Advancements and Challenges in Breast Cancer: A Comprehensive Review
Main Article Content
Abstract
Introduction: Breast cancer is a global health concern, accounting for significant morbidity and mortality among women. The fragile ill prepared healthcare systems in low- & middle-income countries need to address these challenges find solutions with their limited resources.
Objectives: Through a critical examination of the literature, this article aims to contribute to a better understanding of breast cancer and to stimulate further research in this field.
Methods & Analysis: This review article provides an in-depth analysis of the current state of breast cancer research, focusing on advancements in diagnosis, treatment, and prevention, as well as the challenges and future directions.
Conclusion: Emerging technologies, such as AI, 3D bioprinting, and nanotechnology, hold promise for addressing the challenges like management of metastatic disease, global disparities in outcomes, and the need for a better understanding of breast cancer etiology and revolutionizing breast cancer care.
Article Details
How to Cite
SONALIKA, Soumya et al.
Advancements and Challenges in Breast Cancer: A Comprehensive Review.
Medical Research Archives, [S.l.], v. 11, n. 6, june 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3944>. Date accessed: 23 nov. 2024.
doi: https://doi.org/10.18103/mra.v11i6.3944.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1) Alwan NAS. Breast Cancer Among Iraqi Women: Preliminary Findings from a Regional Comparative Breast Cancer Research Project. J Glob Oncol. 2016 Mar 16;2(5):255-258. doi: 10.1200/JGO.2015.003087. PMID: 28717711; PMCID: PMC5493264.
2) Benjamin O. Anderson MD, André M. Ilbawi MD, Nagi S. El Saghir MD., (2014)Breast Cancer in Low and Middle Income Countries (LMICs): A Shifting Tide in Global Health., 2014 Nov 29:21(1):111-118 https://doi.org/10.1111/tbj.12357
3) Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? Journal of Global Oncology 2018 :4, 1-16
4) Tirona MT, Sehgal R, Ballester O. Prevention of breast cancer (part I): epidemiology, risk factors, and risk assessment tools. Cancer investigation. 2010 Jul 1;28(7):743-50.
5) Gage M, Wattendorf D, Henry LR. Translational advances regarding hereditary breast cancer syndromes. Journal of surgical oncology. 2012 Apr 1;105(5):444-51.
6) Bergstrom C, Pence C, Berg J, Partain N, Sadeghi N, Mauer C, Pirzadeh-Miller S, Gao A, Li H, Unni N, Syed S. Clinicopathological features and outcomes in individuals with breast cancer and ATM, CHEK2, or PALB2 mutations. Annals of Surgical Oncology. 2021 Jun;28:3383-93.
7) Salhab M, Bismohun S, Mokbel K. Risk-reducing strategies for women carrying BRCA1/2 mutations with a focus on prophylactic surgery. BMC women's health. 2010 Dec;10(1):1-0.
8) Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S. Report of the international workshop on screening for breast cancer. JNCI: Journal of the National Cancer Institute. 1993 Oct 20;85(20):1644-56.
9) Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. The British Journal of Radiology. 2018 Oct;91(1090):20170441.
10) Houssami N, Skaane P. Overview of the evidence on digital breast tomosynthesis in breast cancer detection. The Breast. 2013 Apr 1;22(2):101-8.
11) MARIBS Study Group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). The Lancet. 2005 May 21;365(9473):1769-78.
12) Cheng F, Su L, Qian C. Circulating tumor DNA: a promising biomarker in the liquid biopsy of cancer. Oncotarget. 2016 Jul 7;7(30):48832.
13) Pantel K, Alix-Panabières C. Liquid biopsy and minimal residual diseaselatest advances and implications for cure. Nature Reviews Clinical Oncology. 2019 Jul;16(7):409-24.
14) Nahta R, Yu D, Hung MC, Hortobagyi GN, Esteva FJ. Mechanisms of disease: understanding resistance to HER2-targeted therapy in human breast cancer. Nature clinical practice Oncology. 2006 May 1;3(5):269-80.
15) Mendes D, Alves C, Afonso N, Cardoso F, Passos-Coelho JL, Costa L, Andrade S, Batel-Marques F. The benefit of HER2-targeted therapies on overall survival of patients with metastatic HER2-positive breast cancer–a systematic review. Breast Cancer Research. 2015 Dec;17(1):1-4.
16) Mouabbi JA, Raghavendra AS, Bassett Jr RL, Hassan A, Tripathy D, Layman RM. Histology-based survival outcomes in hormone receptor-positive metastatic breast cancer treated with targeted therapies. npj Breast Cancer. 2022 Dec 20;8(1):131.
