What is Breast Cancer?

Breast cancer is the most common type of cancer in women worldwide.1 In 2022, 2.3 million new cases of breast cancer worldwide, representing 11.7% of all cancers diagnosed globally.2

 

Breast cancer is a malignant tumor that originates in the tissue of the mammary gland. The tumor is made up of cells that have accumulated alterations in their genetic material, allowing them to evade the control of the cell division cycle, avoid being recognized and eliminated by the immune system, and grow uncontrollably, potentially infiltrating surrounding tissues. These cells can also travel through the blood or lymph to other organs and grow, forming new lesions (metastases).

 

Breast cancer is the most common cancer in Pakistan, with over 30,000 new cases3 diagnosed each year. It is also the leading cause of cancer-related mortality, resulting in more than 16,000 deaths annually. Every ninth woman in Pakistan is at risk of developing breast cancer at some point in her life.
Types:

Breast cancer is a tumor originating from a gland, so the most appropriate term would be adenocarcinoma. We can classify breast cancer according to the presence or absence of invasion of adjacent tissues (carcinoma in situ and invasive carcinoma) ; the origin of the cells that form the tumor (ductal carcinoma and lobular carcinoma) ; the characteristics of the tumor cells themselves (presence or absence of hormone receptors); the degree of differentiation (grade 1 or well- differentiated carcinoma, grade 2 or moderately differentiated carcinoma, or grade 3 and poorly differentiated carcinoma).4

At the time of diagnosis, breast cancer is classified according to the cell type from which it originated. It usually originates in the lobules (lobular) or in the ducts (ductal) of the mammary gland and spreads outwards from these structures until it can disseminate throughout the body.8

(A) Schematic representation of the human breast, showing the terminal lobular ductal unit (TDLU), the functional unit of the breast where most tumors arise, and a cross-sectional view of the branching epithelial ductal tree. The mammary ducts are formed by a bilayer epithelium of luminal and myoepithelial cells, surrounded by an immune, fibroblastic, and adipocyte-rich stroma that influences both normal breast physiology and carcinogenesis. (B) Simplified model of breast cancer pathogenesis. Proliferation of abnormal cells of the ductal or lobular epithelium can lead to preinvasive lesions called carcinoma in situ. Once tumor cells breach the basement membrane and infiltrate the surrounding stroma, the cancer is classified as invasive carcinoma. (C) Summary of the major histologic subtypes of preinvasive lesions and invasive carcinomas of the breast. Invasive ductal carcinoma of no special type (NST) accounts for the vast majority of breast tumors. Approximately 15%–25% of invasive cancers are characterized by distinctive growth patterns and cytologic features. (D) Comparison of the major clinical subtypes of breast cancer, based primarily on histologic features and immunohistochemical expression of the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and the proliferation marker Ki67. ER+ tumors can be stratified as high- or low-risk, based on tumor grade and proliferation (Ki67 score). HER2+ tumors can be subdivided based on ER expression, identifying tumors with distinct molecular and prognostic characteristics. ER is essential for clinical classification, while PR expression is an auxiliary marker. DCIS: ductal carcinoma in situ; LCIS: lobular carcinoma in situ; IDC NST: invasive ductal carcinoma, no special type; CLI: invasive lobular carcinoma; TNBC: triple-negative breast cancer; GES: gene expression signature.5
Non-invasive breast cancer

The earliest form of breast cancer is non-invasive ductal carcinoma in situ (DCIS). It accounts for 16% of breast cancers and is characterized by tumor cells only invading the interior of the mammary ducts.4,6,7

 

 Another form of in situ breast cancer is lobular carcinoma in situ (LCIS), in which the tumor cells do not spread beyond the lobules (milk-producing glands). It is considered a benign condition, but its presence increases the likelihood of developing future breast cancer.4,6
Invasive breast cancer

10%-30% of DCIS cases can progress to invasive cancer, a heterogeneous group of diseases that are subdivided according to cell morphology:

  • Invasive ductal carcinoma: Begins in the mammary ducts and accounts for between 60% and 75% of cases4,6,7
  • Invasive lobular carcinoma: 10% to 15% of tumors. It begins in the milk-producing glands (lobules) and tends to appear at older ages than ductal carcinomas4,6,7

 

They are classified according to whether or not they express different receptors in tumor cells. The most common terminology is 8:

  • RH+, if hormone receptors (estrogens or progesterone) are expressed.
  • HER2+, if there are high values of a protein found on the cell surface called HER2.
  • Triple negative, if neither hormone receptors nor the HER2 protein are expressed.

