Have you ever heard of breast cancer? Maybe a friend or relative of yours has had it. There are actually different types of breast cancer. Today we are going to talk about one of them, which is special and can spread a little faster. That is HER2-Positive (HER2-positive) breast cancer . When you hear this name, you may think it is a little complicated, but don't worry. We will talk about it very simply, in a way that you can understand.
What is HER2-Positive (HER2+) Breast Cancer?
Simply put, HER2-positive (HER2+) breast cancer is a type of cancer that grows quickly and can spread easily outside the breast (`invasive`) . When doctors say you have this type of cancer, it means that your cancer cells have high levels of a special protein that controls the growth and division of cells in your body – called ``Human Epidermal Growth Factor Receptor 2`` , or HER2 for short. This HER2 protein is like a ``signal'' that tells cells to grow. When there is too much of it, the cells divide rapidly and uncontrollably, leading to cancer.
This type of breast cancer is more likely to spread (metastasize) from the breast to other parts of your body, such as the lymph nodes, liver, lungs, or even your brain. But the important thing is that if this cancer is detected early, before it has spread to other parts of the body, doctors can treat it successfully with the advanced treatments available today. That's why early detection is so important.
How common is HER2-positive breast cancer?
According to the American Cancer Society, more than 290,000 women will be diagnosed with invasive breast cancer (invasive ductal carcinoma and lobular breast cancer) in 2023 alone. Of these , 15% to 20% are HER2-positive. Men can also get breast cancer, but HER2-positive breast cancer is much less common in men.
What are the symptoms of HER2-positive breast cancer?
Like many types of breast cancer, this HER2-positive subtype sometimes doesn't show obvious symptoms at first. But when symptoms do appear, they're similar to those seen in regular breast cancer. Let's take a look at what they are:
- A change in the size, shape, or contour of a breast . One breast may feel larger than the other, or its shape may change.
- A lump or lump in the breast or armpit area. This can be as small as a pea. If the lump persists after your menstrual cycle has ended, you should be concerned.
- A change in the appearance or feel of the skin of the breast or nipple. The skin may become rough, dimpled or puckered, or may feel scaly or inflamed. Sometimes the skin may be red or darker than normal.
- Feeling a hard area under the skin, like a marble .
- Bloody or clear fluid coming out of the nipple.
Imagine, your friend, let's call her "Sunita". One day, while taking a bath, Sunita noticed a small change in her breast. It felt like a small lump. At first, she didn't pay much attention to it, thinking, "It'll just go away." But after a few weeks, it was still there. Later, when she showed it to a doctor, she realized that it was a sign of breast cancer. Therefore, if you notice any unusual changes in your breasts, it is very important to seek medical advice without ignoring it.
What causes HER2-positive breast cancer?
HER2-positive breast cancer is caused by a mutation in a gene called HER2. This HER2 gene produces the HER2 protein we talked about earlier. These HER2 proteins (also called `receptors`) are normally found on the surface of all breast cells.
Under normal circumstances, these HER2 proteins control breast cell growth and repair, ensuring that new cells divide in sufficient numbers to replace damaged or dying cells.
However, when the HER2 gene is mutated, it makes too many copies of itself. When the HER2 gene is overexpressed, it also makes too much of the HER2 protein. When the HER2 protein becomes too much, breast cells divide rapidly and grow uncontrollably, becoming cancerous tumors.
What are the risk factors for this?
Like breast cancer, the risk factors for HER2-positive breast cancer are the same as for regular breast cancer. You can get breast cancer whether you have these risk factors or not. However, these things can increase your risk:
- Having an inherited genetic mutation . For example, a mutation in the genes BRCA1 or BRCA2.
- Having had breast cancer before.
- Having other breast-related conditions such as `atypical ductal hyperplasia`.
- Menstrual cycle begins earlier than normal.
- Menopause occurs later than the normal age.
- Taking hormone replacement therapy.
- Having more than one alcoholic drink per day.
- Having undergone radiation therapy for certain conditions such as lymphoma (cancer of the lymphatic system).
What are the complications of HER2-positive breast cancer?
HER2-Positive breast cancer can spread to other parts of the body, or 'metastasize'. In about half of people with this type of breast cancer, the cancer has already spread to other parts of the body, especially the brain, by the time they are diagnosed. Breast cancer that has spread to the brain ('metastatic breast cancer to your brain') can be life-threatening. That's why early detection and prompt treatment are important.