17) Robertson JF, Paridaens RJ, Lichfield J, Bradbury I, Campbell C. Meta-analyses of phase 3 randomised controlled trials of third generation aromatase inhibitors versus tamoxifen as first-line endocrine therapy in postmenopausal women with hormone receptor-positive advanced breast cancer. European Journal of Cancer. 2021 Mar 1;145:19-28.
18) Braal CL, Jongbloed EM, Wilting SM, Mathijssen RH, Koolen SL, Jager A. Inhibiting CDK4/6 in breast cancer with palbociclib, ribociclib, and abemaciclib: similarities and differences. Drugs. 2021 Feb;81:317-31.
19) Vikas P, Borcherding N, Zhang W. The clinical promise of immunotherapy in triple-negative breast cancer. Cancer management and research. 2018;10:6823.
20) Yi M, Zheng X, Niu M, Zhu S, Ge H, Wu K. Combination strategies with PD-1/PD-L1 blockade: current advances and future directions. Molecular cancer. 2022 Dec;21(1):1-27.
21) Kushi LH, Doyle C, McCullough M, Rock CL, Demark‐Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: a cancer journal for clinicians. 2012 Jan;62(1):30-67.
22) Bao T, Prowell T, Stearns V. Chemoprevention of breast cancer: tamoxifen, raloxifene, and beyond. American journal of therapeutics. 2006 Jul 1;13(4):337-48.
23) Crew KD. Addressing barriers to uptake of breast cancer chemoprevention for patients and providers. American Society of Clinical Oncology Educational Book. 2015 Jan 1;35(1):e50-8.
24) Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. Journal of the American College of Radiology. 2018 Mar 1;15(3):408-14.
25) Roukos DH, Agnanti NJ, Paraskevaidis E, Kappas AM. Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Annals of Surgical Oncology. 2002 Dec 1;9(10):941-3.
26) Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Annals of surgical oncology. 2007 Aug;14:2187-94.
27) Collins DC, Sundar R, Lim JS, Yap TA. Towards precision medicine in the clinic: from biomarker discovery to novel therapeutics. Trends in pharmacological sciences. 2017 Jan 1;38(1):25-40.
28) Yip CH, Buccimazza I, Hartman M, Deo SV, Cheung PS. Improving outcomes in breast cancer for low and middle income countries. World journal of surgery. 2015 Mar;39:686-92.
29) Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S. Priorities for cancer research in low-and middle-income countries: a global perspective. Nature Medicine. 2022 Apr;28(4):649-57.
30) Picard M, Scott-Boyer MP, Bodein A, Périn O, Droit A. Integration strategies of multi-omics data for machine learning analysis. Computational and Structural Biotechnology Journal. 2021 Jan 1;19:3735-46.
31) Shelby RA, Taylor KL, Kerner JF, Coleman E, Blum D. The role of community‐based and philanthropic organizations in meeting cancer patient and caregiver needs. CA: A Cancer Journal for Clinicians. 2002 Jul;52(4):229-46.
32) Step MM, Rose JH, Albert JM, Cheruvu VK, Siminoff LA. Modeling patient-centered communication: oncologist relational communication and patient communication involvement in breast cancer adjuvant therapy decision-making. Patient Education and Counseling. 2009 Dec 1;77(3):369-78.
33) McCorkle R, Ercolano E, Lazenby M, Schulman‐Green D, Schilling LS, Lorig K, Wagner EH. Self‐management: Enabling and empowering patients living with cancer as a chronic illness. CA: a cancer journal for clinicians. 2011 Jan;61(1):50-62.
34) Leibig C, Brehmer M, Bunk S, Byng D, Pinker K, Umutlu L. Combining the strengths of radiologists and AI for breast cancer screening: a retrospective analysis. The Lancet Digital Health. 2022 Jul 1;4(7):e507-19.
35) Kourou K, Exarchos TP, Exarchos KP, Karamouzis MV, Fotiadis DI. Machine learning applications in cancer prognosis and prediction. Computational and structural biotechnology journal. 2015 Jan 1;13:8-17.
36) Kim HN, Habbit NL, Su CY, Choi N, Ahn EH, Lipke EA, Kim DH. Microphysiological systems as enabling tools for modeling complexity in the tumor microenvironment and accelerating cancer drug development. Advanced Functional Materials. 2019 May;29(22):1807553.
