Mammography Mammography is the cornerstone of  early breast cancer detection. According to the 
ACS, women over 40 should have annual mammography screening (Society, 2007). 

Ultrasound Ultrasound uses sound waves to detect whether a mammography problem region is 
solid or cystic (Ely & Vioral, 2007). 

Breast Magnetic 
Resonance Imaging

Magnetic resonance imaging (MRI) utilizes magnetic fields to generate highly detailed 
cross-sectional images of  tissue structures, offering excellent contrast for visualizing 
soft tissues (Ely & Vioral, 2007). 

Nuclear Medicine In molecular imaging, patients are administered a radioactive substance known as a 
radiopharmaceutical, and emission detectors capture and analyze the resulting data. 
Combining CT with gamma cameras and PET to improve disease detection and 
localization (Akram et al., 2017). 

Single photon 
emission computerized 
tomography (SPECT)

This technique utilizes specific radioactive isotopes, such as technetium-99, gallium-67, 
and iodine-131, which emit gamma rays. It is a precise and effective scan of  the organ 
of  interest (Akram et al., 2017). 

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Positron emission 
tomography (PET/CT)

Positron emission tomography/computed tomography (PET/CT) is considered safe 
regarding radiation exposure and utilizes positron-emitting radionuclides such as 
carbon-11, fluoride-18, and oxygen-15. A commonly used tracer in PET is a radioactive 
form of  glucose known as [18F]fluoro-2-deoxy-D-glucose (Akram et al., 2017). 

Estrogen and 
progesterone receptors

To determine the presence of  breast cancer, samples are analyzed to detect estrogen, 
progesterone receptors, and the HER2 antigen. These tests provide valuable 
information about the assertiveness of  cancer and help assess the suitability of  specific 
medications for breast cancer treatment (Akram et al., 2017). 

needle aspiration, surgical biopsy, and vacuum-assisted 
stereotactic core biopsy. 

Breast Cancer Biomarkers
Biomarkers are measurable characteristics that can indicate 
the presence, progression, or response to treatment of  a 
disease like breast cancer. In the context of  breast cancer, 
several biomarkers are used for diagnosis, prognosis, and 
guiding treatment decisions (Afzal et al., 2022). A breast 
biopsy or excision is used to diagnose breast cancer, and 
the disease is staged (Tarighati et al., 2022). Here are some 
commonly used biomarkers for breast cancer: 

* Nucleic Acids, Genetic Alterations, and Protein Molecules
* Hormone Receptor Status; Estrogen Receptor and 

Progesterone Receptor
* Human Epidermal Growth Factor Receptor 2 (HER2)
* Ki-67: is a protein associated with cell proliferation
* BRCA1 and BRCA2 Mutations
* Oncotype DX and MammaPrint
* Circulating Tumor Cells (CTCs)

These are just a few examples of  biomarkers used in 
breast cancer diagnosis and management. The specific 
biomarkers used may vary depending on the individual 
case and the stage of  breast cancer. Biomarkers play a 
crucial role in personalized medicine, helping to tailor 
treatment approaches and improve patient outcomes 
(Afzal et al., 2022).

Treatment and Therapy
Treatment recommendations can be made after screening 
and diagnosis are complete. Breast cancer treatment 
involves a multidisciplinary approach, including radiation 
therapy, surgery, chemotherapy, and imaging. These 
different treatment modalities need to be carefully 
coordinated. Over time, neoadjuvant chemotherapy has 
played a significant role in improving overall survival rates. 
It has also facilitated the effectiveness of  locoregional 
treatments such as radiation therapy and surgery, leading 
to long-term improvements in managing this condition 
(Cariati et al., 2005).
Furthermore, hormone therapy, bone-directed therapy, 
and targeted therapy can also be employed (Girish et 
al., 2014). There are two main types of  therapies in 
treating breast cancer: local and systemic. Local therapy 
focuses on removing, eliminating, or controlling cancer 
cells in a specific area. This can be achieved through 
treatments such as radiation therapy. Surgery is often 
the initial approach in breast cancer treatment, and the 

specific procedures, such as lumpectomy, mastectomy, 
and reconstructive surgery, are determined based on the 
extent of  the disease and surgical findings.
On the other hand, systemic therapies aim to target 
and manage cancer cells throughout the body. Systemic 
therapies include hormone therapy, ovarian ablation 
used as adjuvant therapy for breast cancer, aromatase 
inhibitors, brachytherapy, and chemotherapy. Depending 
on the patient’s needs, a patient may receive a single 
treatment or a combination (Girish et al., 2014). In 
addition, psychological support and therapies have 
effectively eased patients’ grief  and enhanced their quality 
of  life (Akram et al., 2017).