How is HER2-positive breast cancer diagnosed?
Doctors primarily use a breast biopsy to diagnose all breast cancers. This involves taking a small piece of tissue from a suspicious area of the breast and examining it under a microscope.
If the breast biopsy confirms that there is cancer, a medical pathologist (a doctor who specializes in diagnosing diseases) will perform special tests to see if the breast tissue cells contain the HER2 protein. There are two main types of tests for this:
1. Immunohistochemistry (IHC): This test allows pathologists to look for the HER2 protein in breast cancer cells. This test uses a special dye (immunostaining) to check the level of HER2 protein in the cancer cells.
2. Fluorescence in situ hybridization (FISH): This FISH test is sometimes used to confirm the results of the IHC test. This test can detect whether there are extra copies of the HER2 gene.
After these tests, doctors further classify the cancer. They use a `scoring system`. This looks at how high the level of the HER2 protein is in the breast tissue sample, as well as how many cancer cells are present. Think about it this way:
- If the test shows that the HER2 protein level is low, it will be scored as 0 or 1+ . The pathologist will then say that it is HER2 negative .
- If there are cancer cells and the protein level is moderate, you can get a score of 2+ . Then the pathologist will also confirm the `FISH` test mentioned earlier.
- If there are a lot of cancer cells and the protein level is very high, you get a score of 3+ . That's when the pathologist says it's HER2 positive .
This scoring system determines exactly whether you are HER2-positive or HER2-negative.
What are the treatments for HER2-positive breast cancer?
Because this is an `invasive` type of breast cancer, treatment options are determined by many factors, such as the stage of the cancer and HER2 status. The following treatments can be used:
- Targeted therapy: This is the most specific treatment for HER2-positive cancer. It involves giving drugs that target the HER2 protein and kill cancer cells. There are several main types of treatment under this:
- Monoclonal antibody therapy: These bind to the HER2 protein and stop cancer cells from growing.
- Tyrosine kinase inhibitor therapy: These drugs enter cancer cells and block signaling pathways that help cells grow.
- Antibody-drug conjugates (ADCs): This is a very advanced method. In this, an anti-cancer drug is attached to an antibody that seeks out cancer cells. This compound then goes directly to the cancer cells and releases the drug, causing less damage to healthy cells.
- Chemotherapy: Chemotherapy is given before surgery to shrink the tumor (neoadjuvant therapy) or to kill any remaining cancer cells after surgery (adjuvant therapy). Sometimes chemotherapy is given together with targeted therapy.
Apart from this, depending on the stage of the cancer, things like `surgery`, `radiation therapy`, or `hormone therapy` can also be done.
What are the side effects of the treatments?
Side effects can vary depending on the treatment. If you are receiving treatment, talk to your doctor about how the treatment will affect you and how it will affect your daily life. Also, ask your doctor about palliative care . Palliative care is a service that helps you manage the symptoms of cancer and the side effects of treatment and make you as comfortable as possible during treatment. It is not just for people who cannot cure cancer, but can help anyone who is undergoing treatment.
Can these treatments completely cure HER2-positive breast cancer?
When doctors say they "cured" a cancer, they probably mean that the cancer was put into remission for years with treatment. Remission means that you are free of symptoms of the cancer and no cancer can be found on tests. A person who is diagnosed with HER2-positive breast cancer, treated, and lives for five years is considered "cured."
According to the US National Cancer Institute (NCI), more than 90% of people diagnosed with HER2-positive breast cancer are still alive after five years. They can be considered cured of their cancer. However, HER2-positive cancer can recur and spread to other parts of the body. Therefore, it is important to continue to go for medical check-ups.
What is the survival rate for HER2-positive breast cancer?
The chances of surviving HER2-positive breast cancer also vary depending on whether the cancer is hormone receptor-positive (HR+) or hormone receptor-negative (HR-) . (These hormone receptors are the receptors on the surface of cells that can bind to hormones. About half of all HER2-positive cancers have these receptors. The NCI classifies these chances by the stage of the cancer: local (limited to the breast), regional (spread to nearby lymph nodes), and distant (spread to distant parts of the body). You can talk to your doctor about this to learn more.
Can HER2-positive breast cancer be prevented?