37) Caldorera-Moore ME, Liechty WB, Peppas NA. Responsive theranostic systems: integration of diagnostic imaging agents and responsive controlled release drug delivery carriers. Accounts of chemical research. 2011 Oct 18;44(10):1061-70.
38) Yan L, Shen J, Wang J, Yang X, Dong S, Lu S. Nanoparticle-based drug delivery system: a patient-friendly chemotherapy for oncology. Dose-Response. 2020 Jul 9;18(3):1559325820936161.
39) Yezhelyev MV, Gao X, Xing Y, Al-Hajj A, Nie S, O'Regan RM. Emerging use of nanoparticles in diagnosis and treatment of breast cancer. The lancet oncology. 2006 Aug 1;7(8):657-67.
40) Adams, S., Schmid, P., Rugo, H. S., Winer, E. P., Loirat, D., Awada, A., & Iwata, H. (2019). Pembrolizumabmonotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase 2 KEYNOTE-086 study. Annals of Oncology, 30(3), 397-404.
41) Barenholz, Y. (2012). Doxil®—The first FDA-approved nano-drug: Lessons learned. Journal of Controlled Release, 160(2), 117-134.
42) Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394-424.
43) Cardoso, F., Senkus, E., Costa, A., Papadopoulos, E., Aapro, M., André, F..& Harbeck, N. (2018). 4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Annals of Oncology, 29(8), 1634-1657.
44) Colditz, G. A., &Bohlke, K. (2014). Priorities for the primary prevention of breast cancer. CA: A Cancer Journal for Clinicians, 64(3), 186-194.
45) Cristofanilli, M., Pierga, J. Y., Reuben, J., Rademaker, A., Davis, A. A., Peeters, D. J.,&Bidard, F. C. (2019). The clinical use of circulating tumor cells (CTCs) enumeration for staging of metastatic breast cancer (MBC): International expert consensus paper. Critical Reviews in Oncology/Hematology, 134, 39-45.
46) Cuzick, J., Sestak, I., Bonanni, B., Costantino, J. P., Cummings, S., DeCensi, A., ...&Veronesi, U. (2013). Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. The Lancet, 381(9880), 1827-1834.
47) Daly, M. B., Pilarski, R., Yurgelun, M. B., Berry, M. P., Buys, S. S., Dickson, P. & Hutton, M. L. (2020). NCCN Guidelines® insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020. Journal of the National Comprehensive Cancer Network, 18(4), 380-391.
48) DeSantis, C. E., Ma, J., Gaudet, M. M., Newman, L. A., Miller, K. D., Goding Sauer, A., ... & Siegel, R. L. (2019). Breast cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(6), 438-451.
49) Early Breast Cancer Trialists' Collaborative Group. (2015). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet, 386(10001)
50) Pattanayak A., Sonalika S., et al, Early Prediction and Detection of Breast Cancer Using Deep Learning Techniques, International Journal of Early Childhood Special Education (INT-JECS)2022;14(4):1217-1224.
2) Benjamin O. Anderson MD, André M. Ilbawi MD, Nagi S. El Saghir MD., (2014)Breast Cancer in Low and Middle Income Countries (LMICs): A Shifting Tide in Global Health., 2014 Nov 29:21(1):111-118 https://doi.org/10.1111/tbj.12357
3) Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? Journal of Global Oncology 2018 :4, 1-16
4) Tirona MT, Sehgal R, Ballester O. Prevention of breast cancer (part I): epidemiology, risk factors, and risk assessment tools. Cancer investigation. 2010 Jul 1;28(7):743-50.
5) Gage M, Wattendorf D, Henry LR. Translational advances regarding hereditary breast cancer syndromes. Journal of surgical oncology. 2012 Apr 1;105(5):444-51.
6) Bergstrom C, Pence C, Berg J, Partain N, Sadeghi N, Mauer C, Pirzadeh-Miller S, Gao A, Li H, Unni N, Syed S. Clinicopathological features and outcomes in individuals with breast cancer and ATM, CHEK2, or PALB2 mutations. Annals of Surgical Oncology. 2021 Jun;28:3383-93.
7) Salhab M, Bismohun S, Mokbel K. Risk-reducing strategies for women carrying BRCA1/2 mutations with a focus on prophylactic surgery. BMC women's health. 2010 Dec;10(1):1-0.
8) Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S. Report of the international workshop on screening for breast cancer. JNCI: Journal of the National Cancer Institute. 1993 Oct 20;85(20):1644-56.
9) Kuhl CK. Abbreviated breast MRI for screening women with dense breast: the EA1141 trial. The British Journal of Radiology. 2018 Oct;91(1090):20170441.