Medications and Role of  Early Detection
As per the World Health Organization (WHO), the 
primary focus of  breast cancer policies is to enhance 
outcomes and survival rates through early detection. 
Early detection plays a fundamental role in the effective 
management of  breast cancer. In treating breast cancer, 
a range of  modern medications are prescribed. These 
medications are carefully selected based on the specific 
characteristics of  the tumour and the individual patient. 
The aim is to provide personalized and targeted treatment 
approaches that maximize the chances of  successful 
outcomes (Mary et al., 2012). Individuals at higher risk 
of  developing breast cancer can potentially prevent the 
disease through medical interventions using antiestrogen 
medications like raloxifene or tamoxifen. These 
medications work by blocking the effects of  estrogen 
and reducing the risk of  breast cancer development. For 
individuals with distant metastases, management strategies 
primarily focus on improving life expectancy and overall 
survival rates. These strategies involve a comprehensive 
approach and supportive care to address symptoms and 
enhance the quality of  life (Abdull Razis & Noor, 2013). 
Moreover, Herbs are considered a natural alternative for 
treating breast cancer patients since some plants may 
have components that naturally have the power to treat 
breast cancer (Zhu et al., 2011). 

Herbal Treatment
Herbs have been explored as a potential natural alternative 
for treating breast cancer due to the presence of  bioactive 
components that may possess therapeutic properties and 
have great medicinal promise. (Keshamma et al., 2022). 
Some plants contain compounds that exhibit anti-cancer 
activities and have been studied for their potential in 

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managing breast cancer (Sohel et al., 2023). Alternative 
medicines with fewer side effects have been developed for 
breast cancer patients, particularly those with metastatic 
cancer. Phytochemicals derived from plants are a valuable 
natural resource for developing anti-cancer drugs, 
accounting for 70% of  the compounds used (Sharma 
& Gupta, 2015). Further research and clinical trials are 
needed to validate their efficacy and ensure safety, and 
healthcare professionals must guide patients regarding 
the use of  alternative medicines (Sohel et al., 2023). 
Research into the effects of  herbs on breast cancer 
is ongoing, and several herbs have shown promise in 
preclinical and early clinical studies. For example, herbs 
like turmeric (Curcuma longa), green tea (Camellia 
sinensis), garlic (Allium sativum), and ginseng (Panax 
ginseng) have been investigated for their potential anti-
cancer properties (Sharma & Gupta, 2015). Curcumin 
from turmeric has shown anti-inflammatory and anti-
cancer effects, green tea catechins have anti-tumour 
properties, garlic contains organosulfur compounds 
with potential anti-cancer effects, and ginseng has 
been studied for immune-enhancing and anti-tumour 
activities (Sharma & Gupta, 2015). However, the efficacy 
and safety of  herbs in breast cancer treatment require 
further investigation in large-scale clinical trials. Herbal 
remedies should not replace standard medical treatments 
but may have complementary effects under healthcare 
professional guidance (Li et al., 2020). Breast cancer 
patients should consult their healthcare providers before 
considering herbal treatments to avoid interference 
with prescribed treatments and potential adverse effects 
(Sharma & Gupta, 2015).

Precautions and Preventions
Prevention and precautions are vital in reducing the risk 
of  breast cancer (Howell et al., 2014). Here are some key 
strategies that can help:

* Regular Breast Self-Exams
* Clinical Breast Exams
* Mammograms; Mammograms can monitor breast 

cancer at early stages when treatment is most effective.
* Hormone Therapy
* If  there is a significant family history, consider genetic 

counselling and testing to assess your risk.
* Stay informed about the latest research, advancements, 

and guidelines related to breast cancer prevention and 
screening

* Take medicines on time
* Take proper rest

It is important to remember that while these preventive 
measures can reduce the risk of  breast cancer, they do not 
provide absolute protection. Regular screenings and early 
detection remain crucial for identifying breast cancer at 
its earliest stages (González-Jiménez et al., 2014)

Lifestyle Modifications and Physical Activity
Lifestyle modifications and regular physical activity are 
important in reducing the risk of  breast cancer. The 

following strategies may help in maintaining a healthy 
lifestyle: 

* Maintain a Healthy Weight; Adopting a healthy diet 
and physical activity can help maintain or achieve a 
healthy weight.

