PAPER

SEMINAR ABOUT BREAST CANCER

Disusun untuk memenuhi tugas Mata Kuliah Bahasa Inggris

Disusun oleh :

Kelompok 1 A.14.1

1. Ainur Muhti Ashari (22020114130106)

2. Aryani Wahyuningsih (22020114120013)

3. Bekti Wulandari (22020114120038)

4. Nadia Khurotul Aini (22020114120064)

 JURUSAN KEPERAWATAN

FAKULTAS KEDOKTERAN

UNIVERSITAS DIPONEGORO

SEMARANG

2015

A. Definition Breast Cancer

Breast cancer is an uncontrolled growth of breast cells. To better understand

breast cancer, it helps to understand how any cancer can develop. Cancer occurs as a
result of mutations, or abnormal changes, in the genes responsible for regulating the
growth of cells and keeping them healthy. The genes are in each cell’s nucleus,
which acts as the “control room” of each cell. Normally, the cells in our bodies replace
themselves through an orderly process of cell growth: healthy new cells take over as old
ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in
a cell. That changed cell gains the ability to keep dividing without control or order,
producing more cells just like it and forming a tumor. A tumor can be benign (not
dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are
not considered cancerous: their cells are close to normal in appearance, they grow slowly,
and they do not invade nearby tissues or spread to other parts of the body. Malignant
tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the
original tumor to other parts of the body (Breastcancer.org, 2015).

B. Prevalence Breast Cancer

Every second of the 10,000 women in the world are expected to develop breast
cancer each year. Breast cancer is one of the main causes of death from cancer in women
worldwide (Depkes, 2009). Breast cancer is a malignancy of the breast tissue that can be
derived from ductal and lobular epithelium. Breast cancer is one type of cancer is highest
in Indonesia. According to Pathological Registration Based in Indonesia, breast cancer
 ranks first with relative frequency of 18.6%. (Data Cancer in Indonesia in 2010,
according to data histopathologic, Registration Agency Cancer Association of Physician
Specialists Pathology Indonesia (IAPI) and the Indonesian Cancer Foundation (ICF),
estimated that the number of events in Indonesia is 12 / 100,000 women, while in the
United States is approximately 92 / 100,000 women with mortality is quite high at 27 /
100,000 or 18% of the deaths were found in women. It may be suffered by the men - men
with a frequency of approximately 1%. In Indonesia, more than 80% of cases are found
to be at an advanced stage, where treatment efforts difficult. Therefore, it needs to be an
understanding of prevention, early diagnosis, curative and palliative treatment and
rehabilitation are good, so that the service can be performed optimally patients
(Kemenkes RI, 2015)

C. Stage of Breast Cancer

The following stages are used for breast cancer:

This section describes the stages of breast cancer. The breast cancer stage is based
on the results of testing that is done on the tumor and lymph nodes removed during
surgery and other tests.

1. Stage 0 (carcinoma in situ)

There are 3 types of breast carcinoma in situ:

a. Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal

cells are found in the lining of a breast duct. The abnormal cells have not spread
outside the duct to other tissues in the breast. In some cases, DCIS may become
invasive cancer and spread to other tissues. At this time, there is no way to know
which lesions could become invasive.
 Ductal carcinoma in situ (DCIS). Abnormal cells are found in the lining of a
breast duct.

b. Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found
in the lobules of the breast. This condition seldom becomes invasive cancer.
Information about LCIS is not included in this summary.
 Lobular carcinoma in situ (LCIS). Abnormal cells are found in the lobules of
the breast. Paget disease of the nipple is a condition in which abnormal cells are
found in the nipple only.

2. Stage I

Stage I breast cancer. In stage IA, the tumor is 2 centimeters or smaller

and has not spread outside the breast. In stage IB, no tumor is found in the breast
or the tumor is 2 centimeters or smaller. Small clusters of cancer cells (larger than
0.2 millimeters but not larger than 2 millimeters) are found in the lymph nodes.