10) Houssami N, Skaane P. Overview of the evidence on digital breast tomosynthesis in breast cancer detection. The Breast. 2013 Apr 1;22(2):101-8.
11) MARIBS Study Group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). The Lancet. 2005 May 21;365(9473):1769-78.
12) Cheng F, Su L, Qian C. Circulating tumor DNA: a promising biomarker in the liquid biopsy of cancer. Oncotarget. 2016 Jul 7;7(30):48832.
13) Pantel K, Alix-Panabières C. Liquid biopsy and minimal residual diseaselatest advances and implications for cure. Nature Reviews Clinical Oncology. 2019 Jul;16(7):409-24.
14) Nahta R, Yu D, Hung MC, Hortobagyi GN, Esteva FJ. Mechanisms of disease: understanding resistance to HER2-targeted therapy in human breast cancer. Nature clinical practice Oncology. 2006 May 1;3(5):269-80.
15) Mendes D, Alves C, Afonso N, Cardoso F, Passos-Coelho JL, Costa L, Andrade S, Batel-Marques F. The benefit of HER2-targeted therapies on overall survival of patients with metastatic HER2-positive breast cancer–a systematic review. Breast Cancer Research. 2015 Dec;17(1):1-4.
16) Mouabbi JA, Raghavendra AS, Bassett Jr RL, Hassan A, Tripathy D, Layman RM. Histology-based survival outcomes in hormone receptor-positive metastatic breast cancer treated with targeted therapies. npj Breast Cancer. 2022 Dec 20;8(1):131.
17) Robertson JF, Paridaens RJ, Lichfield J, Bradbury I, Campbell C. Meta-analyses of phase 3 randomised controlled trials of third generation aromatase inhibitors versus tamoxifen as first-line endocrine therapy in postmenopausal women with hormone receptor-positive advanced breast cancer. European Journal of Cancer. 2021 Mar 1;145:19-28.
18) Braal CL, Jongbloed EM, Wilting SM, Mathijssen RH, Koolen SL, Jager A. Inhibiting CDK4/6 in breast cancer with palbociclib, ribociclib, and abemaciclib: similarities and differences. Drugs. 2021 Feb;81:317-31.
19) Vikas P, Borcherding N, Zhang W. The clinical promise of immunotherapy in triple-negative breast cancer. Cancer management and research. 2018;10:6823.
20) Yi M, Zheng X, Niu M, Zhu S, Ge H, Wu K. Combination strategies with PD-1/PD-L1 blockade: current advances and future directions. Molecular cancer. 2022 Dec;21(1):1-27.
21) Kushi LH, Doyle C, McCullough M, Rock CL, Demark‐Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: a cancer journal for clinicians. 2012 Jan;62(1):30-67.
22) Bao T, Prowell T, Stearns V. Chemoprevention of breast cancer: tamoxifen, raloxifene, and beyond. American journal of therapeutics. 2006 Jul 1;13(4):337-48.
23) Crew KD. Addressing barriers to uptake of breast cancer chemoprevention for patients and providers. American Society of Clinical Oncology Educational Book. 2015 Jan 1;35(1):e50-8.
24) Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. Journal of the American College of Radiology. 2018 Mar 1;15(3):408-14.
25) Roukos DH, Agnanti NJ, Paraskevaidis E, Kappas AM. Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Annals of Surgical Oncology. 2002 Dec 1;9(10):941-3.
26) Gnerlich J, Jeffe DB, Deshpande AD, Beers C, Zander C, Margenthaler JA. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Annals of surgical oncology. 2007 Aug;14:2187-94.
27) Collins DC, Sundar R, Lim JS, Yap TA. Towards precision medicine in the clinic: from biomarker discovery to novel therapeutics. Trends in pharmacological sciences. 2017 Jan 1;38(1):25-40.
28) Yip CH, Buccimazza I, Hartman M, Deo SV, Cheung PS. Improving outcomes in breast cancer for low and middle income countries. World journal of surgery. 2015 Mar;39:686-92.
29) Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S. Priorities for cancer research in low-and middle-income countries: a global perspective. Nature Medicine. 2022 Apr;28(4):649-57.
30) Picard M, Scott-Boyer MP, Bodein A, Périn O, Droit A. Integration strategies of multi-omics data for machine learning analysis. Computational and Structural Biotechnology Journal. 2021 Jan 1;19:3735-46.