* Balanced Diet; Balanced diet provides essential 
nutrients and antioxidants to reduce breast cancer risk.

* Limit Fat Intake; Limit fat intake to reduce the risk 
of  breast cancer. High-fat diets, especially from animal 
sources, have been associated with an increased risk of  
breast cancer.

* Regular Physical Activity; such as brisk walking, 
jogging, cycling, or aerobic exercises, can help lower the 
risk of  breast cancer. Aim for 75 minutes of  strenuous or 
150 minutes of  moderate exercise weekly.

* Weight-Bearing Exercises; These activities help 
improve bone health and maintain muscle mass.

* Limit Alcohol Consumption; Breast cancer risk has 
been associated with excessive alcohol intoxication. It is 
recommended to consume alcohol in moderation or not 
at all.

* Avoid Tobacco; Smoking is associated with an 
increased risk of  various cancers, including breast cancer. 
Taking the decision to quit smoking or consciously 
avoiding exposure to secondhand smoke can substantially 
reduce your risk of  developing breast cancer.

* Breastfeed if  Possible; If  you have the opportunity 
and can breastfeed your baby, It could mitigate the risk 
of  breast cancer.
Lifestyle modifications are beneficial for reducing the 
risk of  breast cancer and overall health and well-being. 
It is important to consult with your healthcare provider 
to discuss personalized recommendations based on your 
specific circumstances (Kerschbaum & Nüssler, 2019).

Limitations and Strengths 
* The management and treatments discussed in this 

review do not guarantee the reversal of  the disease.
* Several participants were not tested in this review; the 

review is based on factual data.
* The most coherent risk factor of  mortality due to 

breast cancer is increasing age, which has not been 
extensively discussed.

* The biggest strength of  this review is that very 
generalized terms have been used in searching strategies 
to combat vast unrelated data.

* This review is based on scientifically proven facts.

CONCLUSION
In conclusion, breast cancer in elderly women is a 
significant health concern, affecting many individuals. 
It encompasses various types and stages that require 
tailored treatment approaches. The expanding knowledge 
regarding breast cancer pathophysiologic mechanisms 
has facilitated remarkable advancements in identifying 
and utilizing biomolecular markers. Moreover, regular 
screenings and early detection are essential for improving 
outcomes. Breast cancer in elderly women can be 

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diagnosed through mammograms, clinical exams, and 
biopsies. Treatment options include surgery, radiation 
therapy, chemotherapy, hormonal therapy, targeted 
therapy, and medications. Lifestyle modifications can 
help diminish the chance of  breast cancer and improve 
overall well-being. By raising awareness, encouraging 
early detection, and embracing a healthy lifestyle, 
patients can strive for improved outcomes and a brighter 
future in the fight against breast cancer. Elderly women 
must coordinate with their medical team to develop a 
personalized treatment plan, considering their unique 
needs and preferences. In addition, elderly women can 
actively manage and potentially prevent breast cancer by 
receiving periodic updates on developments in breast 
cancer treatment.

Research Gap
This review aims to address potential research gaps in 
understanding breast cancer in elderly women, including 
limited research, age-related factors, screening and 
diagnostic methods effectiveness, personalized treatment 
approaches, and supportive care and quality of  life. It 
will explore the challenges faced by this population and 
identify interventions to improve their well-being and 
overall outcomes.

Future Research Directions
Future research directions for breast cancer in elderly 
women include investigating long-term outcomes, 
optimal treatment strategies, personalized medicine, 
geriatric assessment, and health disparities. These areas 
can help improve treatment strategies, supportive 
care interventions, and outcomes for this population. 
Understanding the unique needs and challenges faced 
by elderly breast cancer survivors can inform supportive 
care interventions and improve overall well-being.

Contribution to Knowledge
The reviewed article contributes to knowledge by 
consolidating and synthesizing existing evidence on 
breast cancer in elderly women, identifying research gaps, 
offering novel insights, and providing recommendations 
for future research and practice. By summarizing various 
studies and sources, it provides a comprehensive overview 
of  the current state of  knowledge. The article also 
highlights areas where further investigation is needed, 
offering valuable insights into the challenges, treatment 
approaches, and outcomes specific to elderly women with 
breast cancer. The article’s contribution to knowledge is 
essential for informed decision-making and patient care 
improvements.