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

a. In stage IA, the tumor is 2 centimeters or smaller. Cancer has not spread
outside the breast.

b. In stage IB, small clusters of breast cancer cells (larger than 0.2 millimeter but
not larger than 2 millimeters) are found in the lymph nodes and either:

o no tumor is found in the breast

o the tumor is 2 centimeters or smaller

3. Stage II
Stage II is divided into stages IIA and IIB.

a. In stage IIA:

o No tumor is found in the breast or the tumor is 2 centimeters or smaller.

Cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes
or in the lymph nodes near the breastbone (found during a sentinel lymph
node biopsy).

o The tumor is larger than 2 centimeters but not larger than 5 centimeters.
Cancer has not spread to the lymph nodes.

No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph

nodes or lymph nodes near the breastbone (left panel) or the tumor is 2 centimeters or
smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the
breastbone (middle panel) or the tumor is larger than 2 centimeters but not larger than
5 centimeters and has not spread to the lymph nodes (right panel).
 b. In stage IIB, the tumor is:

o Larger than 2 centimeters but not larger than 5 centimeters. Small clusters
of breast cancer cells (larger than 0.2 millimeter but not larger than 2
millimeters) are found in the lymph nodes; or

o Larger than 2 centimeters but not larger than 5 centimeters. Cancer has
spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the
breastbone (found during a sentinel lymph node biopsy); or

o Larger than 5 centimeters. Cancer has not spread to the lymph nodes.

The tumor is larger than 2 centimeters but not larger than 5 centimeters and small
clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are
found in the lymph nodes (left panel), or the tumor is larger than 2 centimeters but not
larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph
nodes near the breastbone (middle panel), or the tumor is larger than 5 centimeters and
has not spread to the lymph nodes (right panel).
4. Stage IIIA

No tumor is found in the breast or the tumor may be any size and cancer is
found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone (left panel)
or the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than
0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes (middle
panel) or the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary
lymph nodes or lymph nodes near the breastbone (right panel).

In stage IIIA:

 No tumor is found in the breast or the tumor may be any size. Cancer is found in 4
to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during
imaging tests or a physical exam); or

 The tumor is larger than 5 centimeters. Small clusters of breast cancer cells (larger
than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph
nodes; or
  The tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph
nodes or to the lymph nodes near the breastbone (found during a sentinel lymph
node biopsy).

5. Stage IIIB

The tumor may be any size and cancer has spread to the chest wall and/or to
the skin of the breast and caused swelling or an ulcer. Cancer may have spread to up
to 9 axillary lymph nodes or the lymph nodes near the breastbone. Cancer that has
spread to the skin of the breast may be inflammatory breast cancer.

In stage IIIB, the tumor may be any size and cancer has spread to the chest
wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may
have spread to:

 Up to 9 axillary lymph nodes.

  The lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory
breast cancer. See the section on Inflammatory Breast Cancer for more information.

6. Stage IIIC

No tumor is found in the breast or the tumor may be any size and may have
spread to the chest wall and/or to the skin of the breast and caused swelling or an
ulcer. Also, cancer has spread to 10 or more axillary lymph nodes (left panel); OR to
lymph nodes above or below the collarbone (middle panel); OR to axillary lymph
nodes and lymph nodes near the breastbone (right panel). Cancer that has spread to
the skin of the breast may be inflammatory breast cancer.

In stage IIIC, no tumor is found in the breast or the tumor may be any size.
Cancer may have spread to the skin of the breast and caused swelling or an ulcer
and/or has spread to the chest wall. Also, cancer has spread to:
  10 or more axillary lymph nodes.

 Lymph nodes above or below the collarbone.

 Axillary lymph nodes and lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory
breast cancer. See the section on Inflammatory Breast Cancer for more information.
For treatment, stage IIIC breast cancer is divided into operable and inoperable stage
IIIC.