 

Invasive breast cancer subtypes are classified according to molecular classification into 4 subtypes: Luminal A, Luminal B, HER2 +/- and triple negative4:
 
Luminal A 


Luminal A tumors are characterized by the presence of estrogen receptor (ER) and/or progesterone receptor (PR) and the absence of HER2. In this subtype, ER transcription factors activate genes whose expression is characteristic of the luminal epithelium lining the mammary ducts. They also exhibit low expression of genes related to cell proliferation. Clinically, they are low-grade, slow-growing, and tend to have the best prognosis.9
 
Luminal B


Luminal B tumors are higher grade and have a worse prognosis. They are ER-positive and may be PR-negative and/or HER2-positive. They also have high expressions of proliferation-related genes (e.g., MKI67 and AURKA). ER is expressed similarly in subtypes A and B and is used to distinguish luminal from non-luminal disease.9
 
HER2 +/-


The HER2 group represents between 10 and 15% of breast cancers. It is characterized by high HER2 expression with the absence of ER and PR. HER2 cancers grow faster than luminal cancers and used to have the worst prognosis of the subtypes before the introduction of HER2-targeted therapies.9
 
Triple Negative


Triple-negative breast cancer (TNBC) is a heterogeneous group of breast cancers characterized as ER-negative, PR-negative, and HER2-negative. They constitute approximately 20% of all breast cancers. TNBC is more common among women under 40 years of age and African American women and is characterized by being biologically aggressive and having a poorer prognosis.9
 
Inflammatory breast cancer


Inflammatory breast cancer is a rare and highly aggressive disease in which cancer cells block the lymphatic vessels in the skin of the breast. This type of breast cancer is called "inflammatory" because the breast often appears swollen and red, or "inflamed." Inflammatory breast cancer is rare, accounting for 1 to 5% of all diagnosed breast cancers.10
 
Paget's disease of the breast


Paget's disease of the breast is a rare type of cancer that affects the skin of the nipple and areola. Most people with Paget's disease of the breast also have one or two tumors inside the same breast. These breast tumors are either ductal carcinoma in situ or invasive breast cancer.11
 
Phyllodes tumor or phyllodes cystosarcoma


Phyllodes tumors are rare breast tumors that begin in the connective tissue (stroma) of the breast. Most phyllodes tumors are benign, and only a small number are malignant.12
 
Angiosarcoma


Breast angiosarcomas are aggressive malignant tumors that derive from endothelial cells. We differentiate two types, primary angiosarcoma which develops in young women with no previous history of cancer, and radiation-induced angiosarcoma which occurs in the field of radiotherapy in older women, the latter being more aggressive, with a high recurrence and survival after diagnosis of about two years.13
 
Breast cancer diagnosis: how to detect it

The main reason for consultation is the appearance of a lump in the breast, usually painless. 90% of breast masses are benign (fibroadenomas, cysts, etc.). However, it is important to pay attention to the following4,5:

  • Hard, immobile or irregular breast or axillary nodules5,14
  • Breast swelling or changes in shape1,5
  • Changes in the skin of the breast (erythema, dimpling, pitting, ulceration or orange peel skin)1,5
  • Changes in the nipple (inversion, change of color or secretion)1,5

A physical examination is a careful manual examination of the breasts performed by a doctor. Lumps, thickening, asymmetries (differences in appearance between one breast and the other); breast changes that may be ignored or thought to be “normal” can be detected by a health professional who routinely examines breasts.15

 

The physical examination should include both breasts, chest, the armpits, and the regional lymph nodes. The skin is visually examined for abnormalities. The patient then raises her hands upward and backward, resting them on her hips, to see if this movement reveals any lumps.5 The physician then gently palpates the margins of each breast, from upper to lower and from medial to lateral, looking for any differences in the tissue. The four quadrants of each breast are then examined, ending with the areola-nipple complex. The examination concludes with palpation of the axillary lymph nodes, both superficial and deep, and the supraclavicular lymph nodes.16

 

When the physical examination suggests a possible diagnosis of breast cancer, this should be confirmed with additional tests.