Novelty of  Research 
The review focuses on breast cancer in elderly women, 
highlighting unique characteristics, challenges, and 
treatment considerations. It integrates findings from 
various sources, including clinical trials, observational 
studies, and qualitative research, to provide a 

comprehensive understanding. The review explores age-
related factors, geriatric assessment tools, and quality 
of  life and survivorship outcomes, offering novel 
insights into the disease’s impact on elderly women. By 
incorporating these aspects, the review contributes to 
the existing knowledge base on breast cancer in elderly 
women, offering new perspectives and insights.

REFERENCES
Abdull Razis, A. F., & Noor, N. M. (2013). Cruciferous 

vegetables: dietary phytochemicals for cancer 
prevention. Asian Pacific Journal of  Cancer Prevention, 
14(3), 1565-1570. 

Afzal, S., Hassan, M., Ullah, S., Abbas, H., Tawakkal, F., 
& Khan, M. A. (2022). Breast Cancer; Discovery of  
Novel Diagnostic Biomarkers, Drug Resistance, and 
Therapeutic Implications. Front Mol Biosci, 9, 783450. 
https://doi.org/10.3389/fmolb.2022.783450 

Akram, M., Iqbal, M., Daniyal, M., & Khan, A. U. (2017). 
Awareness and current knowledge of  breast cancer. 
Biological research, 50, 1-23. 

Anuradha, D., & Lakshmi, A. B. (2014). Mucinous carcinoma 
of  breast with neuroendocrine differentiation: a rare 
case report with review of  literature. 

Aronson, K. J., Miller, A. B., Woolcott, C. G., Sterns, E. 
E., McCready, D. R., Lickley, L. A., Fish, E. B., Hiraki, 
G. Y., Holloway, C., & Ross, T. (2000). Breast adipose 
tissue concentrations of  polychlorinated biphenyls 
and other organochlorines and breast cancer risk. 
Cancer epidemiology biomarkers & prevention, 9(1), 55-63. 

Barrios, C. H. (2022). Global challenges in breast cancer 
detection and treatment. The Breast, 62, S3-S6. 

Basu, P., Zhang, L., Hariprasad, R., Carvalho, A. L., & 
Barchuk, A. (2020). A pragmatic approach to tackle 
the rising burden of  breast cancer through prevention 
& early detection in countries ‘in transition’. The Indian 
Journal of  Medical Research, 152(4), 343. 

Brayboy, L. M., Oulhen, N., Long, S., Voigt, N., Raker, 
C., & Wessel, G. M. (2017). Multidrug resistance 
transporter-1 and breast cancer resistance protein 
protect against ovarian toxicity, and are essential in 
ovarian physiology. Reproductive Toxicology, 69, 121-131. 

Cariati, M., Bennett-Britton, T., Pinder, S., & Purushotham, 
A. (2005). “Inflammatory” breast cancer. Surgical 
oncology, 14(3), 133-143. 

Chinweike-Umeh, S., Ekwunife, C., & Onwuachusi, 
G. (2023). Cancer Genetic Markers Among School 
Children in Relation to Urogenital Schistosomiasis. 
American Journal of  Medical Science and Innovation, 2(1), 
32-38. 

Clauser, P., Marino, M. A., Baltzer, P. A., Bazzocchi, M., 
& Zuiani, C. (2016). Management of  atypical lobular 
hyperplasia, atypical ductal hyperplasia, and lobular 
carcinoma in situ. Expert Review of  Anticancer Therapy, 
16(3), 335-346. 

Cullinane, C., Brien, A., Shrestha, A., Hanlon, E., Walshe, 
J., Geraghty, J., Evoy, D., McCartan, D., McDermott, 
E., & Prichard, R. (2022). The association between 

https://journals.e-palli.com/home/index.php/ajmsi


Pa
ge

 
24

https://journals.e-palli.com/home/index.php/ajmsi

Am. J. Med. Sci. Innov. 2(2) 16-25, 2023

breast density and breast cancer pathological response 
to neoadjuvant chemotherapy. Breast Cancer Research 
and Treatment, 194(2), 385-392. 

DeVita, V. (2005). Cancer principles and practice. In: 
Philadelphia: Lippincott Williams & Wilkins. 169–233.