7. Stage IV

The cancer has spread to other parts of the body, most often the bones, lungs,
liver, or brain. In stage IV, cancer has spread to other organs of the body, most often
the bones, lungs, liver, or brain.
D. Risk Factors Breast Cancer
1. Breast cancer risk factors you cannot change
a. Gender
Simply being a woman is the main risk factor for developing breast
cancer. Men can develop breast cancer, but it’s about 100 times more common
among women than men. This is probably because men have less breast tissue, as
well as less of the female hormones estrogen and progesterone, which can
promote breast cancer cell growth.
 Aging
Your risk of developing breast cancer goes up as you get older. About 1
out of 8 invasive breast cancers are found in women younger than 45, while about
2 of 3 invasive breast cancers are found in women age 55 or older.
 Inheriting certain genes
About 5% to 10% of breast cancer cases are thought to be hereditary,
meaning that they are caused by gene defects (called mutations) passed on from a
parent.
 Family history of breast cancer
Breast cancer risk is higher among women whose close blood relatives
have this disease. Having a first-degree relative (mother, sister, or daughter) with
breast cancer about doubles a woman’s risk. Having 2 first-degree relatives
increases her risk about 3-fold. Although the exact risk is not known, women with
a family history of breast cancer in a father or brother also have an increased risk
of breast cancer. Overall, less than 15% of women with breast cancer have a
family member with this disease. This means that most (85%) women who get
breast cancer do not have a family history of this disease.
 Personal history of breast cancer
A woman with cancer in one breast has an increased risk of developing a
new cancer in the other breast or in another part of the same breast. (This is
different from a recurrence (return) of the first cancer.) This risk is even higher if
breast cancer was diagnosed at a younger age.
 Race and ethnicity
Overall, white women are slightly more likely to develop breast cancer
than are African- American women, but African-American women are more likely
to die of this cancer. In women under 45 years of age, however, breast cancer is
more common in African- American women. Asian, Hispanic, and Native
American women have a lower risk of developing and dying from breast cancer.

 Dense breast tissue

 Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. A
woman is said to have dense breasts (on a mammogram) when she has more
glandular and fibrous tissue and less fatty tissue. Women with dense breasts on a
mammogram have a risk of breast cancer that is 1.2 to 2 times that of women with
average breast density. Unfortunately, dense breast tissue can also make
mammograms less accurate.
 Starting menstruation before age 12
Women who have had more menstrual cycles (periods) because they
started menstruating early (before age 12) have a slightly higher risk of breast
cancer. The increase in risk may be due to a longer lifetime exposure to the
hormones estrogen and progesterone.
 Going through menopause after age 55
Women who have had more menstrual cycles because they went through
menopause later (after age 55) have a slightly higher risk of breast cancer. The
increase in risk may be due to a longer lifetime exposure to the hormones estrogen
and progesterone.
 Previous chest radiation
Women who as children or young adults were treated with radiation
therapy to the chest area for another cancer (such as Hodgkin disease or non-
Hodgkin lymphoma) have an increased breast cancer risk. This varies with the
patient’s age when they got radiation. The risk is highest if the radiation was given
during adolescence, when the breasts were still developing. Radiation treatment
after age 40 does not seem to increase breast cancer risk.
2. Lifestyle-related risk factors for breast cancer
a. Drinking alcohol
Drinking alcohol is clearly linked to an increased risk of breast cancer. The
risk increases with the amount of alcohol consumed. Excessive alcohol
consumption is also known to increase the risk of developing several other
cancers.