Most likely not. Although there are things you can do to reduce your risk of breast cancer, HER2-positive breast cancer is caused by a mutation in the HER2 gene that causes cancer cells to form. Researchers are still studying why this happens, so they can't yet say exactly what can be done to prevent HER2-positive cancer.
However, you can do these things to reduce your risk of breast cancer in general:
- Take care of your breast health. Do regular breast self-exams, and get mammograms at the age and intervals recommended by your doctor. Be aware of any changes in your breasts. This way, cancer can be detected early and treated more easily.
- Maintain a healthy weight. This should be a weight that is comfortable for you. Ask your doctor for advice on how to maintain a healthy weight.
- Eat a healthy diet. Some studies have shown that a diet rich in vegetables, fruits, calcium-rich dairy products, and lean proteins can reduce the risk of breast cancer. It's also a good idea to limit red and processed meats.
- Be active. Studies have shown that regular physical activity reduces the risk of breast cancer. Even just walking for 30 minutes a day is good.
- Avoid alcoholic beverages. Research shows a link between breast cancer and alcohol. The American Medical Association recommends that women limit their alcohol intake to one drink per day.
How do I take care of myself?
Living with breast cancer means living with the symptoms of cancer, the treatments, and the side effects of treatment. And, at times, you may have to live with a sense of uncertainty about the future. You may feel overwhelmed and frustrated at times. If you feel that way, consider these suggestions for taking care of yourself:
- Get enough rest. Breast cancer and its treatment are very tiring. Remember to rest not only when you have time, but whenever you feel like it.
- Eat well. Treatment may reduce your appetite, but eating a diet rich in fruits, vegetables, lean proteins, and healthy grains will help you stay strong during treatment.
- Manage your stress. Cancer is a major stressor. Exercise can help with this. Regular walking and participating in exercise programs like yoga are good.
- Get support. You are a breast cancer survivor, and that starts the day you are diagnosed. Ask your doctor about cancer survivorship programs . These can help you overcome the challenges of living with breast cancer. Talking to your family and friends is also a great way to support yourself.
When should I see a doctor?
You will need to see your doctor regularly during treatment. However, if you notice any new changes in your breasts or body that could be signs that your HER2-positive cancer has spread, tell your doctor right away. For example, if breast cancer has spread to the lungs, you may experience symptoms such as chest pain, frequent chest infections, difficulty breathing, or coughing up blood.
When should I go to the emergency room?
If your body's response to cancer treatment is worse than you expected, you should go to the emergency room. For example, if you are severely dehydrated due to persistent vomiting, go to the hospital immediately.
What questions should I ask my doctor?
If your tests show that you have HER2-positive breast cancer, you may want to ask your doctor questions like:
- What exactly is my HER2 status ? (i.e. what is my IHC/FISH score?)
- What is my hormone receptor status ? (HR+ or HR-?)
- How do these HER2 and hormone receptor statuses affect my prognosis (i.e., the prognosis and future course of the disease)?
- What treatments do you recommend for me? Why?
- Should I consider participating in a clinical trial to treat HER2-positive breast cancer?
Breakthroughs in cancer treatment are rare. That's why cancer researchers were so excited when studies showed that mutations in the HER2 gene cause cells to divide more quickly than normal. They quickly discovered a link between HER2 gene mutations and some types of fast-growing breast cancer. From there, they developed treatments that can effectively treat early-stage HER2-positive breast cancer. Now researchers are focusing on finding more effective treatments that can slow or stop the spread of cancer. Clinical trials are where these new discoveries happen. If you have metastatic ('metastatic') HER2-positive breast cancer, talk to your doctor about taking part in a clinical trial. They can help you.
Finally, take-home message
HER2-positive breast cancer is a serious, fast-spreading type of cancer. However, with accurate and early detection and advanced treatment options, it is now possible to successfully control and cure this condition.
- Always pay attention to your body, especially your breasts. If you notice any unusual changes, do not ignore them and seek medical advice immediately.
- Follow the tests and treatments your doctor recommends exactly. Don't be afraid to talk to your doctor about any questions or concerns you may have.
- It's very important to stay positive. You are not alone. There are family, friends, doctors, and counseling services to help you.
We hope this information is useful to you. Stay healthy!
` Breast cancer, HER2-Positive, cancer symptoms, cancer treatment, women's health, genetic mutations, mammogram
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