Donnelly, T. T., Al Khater, A.-H., Al-Bader, S. B., Al 
Kuwari, M. G., Al-Meer, N., Malik, M., Singh, R., & 
Jong, F. C.-D. (2013). Arab women’s breast cancer 
screening practices: a literature review. Asian Pacific 
Journal of  Cancer Prevention, 14(8), 4519-4528. 

Ely, S., & Vioral, A. N. (2007). Breast cancer overview. 
Plastic and Aesthetic Nursing, 27(3), 128-133. 

Errichetti, E., Avellini, C., Pegolo, E., & De Francesco, 
V. (2017). Dermoscopy as a supportive instrument 
in the early recognition of  erosive adenomatosis of  
the nipple and mammary Paget’s disease. Annals of  
Dermatology, 29(3), 365-367. 

Fahad Ullah, M. (2019). Breast cancer: current perspectives 
on the disease status. Breast Cancer Metastasis and Drug 
Resistance: Challenges and Progress, 51-64. 

Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, 
C., Rebelo, M., Parkin, D. M., Forman, D., & Bray, 
F. (2015). Cancer incidence and mortality worldwide: 
sources, methods and major patterns in GLOBOCAN 
2012. International journal of  cancer, 136(5), E359-E386. 

Foulkes, W. D., Smith, I. E., & Reis-Filho, J. S. (2010). 
Triple-negative breast cancer. New England journal of  
medicine, 363(20), 1938-1948. 

Girish, C., Vijayalakshmi, P., Mentham, R., Rao, C. 
B., & Nama, S. (2014). A review on breast cancer. 
International Journal of  Pharma and Bio Sciences, 4(2), 47-
54. 

González‐Jiménez, E., García, P. A., Aguilar, M. J., 
Padilla, C. A., & Álvarez, J. (2014). Breastfeeding 
and the prevention of  breast cancer: a retrospective 
review of  clinical histories. Journal of  clinical nursing, 
23(17-18), 2397-2403. 

Hang, J. A., Sim, L., & Zakaria, Z. (2017). Non-invasive 
breast cancer assessment using magnetic induction 
spectroscopy technique. International Journal of  
Integrated Engineering, 9(2). 

Harris, L. N., Ismaila, N., McShane, L. M., Andre, F., 
Collyar, D. E., Gonzalez-Angulo, A. M., Hammond, 
E. H., Kuderer, N. M., Liu, M. C., & Mennel, R. G. 
(2016). Use of  biomarkers to guide decisions on 
adjuvant systemic therapy for women with early-stage 
invasive breast cancer: American Society of  Clinical 
Oncology Clinical Practice Guideline. Journal of  
Clinical Oncology, 34(10), 1134. 

Howell, A., Anderson, A. S., Clarke, R. B., Duffy, S. W., 
Evans, D. G., Garcia-Closas, M., Gescher, A. J., Key, 
T. J., Saxton, J. M., & Harvie, M. N. (2014). Risk 
determination and prevention of  breast cancer. Breast 
Cancer Research, 16(5), 1-19. 

Inoue, M., Nakagomi, H., Nakada, H., Furuya, K., 
Ikegame, K., Watanabe, H., Omata, M., & Oyama, T. 
(2017). Specific sites of  metastases in invasive lobular 
carcinoma: a retrospective cohort study of  metastatic 

breast cancer. Breast Cancer, 24, 667-672. 
Joglekar-Javadekar, M., Van Laere, S., Bourne, M., Moalwi, 

M., Finetti, P., Vermeulen, P. B., Birnbaum, D., Dirix, 
L. Y., Ueno, N., & Carter, M. (2017). Characterization 
and targeting of  platelet-derived growth factor 
receptor alpha (PDGFRA) in inflammatory breast 
cancer (IBC). Neoplasia, 19(7), 564-573. 

Kerschbaum, E., & Nüssler, V. (2019). Cancer prevention 
with nutrition and lifestyle. Visceral medicine, 35(4), 
204-209. 

Keshamma, E., Kumar, A., Jha, R., Amle, V. S., Dudhate, 
G. S., Patel, D., Saha, P., & Kumar, R. (2022). Breast 
Cancer Treatment Relying on Herbal Bioactive 
Components. Journal for Research in Applied Sciences and 
Biotechnology, 1(4), 105-115. 

KJ, K. A. O. G. K., & Khamzaeva, N. (2023).  Identification 
Of  The Prevalence Of  Breast Cancer Among 
Different Age Groups Of  The Population And Its 
Prevention. Open Access Repository, 4(3), 341-344. 