 Being overweight or obese

 Being overweight or obese after menopause increases breast cancer risk.
Before menopause your ovaries make most of your estrogen, and fat tissue makes
a small amount. After menopause (when the ovaries stop making estrogen), most
of a woman’s estrogen comes from fat tissue. Having more fat tissue after
menopause can increase your chance of getting breast cancer by raising estrogen
levels. Also, women who are overweight tend to have higher blood insulin levels.
Higher insulin levels have also been linked to some cancers, including breast
cancer.
The connection between weight and breast cancer risk is complex. For
instance, risk appears to be increased for women who gained weight as an adult
but may not be increased in those who have been overweight since childhood.
Also, excess fat in the waist area may affect risk more than the same amount of fat
in the hips and thighs. Researchers believe that fat cells in various parts of the
body have subtle differences that may explain this.
 Physical activity
Evidence is growing that physical activity in the form of exercise reduces
breast cancer risk. The main question is how much exercise is needed. In one
study from the Women’s Health Initiative, as little as 1¼ to 2½ hours per week of
brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced
the risk a little more.
 Having children
Women who have not had children or who had their first child after age 30
have a slightly higher breast cancer risk overall. Having many pregnancies and
becoming pregnant at an early age reduces breast cancer risk overall. Still, the
effect of pregnancy is different for different types of breast cancer.
 Birth control
Oral contraceptives: Studies have found that women using oral contraceptives
(birth control pills) have a slightly greater risk of breast cancer than women who
have never used them. This risk seems to go back to normal over time once the
pills are stopped. Women who stopped using oral contraceptives more than 10
years ago don’t appear to have any increased breast cancer risk.
 Depot-medroxyprogesterone acetate (DMPA; Depo-Provera): This is
aninjectable form of progesterone that is given once every 3 months as birth
control. A few studies have looked at the effect of DMPA on breast cancer risk.
Women currently using DMPA seem to have an increase in risk, but the risk
doesn’t seem to be increased if this drug was used more than 5 years ago.
 Hormone therapy after menopause
Hormone therapy with estrogen (often combined with progesterone) has
been used for many years to help relieve symptoms of menopause and to help
prevent osteoporosis (thinning of the bones). This treatment goes by many names,
such as post-menopausal hormone therapy (PHT), hormone replacement therapy
(HRT), and menopausal hormone therapy (MHT).
There are 2 main types of hormone therapy:
· For women who still have a uterus (womb), doctors generally prescribe estrogen
and progesterone (known as combined hormone therapy or HT). Progesterone is
needed because estrogen alone can increase the risk of cancer of the uterus.
· For women who’ve had a hysterectomy (those who no longer have a uterus),
estrogen alone can be prescribed. This is commonly known as estrogen
replacement therapy (ERT) or just estrogen therapy (ET).
Combined hormone therapy (HT): Use of combined hormone therapy increases
the risk of getting breast cancer. It may also increase the chances of dying from
breast cancer.
Estrogen therapy (ET): The use of estrogen alone after menopause does not
appear to increase the risk of developing breast cancer. For more information
about this topic, see Menopausal Hormone Therapy and Cancer Risk.
 Breastfeeding
Some studies suggest that breastfeeding may slightly lower breast cancer
risk, especially if it’s done for at least a year. But this has been hard to study,
especially in countries like the United States, where breastfeeding for this long is
uncommon. The reason for this possible effect may be that breastfeeding reduces
a woman’s total number of lifetime menstrual cycles (the same as starting
menstrual periods at a later age or going through early menopause).
E. Prevent Breast Cancer
According to Tapan (2005) breast cancer prevention can be done with a healthy
lifestyle and early detection. Early detection can be done by: doing Breast Self
Examination (BSE) since the age of 20 years, regular checkups by a doctor every 2-3
years at age 20-35 years, mammography performed once at the age of 35-40 years, at the
age of 40-49 year made 1 or 2 times, at the age of 50 years onwards, carried out once a
year. Healthy life-style Tapan prevent breast cancer in 2005 include: limiting
consumption of alcohol, avoid smoking, balanced diet and regular exercise,
environmental and occupational health.
a. BSE
According to the DEPKES (2009) definition of BSE is the breast examination
conducted himself with learning to see and examine her own breasts every month. By
conducting regular checks will note any lumps or other problems early, although still
small so it is more effective to treat.
1. Stand before a mirror and look at both breasts. Check for anything unusual, such
as nipple retraction, redness, puckering, dimpling, or scaling of the skin. Look for
nipple discharge. Some discharge can be normal, due to hormones or medication.
However, all discharge should be reported to your doctor. Note the color of the
discharge, whether it came from both breasts and whether it came from one or
more openings.

2. Next, press your hands firmly on your hips and lean slightly toward your mirror
as you pull your shoulders and elbows forward with a squeezing or hugging
 motion. Look for any change in the normal shape of your breasts. Now, bend
forward at the waist, hold your head up and look in the mirror. You may notice
that one breast is larger than the other and this is normal.

3. Looking in the mirror, raise your arms and rest your hands behind your head. This
allows you to see the underside of your breasts.

4. Press your nipple, look your nipple if your nipple expel abnormal liquid
5. Raise your left arm. Use the pads of three or four fingers of your right hand to
examine your left breast. Use three levels of pressure (light, medium, and firm)
while moving in a circular motion. Check your breast area using a set pattern. You
can choose (1) lines, (2) circles or (3) wedges.

