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Breast Cancer : A Common Malignancy

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Breast cancer is the most common malignancy in the UK, accounting for 15% of all diagnosed cancers, affecting around 50,000 women and 350 men, leading to just under 12,000 deaths in 11/12.1,2 The risk of getting breast cancer is linked to increased age, gender & genetics (BRCA 1 & BRCA 2 gene mutations). Lifestyle factors that also increase the incidence of breast cancer (around 27% each year) are; Oestrogen exposure, being overweight/obese, high alcohol intake, tobacco smoke, oral contraceptives and certain hormonal replacement therapies.2,3,4

Although the incidence of breast cancer is increasing, mortality rates are declining due to better treatment and screening, and earlier detection.4,5 Patients are being made more aware of the
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Her previous medical history shows that she previously had ER+, HER2+ stage one breast cancer. Following a chemotherapy regimen of 4 x FEC-100 cycles, she was prescribed adjuvant Tamoxifen hormonal therapy for five years, which is shown to decrease the probability of breast cancer recurrence.10 Mrs. Smith’s respiratory complaints are diagnosed as a lung metastasis (advanced breast cancer, stage IV), upon which, her consultant decided to adhere to NICE guidelines and start her on Anthracycline chemotherapy, particularly, liposomal Doxorubicin.11

A study conducted by the CAELYX Breast Cancer Study Group (O’Brien et al.)12 aimed to demonstrate that pegylated liposomal Doxorubicin (PLD) was no less inferior to conventional Doxorubicin in leading to progression-free survival, whilst being markedly less cardiotoxic, when used as first line therapy for metastatic breast cancer. They conducted a randomized trial on 509 female patients, who received either 50mg/m2 PLD every four weeks, or Doxorubicin 60mg/m2 every three weeks. The inclusion criteria for the study was: females 18 years or older with a WHO performance status of ≤2 and measurable or evaluable, stages 3B or 4 metastatic breast cancer.13 Normal renal cardiac LVEF, haematological and hepatic functions were required. Exclusion criteria were; patients who had a history of ICH or LVEF below normal ranges.

Overall risk of cardiotoxicity
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