Kurbonov, A., Olimjonova, G., Khusainova, K., & 
Khamzaeva, N. (2023). Identification Of  The 
Prevalence Of  Breast Cancer Among Different Age 
Groups Of  The Population And Its.

Li, S., So, T.-h., Tang, G., Tan, H.-Y., Wang, N., Ng, B. F. 
L., Chan, C. K. W., Yu, E. C.-L., & Feng, Y. (2020). 
Chinese herbal medicine for reducing chemotherapy-
associated side-effects in breast cancer patients: 
a systematic review and meta-analysis. Frontiers in 
Oncology, 10, 599073. 

Mary, J. S., Vinotha, P., & Pradeep, A. M. (2012). Screening 
for in vitro cytotoxic activity of  seaweed, Sargassum 
sp. against Hep-2 and MCF-7 cancer cell lines. Asian 
Pacific Journal of  Cancer Prevention, 13(12), 6073-6076. 

Mateo, A. M., Pezzi, T. A., Sundermeyer, M., Kelley, C. A., 
Klimberg, V. S., & Pezzi, C. M. (2017). Chemotherapy 
significantly improves survival for patients with T1c-
T2N0M0 medullary breast cancer: 3739 cases from 
the National Cancer Data Base. Annals of  surgical 
oncology, 24, 1050-1056. 

Merrill, A. Y., White, A., & Howard-McNatt, M. (2017). 
Paget’s disease of  the breast: an institutional review 
and surgical management. The American Surgeon, 83(3), 
96-98. 

Mojisola, O. L. (2023). Assessment of  Breast Cancer 
Awareness Among Women of  Reproductive Age in 
Akure South Local Government Area of  Ondo State. 
American Journal of  Medical Science and Innovation, 2(1), 
21-25. 

Moran, M. S., Schnitt, S. J., Giuliano, A. E., Harris, J. 
R., Khan, S. A., Horton, J., Klimberg, S., Chavez-
MacGregor, M., Freedman, G., & Houssami, N. 
(2014). Society of  Surgical Oncology–American 
Society for Radiation Oncology consensus guideline 
on margins for breast-conserving surgery with whole-
breast irradiation in stages I and II invasive breast 
cancer. International Journal of  Radiation Oncology* 
Biology* Physics, 88(3), 553-564. 

Neuman, H. B., Morrogh, M., Gonen, M., Van Zee, K. 

https://journals.e-palli.com/home/index.php/ajmsi


Pa
ge

 
25

https://journals.e-palli.com/home/index.php/ajmsi

Am. J. Med. Sci. Innov. 2(2) 16-25, 2023

J., Morrow, M., & King, T. A. (2010). Stage IV breast 
cancer in the era of  targeted therapy: does surgery 
of  the primary tumor matter? Cancer: Interdisciplinary 
International Journal of  the American Cancer Society, 
116(5), 1226-1233. 

Page, K., Guttery, D. S., Fernandez-Garcia, D., Hills, A., 
Hastings, R. K., Luo, J., Goddard, K., Shahin, V., 
Woodley-Barker, L., & Rosales, B. M. (2017). Next 
generation sequencing of  circulating cell-free DNA 
for evaluating mutations and gene amplification in 
metastatic breast cancer. Clinical chemistry, 63(2), 532-
541. 

Parikh, U., Chhor, C. M., & Mercado, C. L. (2018). Ductal 
carcinoma in situ: the whole truth. American Journal of  
Roentgenology, 210(2), 246-255. 

Prabhakaran, S., Rizk, V. T., Ma, Z., Cheng, C.-H., 
Berglund, A. E., Coppola, D., Khalil, F., Mulé, J. J., & 
Soliman, H. H. (2017). Evaluation of  invasive breast 
cancer samples using a 12-chemokine gene expression 
score: correlation with clinical outcomes. Breast Cancer 
Research, 19, 1-11. 

Prager, G. W., Braga, S., Bystricky, B., Qvortrup, C., 
Criscitiello, C., Esin, E., Sonke, G. S., Martínez, G., 
Frenel, J.-S., & Karamouzis, M. (2018). Global cancer 
control: responding to the growing burden, rising 
costs and inequalities in access. ESMO open, 3(2), 
e000285. 

Priya, V., & Prasaad, P. (2017). Tubulo-lobular carcinoma: 
a rare mixed invasive carcinoma of  breast. Int. J. Res . 
Med Sci, 5(6), 2818-2820. 