The main imaging tests performed are4:

 
Mammography


It is the most common technique for confirming or ruling out a diagnosis of breast cancer. Mammography uses low doses of X-rays (radiography) to generate an image of the breast. It is a painless test that can detect breast abnormalities up to two years before they are detectable in a physical exam.4,17,18

Ultrasound


Ultrasound creates images using high-frequency sound waves (ultrasound). It allows differentiation between a breast lump, which is usually benign, and other solid lesions, which are more likely to be cancerous. It is a complementary technique to mammography.4,18

Nuclear Magnetic Resonance (NMR)


Breast images are created by processing data obtained using electromagnetic waves. This is a highly effective technique. 4,18

A breast biopsy is a procedure in which a small tissue sample is removed to look for signs of a condition. A doctor (pathologist) examines the tissue under a microscope to detect cancer or other breast diseases.19

 

Biopsies: types, applications and usefulness

  • Core needle biopsy (CNB): also called core biopsy, consists of extracting a tissue sample using a single hollow needle that allows several samples to be taken from the area.4,17
  • Fine-needle aspiration (FNA) biopsy: A very fine needle is used to extract a small amount of the detected mass. It allows differentiation between a solid tumor and a cyst but cannot determine if a tumor is invasive.4,17
  • Surgical biopsy : In this type of biopsy, surgery is used to remove all or part of a suspicious area so that the presence of cancer cells can be checked. In an incisional biopsy, only a portion of the tumor is removed, while in an excisional biopsy, all the abnormal tissue is removed; sometimes an area around the tumor, called tumor margins, is also removed.20
  • Lymph node biopsy : The first lymph nodes near the tumor (sentinel nodes, usually axillary lymph nodes) are surgically removed and analyzed to see if they contain tumor cells.4,17

Although the absence of a family history of cancer does not mean that the disease cannot develop in the future, it is true that certain inherited mutations increase the risk of breast cancer. Therefore, genetic testing to determine the status (mutated or not) of certain genes in relatives of affected individuals is becoming increasingly common. The most important of these are the BRCA1, BRCA2, and PALB-2 genes.19,20,6

 

Genetic testing is also performed once cancer has been diagnosed to determine the prognosis and aggressiveness of the cancer:

 

NGS (Next Generation Sequencing)

The detection of genetic variants from NGS data involves identifying differences in an individual's DNA sequence by comparing it to a reference DNA. NGS has the potential to detect any type of genomic variant in a single experiment.22

 

PCR (polymerase chain reaction)

PCR is used to identify and characterize circulating tumor cells by searching for tumor-associated point mutations in oncogenes or tumor suppressor genes.23

 

PD-L1 (Programmed Death-Ligand 1) status

PD-L1 is a protein that acts as a “brake” controlling the body’s immune responses. PD-L1 is found on some normal cells and is present in higher than normal amounts on some types of cancer cells. When PD-L1 binds to another protein called PD-1 (T-cell protein), it prevents T cells from destroying cells that contain PD-L1, such as cancer cells.24 A PD-L1 test uses a sample of cancerous tumor tissue to measure the amount of PD-L1 found on the cancer cells. If you have certain types of cancer, PD-L1 testing can determine if you may benefit from a type of cancer treatment called immunotherapy. Immunotherapy helps your own immune system fight cancer.25

 

PIK3CA mutation status

The PIK3CA gene tells the body to make the PI3K protein, which helps ensure that cells get the energy they need to grow. When the PIK3CA gene mutates, it starts giving the body incorrect instructions, and the PI3K protein doesn't work as it should, which can cause cancer cells to survive and grow.26

 

ESR1 mutation status

The ESR1 gene instructs the body to produce estrogen receptors. These receptors signal estrogen receptor-positive breast cancer to grow in the presence of estrogen. In many cases, metastatic estrogen receptor-positive breast cancer develops a mutation in the ESR1 gene during hormone therapy. This mutation causes cancer to grow, even during hormone therapy.26

 
Stages of breast cancer

Cancer tumor staging defines: the extent of the cancer, the size of the tumor, and its degree of spread in the body.27

 

Classifying the patient's tumor in these terms allows doctors to27:

  • Understanding the severity of cancer and the chances of survival.
  • Plan the best treatment.
  • Identify clinical studies that could be treatment options.

The diagnosis of cancer is always accompanied by the stage name, although this may change later. Even if the cancer changes, the stage does not.27

 

The TNM staging system is the most widely used in the world. Most hospitals and medical centers use the TNM system as their primary method for reporting cancer cases. You are likely to see these descriptions in the pathology report prepared by your doctor.27

 

The TNM staging system bases its classification on:4,5,27

  • The T indicates the size and extent of the tumor. In general, the main tumor is called the primary tumor.
  • The N indicates the number of nearby lymph nodes that are cancerous.
  • The M indicates the presence of metastasis. This means that cancer has spread to other parts of the body.