6. Lines
Beginning at the outer edge of your breast move your fingers downward using a
circular motion until they are below the breast. Then move your fingers slightly
toward the middle and slowly move back up. Go up and down until you go over
the entire breast area.
 7. Circle
Beginning at the outer edge of your breast use the flat part of your fingers,
moving in circles slowly around the breast. Gradually make smaller and smaller
circles toward the nipple. Be sure to cover the entire breast and check behind the
nipple.

 Wedges
Starting at the outer edge of the breast, move your fingers toward the nipple and back to
the edge. Check your entire breast, covering one wedge-shaped area at a time.

8. Give the special attention on the red area because in that area usually grows tumor.
  Limiting consumption of alcohol.
 Avoid smoking
 Balanced diet
 Environmental
 Regular exercise and
 Occupational health
F. Breast Cancer Test And Treatment
1. Breast Cancer Test
There are many tests and procedures may be used to check for breast cancer:

a. Clinical breast exam (CBE) is an exam of the breast by a doctor or other health
professional. The doctor will carefully feel the breasts and under the arms for lumps
or anything else that seems unusual.

b. Mammogram: An X-ray image of breast used to screen for breast cancer.

Mammogram plays a key role in early breast cancer detection and help decrease
breast cancer deaths.
c. Ultrasound exam is a procedure in which high-energy sound waves (ultrasound) are
bounced off internal tissues or organs and make echoes. The picture can be printed to
be looked at later.

d. MRI (magnetic resonance imaging) is a procedure that uses a magnet, radio waves,
and a computer to make a series of detailed pictures of both breasts.

e. Blood chemistry studies is a procedure in which a blood sample is checked to

measure the amounts of certain substances released into the blood by organs and
tissues in the body. An unusual (higher or lower than normal) amount of a substance
can be a sign of disease.

f. Biopsy is the removal of cells or tissues so they can be viewed under a microscope
by a pathologist to check for signs of cancer. There are four types of biopsy used to
check for breast cancer:

 Excisional biopsy : The removal of an entire lump of tissue.

 Incisional biopsy : The removal of part of a lump or a sample of tissue.

 Core biopsy : The removal of tissue using a wide needle.

  Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid, using a
thin needle.

g. Sentinel lymph node biopsy is the removal of the sentinel lymph node during
surgery. The sentinel lymph node is the first lymph node to receive lymphatic
drainage from a tumor and likely spreaded. A radioactive substance and/or blue dye
is injected near the tumor. The substance or dye flows through the lymph ducts to the
lymph nodes. The first lymph node to receive the substance or dye is removed. A
pathologist views the tissue under a microscope to look for cancer cells. If cancer
cells are not found, it may not be necessary to remove more lymph nodes.

h. PET scan (positron emission tomography scan) is a procedure to find malignant

tumor cells in the body. A small amount of radioactive glucose (sugar) is injected
into a vein. The PET scanner rotates around the body and makes a picture of where
glucose is being used in the body. Malignant tumor cells show up brighter in the
picture because they are more active and take up more glucose than normal cells do.

2. Breast Cancer Treatment

There are five types of standard treatment are used:

a. Surgery
Types of surgery include the following:
1. Breast-conserving surgery is an operation to remove the cancer and some
normal tissue around it, but not the breast itself. Part of the chest wall lining
may also be removed if the cancer is near it.
2. Total mastectomy is surgery to remove the whole breast that has cancer. Some
of the lymph nodes under the arm may be removed and checked for cancer. The
dotted line shows where the entire breast is removed.