31) Shelby RA, Taylor KL, Kerner JF, Coleman E, Blum D. The role of community‐based and philanthropic organizations in meeting cancer patient and caregiver needs. CA: A Cancer Journal for Clinicians. 2002 Jul;52(4):229-46.
32) Step MM, Rose JH, Albert JM, Cheruvu VK, Siminoff LA. Modeling patient-centered communication: oncologist relational communication and patient communication involvement in breast cancer adjuvant therapy decision-making. Patient Education and Counseling. 2009 Dec 1;77(3):369-78.
33) McCorkle R, Ercolano E, Lazenby M, Schulman‐Green D, Schilling LS, Lorig K, Wagner EH. Self‐management: Enabling and empowering patients living with cancer as a chronic illness. CA: a cancer journal for clinicians. 2011 Jan;61(1):50-62.
34) Leibig C, Brehmer M, Bunk S, Byng D, Pinker K, Umutlu L. Combining the strengths of radiologists and AI for breast cancer screening: a retrospective analysis. The Lancet Digital Health. 2022 Jul 1;4(7):e507-19.
35) Kourou K, Exarchos TP, Exarchos KP, Karamouzis MV, Fotiadis DI. Machine learning applications in cancer prognosis and prediction. Computational and structural biotechnology journal. 2015 Jan 1;13:8-17.
36) Kim HN, Habbit NL, Su CY, Choi N, Ahn EH, Lipke EA, Kim DH. Microphysiological systems as enabling tools for modeling complexity in the tumor microenvironment and accelerating cancer drug development. Advanced Functional Materials. 2019 May;29(22):1807553.
37) Caldorera-Moore ME, Liechty WB, Peppas NA. Responsive theranostic systems: integration of diagnostic imaging agents and responsive controlled release drug delivery carriers. Accounts of chemical research. 2011 Oct 18;44(10):1061-70.
38) Yan L, Shen J, Wang J, Yang X, Dong S, Lu S. Nanoparticle-based drug delivery system: a patient-friendly chemotherapy for oncology. Dose-Response. 2020 Jul 9;18(3):1559325820936161.
39) Yezhelyev MV, Gao X, Xing Y, Al-Hajj A, Nie S, O'Regan RM. Emerging use of nanoparticles in diagnosis and treatment of breast cancer. The lancet oncology. 2006 Aug 1;7(8):657-67.
40) Adams, S., Schmid, P., Rugo, H. S., Winer, E. P., Loirat, D., Awada, A., & Iwata, H. (2019). Pembrolizumabmonotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase 2 KEYNOTE-086 study. Annals of Oncology, 30(3), 397-404.
41) Barenholz, Y. (2012). Doxil®—The first FDA-approved nano-drug: Lessons learned. Journal of Controlled Release, 160(2), 117-134.
42) Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68(6), 394-424.
43) Cardoso, F., Senkus, E., Costa, A., Papadopoulos, E., Aapro, M., André, F..& Harbeck, N. (2018). 4th ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4). Annals of Oncology, 29(8), 1634-1657.
44) Colditz, G. A., &Bohlke, K. (2014). Priorities for the primary prevention of breast cancer. CA: A Cancer Journal for Clinicians, 64(3), 186-194.
45) Cristofanilli, M., Pierga, J. Y., Reuben, J., Rademaker, A., Davis, A. A., Peeters, D. J.,&Bidard, F. C. (2019). The clinical use of circulating tumor cells (CTCs) enumeration for staging of metastatic breast cancer (MBC): International expert consensus paper. Critical Reviews in Oncology/Hematology, 134, 39-45.
46) Cuzick, J., Sestak, I., Bonanni, B., Costantino, J. P., Cummings, S., DeCensi, A., ...&Veronesi, U. (2013). Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. The Lancet, 381(9880), 1827-1834.
47) Daly, M. B., Pilarski, R., Yurgelun, M. B., Berry, M. P., Buys, S. S., Dickson, P. & Hutton, M. L. (2020). NCCN Guidelines® insights: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020. Journal of the National Comprehensive Cancer Network, 18(4), 380-391.
48) DeSantis, C. E., Ma, J., Gaudet, M. M., Newman, L. A., Miller, K. D., Goding Sauer, A., ... & Siegel, R. L. (2019). Breast cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(6), 438-451.
49) Early Breast Cancer Trialists' Collaborative Group. (2015). Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. The Lancet, 386(10001)
50) Pattanayak A., Sonalika S., et al, Early Prediction and Detection of Breast Cancer Using Deep Learning Techniques, International Journal of Early Childhood Special Education (INT-JECS)2022;14(4):1217-1224.