When describing cancer using the TNM system, numbers are included after each letter to provide more information about the cancer. For example: T1N0MX or T3N1M0.27
Tumor

TIS

Carcinoma in situ

T1

Tumor 2-5cm

T2

Tumor 2-5cm

T3

Tumor > 5cm

T4

Tumor with extension to skin or chest wall
Lymph Node (N)

N0

No regional lymph node involvement

N1

Axillary or ipsilateral internal mammary chain involvement (1 to 3 nodes), mobile. Detected by sentinel lymph node biopsy (SLN).

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

N3

Ipsilateral infraclavicular or supraclavicular lymph nodes, or ipsilateral internal mammary lymph nodes in combination with axillary lymph nodes. Detected by sentinel lymph node biopsy, physical examination, or radiological tests
Metastasis (M)

M0

No distant metastasis.

M1

Distant metastases detected by physical examination or imaging tests should also be biopsied.

TIS

Carcinoma in situ

T1

Tumor 2-5cm

T2

Tumor 2-5cm

T3

Tumor > 5cm

T4

Tumor with extension to skin or chest wall

N0

No regional lymph node involvement

N1

Axillary or ipsilateral internal mammary chain involvement (1 to 3 nodes), mobile. Detected by sentinel lymph node biopsy (SLN).

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

N3

Ipsilateral infraclavicular or supraclavicular lymph nodes, or ipsilateral internal mammary lymph nodes in combination with axillary lymph nodes. Detected by sentinel lymph node biopsy, physical examination, or radiological tests

M0

No distant metastasis.

M1

Distant metastases detected by physical examination or imaging tests should also be biopsied.

TIS

Carcinoma in situ

T1

Tumor 2-5cm

T2

Tumor 2-5cm

T3

Tumor > 5cm

T4

Tumor with extension to skin or chest wall

N0

No regional lymph node involvement

N1

Axillary or ipsilateral internal mammary chain involvement (1 to 3 nodes), mobile. Detected by sentinel lymph node biopsy (SLN).

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

N3

Ipsilateral infraclavicular or supraclavicular lymph nodes, or ipsilateral internal mammary lymph nodes in combination with axillary lymph nodes. Detected by sentinel lymph node biopsy, physical examination, or radiological tests

M0

No distant metastasis.

M1

Distant metastases detected by physical examination or imaging tests should also be biopsied.
Tumor

TIS

Carcinoma in situ

T1

Tumor 2-5cm

T2

Tumor 2-5cm

T3

Tumor > 5cm

T4

Tumor with extension to skin or chest wall
Lymph Node (N)

N0

No regional lymph node involvement

N1

Axillary or ipsilateral internal mammary chain involvement (1 to 3 nodes), mobile. Detected by sentinel lymph node biopsy (SLN).

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

N3

Ipsilateral infraclavicular or supraclavicular lymph nodes, or ipsilateral internal mammary lymph nodes in combination with axillary lymph nodes. Detected by sentinel lymph node biopsy, physical examination, or radiological tests
Metastasis (M)

M0

No distant metastasis.

M1

Distant metastases detected by physical examination or imaging tests should also be biopsied.

Ipsilateral: on the same side of the body as the affected

Breast cancer treatment depends on the stage of the tumor, that is, the extent of invasion it has achieved.28

 

To better understand this, doctors combine the TNM classification with the level of invasion the tumor has reached.
Stadium

Early carcinoma, in situ
Stadium I

IA

<2 cm, no affected lymph nodes.

IB

Cell clusters <2 mm in lymph nodes or in combination with a breast tumor <2 cm
Stadium II

IIA

Tumor 2 to 5 cm, <2 cm but with lymph node metastases, or affected lymph nodes without tumor in the breast

IIB

>5 cm, between 2 and 5 cm with mildly affected lymph nodes or with 1 to 3 lymph nodes
Stadium III

IIIA

>5 cm with mild lymph node involvement, >5 cm and 1 to 3 affected lymph nodes, or no tumor in the breast but with 4 to 9 mildly affected lymph nodes

IIIB

Metastasis to the skin of the breast or chest wall, with possible diffuse lymph node involvement

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests
Stadium IV

Appearance of metastases in other organs of the body.

Early carcinoma, in situ

IA

<2 cm, no affected lymph nodes.