3. Modified radical mastectomy is surgery to remove the whole breast that has
cancer, many of the lymph nodes under the arm, the lining over the chest
muscles, and sometimes, part of the chest wall muscles.
 Most patients with breast cancer have surgery to remove the cancer.
Chemotherapy may be given before surgery to remove the tumor. When given before
surgery, chemotherapy will shrink the tumor and reduce the amount of tissue that
needs to be removed during surgery. Even if the doctor removes all the cancer that can
be seen at the time of the surgery, some patients may be given radiation therapy,
chemotherapy, or hormone therapy after surgery, to kill any cancer cells that are left. If
a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a
breast’s shape after a mastectomy) may be considered. Breast reconstruction may be
done at the time of the mastectomy or at some time after. The reconstructed breast may
be made with the patient’s own (non-breast) tissue or by using implants filled with
saline or silicone gel.

a. Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or
other types of radiation to kill cancer cells or keep them from growing. There are
two types of radiation therapy. External radiation therapy uses a machine outside
the body to send radiation toward the cancer. External radiation therapy is used to
treat breast cancer. Internal radiation therapy uses a radioactive substance sealed
 in needles, seeds, wires, or catheters that are placed directly into or near the
cancer. Late effects of radiation therapy are not common, but may include:
 Inflammation of the lung after radiation therapy to the breast, especially
when chemotherapy is given at the same time.
 Arm lymphedema, especially when radiation therapy is given after lymph
node dissection.
 In women younger than 45 years who receive radiation therapy to the
chest wall after mastectomy, there may be a higher risk of developing breast
cancer in the other breast.

b. Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping them from dividing. When
chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter
the bloodstream and can reach cancer cells throughout the body (systemic
chemotherapy). The way of the chemotherapy depends on the type and stage of
the cancer being treated. Systemic chemotherapy is used in the treatment of breast
cancer. Late effects of chemotherapy depend on the drugs used, but may include:
 Heart failure.
 Blood clots.
 Premature menopause.
 Second cancer, such as leukemia.

c. Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks
their action and stops cancer cells from growing. Some hormones can cause
certain cancers to grow. If tests show that the cancer cells have places where
hormones can attach (receptors), drugs, surgery, or radiation therapy is used to
reduce the production of hormones or block them from working. The hormone
estrogen, which makes some breast cancers grow, is made mainly by the ovaries.
Treatment to stop the ovaries from making estrogen is called ovarian ablation.
Hormone therapy with tamoxifen is often given to patients with early localized
 breast cancer that can be removed by surgery and those with metastatic breast
cancer (cancer that has spread to other parts of the body). Hormone therapy with
an aromatase inhibitor is given to some postmenopausal women who have
hormone receptor–positive breast cancer. Aromatase inhibitors decrease the
body's estrogen by blocking an enzyme called aromatase from turning androgen
into estrogen. Anastrozole and letrozole are two types of aromatase inhibitors.

d. Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances
to identify and attack specific cancer cells without harming normal cells.
Monoclonal antibodies, tyrosine kinase inhibitors, and cyclin-dependent kinase
inhibitors are types of targeted therapies used in the treatment of breast cancer.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in
the laboratory, from a single type of immune system cell. These antibodies can
identify substances on cancer cells or normal substances that may help cancer
cells grow. The antibodies attach to the substances and kill the cancer cells, block
their growth, or keep them from spreading. Monoclonal antibodies are given by
infusion. They may be used alone or to carry drugs, toxins, or radioactive material
directly to cancer cells. Monoclonal antibodies may be used in combination with
chemotherapy as adjuvant therapy. Tyrosine kinase inhibitors are targeted therapy
drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors
may be used with other anticancer drugs as adjuvant therapy. Cyclin-dependent
kinase inhibitors are targeted therapy drugs that block proteins called cyclin-
dependent kinases, which cause the growth of cancer cells. PARP inhibitors are a
type of targeted therapy that block DNA repair and may cause cancer cells to die.
PARP inhibitor therapy is being studied for the treatment of patients with triple
negative breast cancer or tumors with BRCA1 or BRCA2 mutations. Late effects
of targeted therapy may include heart problems such as heart failure.
There are different types of treatment for patients with breast cancer.
a. Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early-stage breast cancer (stage I and stage II) may include the following:
 Modified radical mastectomy.
  Breast-conserving surgery followed by radiation therapy. In pregnant women,
radiation therapy is delayed until after the baby is born.
 Modified radical mastectomy or breast-conserving surgery during pregnancy
followed by chemotherapy after the first 3 months of pregnancy.
b. Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late-stage breast cancer (stage III and stage IV) may include the following:
 Radiation therapy.
 Chemotherapy.
Radiation therapy and chemotherapy should not be given during the first 3 months of
pregnancy.
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