Sera, T., Kashiwagi, S., Takashima, T., Asano, Y., Goto, 
W., Iimori, N., Noda, S., Onoda, N., Ohsawa, M., & 
Hirakawa, K. (2017). Multiple metastatic malignant 
phyllodes tumor of  the breast with tonsillar metastasis: 
a case report. BMC research notes, 10(1), 1-4. 

Shamsi, U., Khan, S., Usman, S., Soomro, S., & Azam, I. 
(2013). A multicenter matched case control study of  
breast cancer risk factors among women in Karachi, 
Pakistan. Asian Pacific Journal of  Cancer Prevention, 14(1), 
183-188. 

Shannon, C., & Smith, I. (2003). Breast cancer in 
adolescents and young women. European Journal of  
cancer, 39(18), 2632-2642. 

Sharma, S. B., & Gupta, R. (2015). Drug development 
from natural resource: a systematic approach. Mini 
reviews in medicinal chemistry, 15(1), 52-57. 

Shaukat, U., Ismail, M., & Mehmood, N. (2013). 
Epidemiology, major risk factors and genetic 
predisposition for breast cancer in the Pakistani 

population. Asian Pacific Journal of  Cancer Prevention, 
14(10), 5625-5629. 

Society, A. C. (2007). Breast cancer facts & figures. 
American Cancer Society. 

Sohel, M., Aktar, S., Biswas, P., Amin, M. A., Hossain, M. 
A., Ahmed, N., Mim, M. I. H., Islam, F., & Mamun, 
A. A. (2023). Exploring the anti-cancer potential of  
dietary phytochemicals for the patients with breast 
cancer: A comprehensive review. Cancer Medicine. 

Somiari, R. I., Sullivan, A., Russell, S., Somiari, S., Hu, H., 
Jordan, R., George, A., Katenhusen, R., Buchowiecka, 
A., & Arciero, C. (2003). High-throughput proteomic 
analysis of  human infiltrating ductal carcinoma of  the 
breast. Proteomics, 3(10), 1863-1873. 

Strode, M., Khoury, T., Mangieri, C., & Takabe, K. 
(2017). Update on the diagnosis and management of  
malignant phyllodes tumors of  the breast. The Breast, 
33, 91-96. 

Szuhany, K. L., Malgaroli, M., Riley, G., Miron, C. D., Suzuki, 
R., Park, J. H., Rosenthal, J., Chachoua, A., Meyers, M., 
& Simon, N. M. (2021). Barriers and engagement in 
breast cancer survivorship wellness activities. Breast 
Cancer Research and Treatment, 188, 317-325. 

Tang, X. (2022). Evaluation on Risk Factors and 
Preventative Measures for Breast Cancer in China. 

Tanis, P. J., Nieweg, O. E., Olmos, R. A. V., & Kroon, 
B. B. (2001). Anatomy and physiology of  lymphatic 
drainage of  the breast from the perspective of  
sentinel node biopsy. Journal of  the American College of  
Surgeons, 192(3), 399-409. 

Tarighati, E., Keivan, H., & Mahani, H. (2022). A review 
of  prognostic and predictive biomarkers in breast 
cancer. Clinical and Experimental Medicine, 1-16. 

Waks, A. G., & Winer, E. P. (2019a). Breast cancer 
treatment. Jama, 321(3), 316-316. 

Waks, A. G., & Winer, E. P. (2019b). Breast cancer 
treatment: a review. Jama, 321(3), 288-300. 

Zheng, H., Ge, C., Lin, H., Zhou, S., Tang, W., Wang, 
Q., Zhang, X., Jin, X., Xu, X., & Du, J. (2023). The 
impact of  age on outcomes of  breast cancer in 
different hormone receptor and HER2 groups. PloS 
one, 18(1), e0280474. 

Zhu, Y.-Y., Zhou, L., Jiao, S.-c., & Xu, L.-z. (2011). 
Relationship between soy food intake and breast cancer 
in China. Asian Pac. J. Cancer Prev, 12(11), 2837-2840. 

Ziperstein, M. J., Guzman, A., & Kaufman, L. J. (2016). 
Evaluating breast cancer cell morphology as a 
predictor of  invasive capacity. Biophysical Journal, 
110(3), 621a. 

https://journals.e-palli.com/home/index.php/ajmsi