IB

Cell clusters <2 mm in lymph nodes or in combination with a breast tumor <2 cm

IIA

Tumor 2 to 5 cm, <2 cm but with lymph node metastases, or affected lymph nodes without tumor in the breast

IIB

>5 cm, between 2 and 5 cm with mildly affected lymph nodes or with 1 to 3 lymph nodes

IIIA

>5 cm with mild lymph node involvement, >5 cm and 1 to 3 affected lymph nodes, or no tumor in the breast but with 4 to 9 mildly affected lymph nodes

IIIB

Metastasis to the skin of the breast or chest wall, with possible diffuse lymph node involvement

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

Appearance of metastases in other organs of the body.

Early carcinoma, in situ

IA

<2 cm, no affected lymph nodes.

IB

Cell clusters <2 mm in lymph nodes or in combination with a breast tumor <2 cm

IIA

Tumor 2 to 5 cm, <2 cm but with lymph node metastases, or affected lymph nodes without tumor in the breast

IIB

>5 cm, between 2 and 5 cm with mildly affected lymph nodes or with 1 to 3 lymph nodes

IIIA

>5 cm with mild lymph node involvement, >5 cm and 1 to 3 affected lymph nodes, or no tumor in the breast but with 4 to 9 mildly affected lymph nodes

IIIB

Metastasis to the skin of the breast or chest wall, with possible diffuse lymph node involvement

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests

Appearance of metastases in other organs of the body.
Stadium

Early carcinoma, in situ
Stadium I

IA

<2 cm, no affected lymph nodes.

IB

Cell clusters <2 mm in lymph nodes or in combination with a breast tumor <2 cm
Stadium II

IIA

Tumor 2 to 5 cm, <2 cm but with lymph node metastases, or affected lymph nodes without tumor in the breast

IIB

>5 cm, between 2 and 5 cm with mildly affected lymph nodes or with 1 to 3 lymph nodes
Stadium III

IIIA

>5 cm with mild lymph node involvement, >5 cm and 1 to 3 affected lymph nodes, or no tumor in the breast but with 4 to 9 mildly affected lymph nodes

IIIB

Metastasis to the skin of the breast or chest wall, with possible diffuse lymph node involvement

N2

Fixed ipsilateral axillary lymph node involvement or non-fixed ipsilateral internal mammary lymph nodes (4 to 9 nodes). Detected by physical examination or radiological tests
Stadium IV

Appearance of metastases in other organs of the body.
Roche in breast cancer

At Roche, we remain committed to improving the evolution of breast cancer, with the aim of achieving more cures, greater survival rates, and a higher quality of life through precision medicine that can be applied to each woman based on her individual characteristics and needs, because no two women are the same.

 

Twenty-five years ago, we changed the prognosis for patients with HER2+ breast cancer with the approval of the first anti-HER2+ targeted therapy. Since then, Roche remains committed to the search for a cure, more Roche therapies approved for this type of cancer and a promising portfolio.

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2. Global cancer burden grows amid mounting need for services. World Health Organization (WHO). https://www.who.int/es/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services [Accessed 29 January 2025].

3. Globocan 2022 Pakistan

4.Breast Cancer - SEOM: Spanish Society of Medical Oncology 2019. Available at: https://seom.org/125-Informaci%C3%B3n%20al%20P%C3%BAblico%20-%20Patolog%C3%ADas/cancer-de-mama. [Accessed 15 January 2025].

5.Katsura C, Ogunmwonyi I, Kankam HK, Saha S. Breast cancer: presentation, investigation and management. Br J Hosp Med (London). 2022;83(2):1-7. doi:10.12968/hmed.2021.0459. [Cited January 15, 2025].

6.Types of breast cancer. Breastcancer.org. Available at: https://www.breastcancer.org/es/tipos. [Accessed 15 January 2025].

7. Nolan E, Lindeman GJ, Visvader JE. Deciphering breast cancer: from biology to the clinic. Cell. 2023;186(8):1708-1728. doi:10.1016/j.cell.2023.01.040.

8. Nolan E, Lindeman GJ, Visvader JE. Deciphering breast cancer: from biology to the clinic. Cell. 2023;186(8):1708-1728. doi:10.1016/j.cell.2023.01.040.

9. Łukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast Cancer—Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies—An Updated Review. Cancers. 2021;13(17):4287. doi:10.3390/cancers13174287.

10. Inflammatory breast cancer - National Cancer Institute (NIH). Available at: https://www.cancer.gov/espanol/tipos/seno/hoja-informativa-seno-inflamatoria. [Accessed 29 January 2025].

11. Paget's disease of the breast - National Cancer Institute (NIH). Available at: https://www.cancer.gov/espanol/tipos/seno/hoja-informativa-paget-seno . [Accessed 29 January 2025].

12. Phyllodes tumors of the breast. American Cancer Society. Available at: https://www.cancer.org/es/cancer/tipos/cancer-de-seno/afecciones-no-cancerosas-de-los-senos/tumores-filoides-del-seno.html. [Accessed 29 January 2025].

13. Alcaide Lucena M, et al. Radiotherapy-related angiosarcoma of the breast. A literature review apropos of two cases treated in our hospital. Revista de Senología y Patología Mamaria 34(2021); 56-59. https://doi.org/10.1016/j.senol.2020.05.005.

14. What is breast cancer? American Cancer Society. Available at: https://www.cancer.org/es/cancer/tipos/cancer-de-seno/acerca/que-es-el-cancer-de-seno.html. [Accessed 29 January 2025].

15. Physical breast examination. Breastcancer.org. Available at: https://www.breastcancer.org/es/pruebas-deteccion/exploracion-fisica-mama. [Accessed 29 January 2025].

16. Anayyat U, Ahad F, Muluh TA, et al. Immunotherapy: Constructive Approach for Breast Cancer Treatment. Breast Cancer (Dove Med Press). 2023;15:925-951. doi:10.2147/BCTT.S424624.

17. Obeagu EI, Obeagu GU. Breast cancer: A review of risk factors and diagnosis. Medicine. 2024;103(3):e36905. doi:10.1097/MD.0000000000036905.

18. Zhang YN, Xia KR, Li CY, Wei BL, Zhang B. Review of Breast Cancer Pathological Image Processing. Biomed Res Int. 2021;2021:1994764. doi:10.1155/2021/1994764.

19. Breast Biopsy. MedlinePlus. Available at: https://medlineplus.gov/spanish/pruebas-de-laboratorio/biopsia-de-seno/ . [Accessed 29 January 2025].

20. Surgical Breast Biopsies | Breast Biopsy Surgery. Available at: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-biopsy/surgical-breast-biopsy.html . [Accessed 15 January 2025].

21. Breast cancer. GEICAM - Breast Cancer Research. Available at: https://www.geicam.org/pacientes/cancer-de-mama . [Accessed 15 January 2025].

22. Rodríguez-Santiago B, Armengol Ll. Next generation sequencing technology in pre- and postnatal genetic diagnosis. Diagn Prenat, 2012;23(2): 56-66. https://doi.org/10.1016/j.diapre.2012.02.001.

23. Ceballos P, Ghersevich S. Perspectives in breast cancer: detection of circulating tumor cells using mammaglobin A. Clin Invest Gin Obst. 2008;35(6):207-14. DOI: 10.1016/S0210-573X(08)75105-0.

24. PDL1 - National Cancer Institute (NIH). Available at: https://www.cancer.gov/espanol/publicaciones/diccionarios/diccionario-cancer/def/pd-l1 . [Accessed 29 January 2025].

25. What is the PD-L1 test? MedlinePlus. Available at: https://medlineplus.gov/spanish/pruebas-de-laboratorio/prueba-de-pd-l1-inmunoterapia/. [Accessed 29 January 2025].

26. Biomarkers and biomarker analysis in breast cancer. Breastcancer.org. Available at: https://www.breastcancer.org/es/pruebas-deteccion/analisis-marcadores-tumorales. [Accessed 29 January 2025].

27. Staging. National Cancer Institute, USA (NIH. https://www.cancer.gov/espanol/cancer/diagnostico-estadificacion/estadifica-cion#:~:text=En%20el%20sistema%20TNM%2C%20las,linf%C3%A1ticos%20cercanos%20que%20son%20cancerosos [Accessed 15 January 2025].

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29. Trayes KP, Cokenakes SEH. Breast Cancer Treatment. Am Fam Physician. 2021;104(2):171-178.

 

Disclaimer:

If a patient becomes pregnant while receiving Phesgo, or within 7 months following the last dose of Herceptin, please immediately report pregnancy to the local Roche Adverse Event Line at +92 301 8287010 or email at pakistan.drug_safety@roche.com.

 

Additional information will be requested during a Phesgo-exposed pregnancy and the first year of the infant’s life. This will enable Roche to better understand the safety of Phesgo and to provide appropriate information to health authorities, healthcare providers, and patients.

 

For additional information, please refer to Phesgo Prescribing information.

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