International Journal of Community Medicine and Public Health

Sobuj DR et al. Int J Community Med Public Health. 2025 Dec;12(12):5839-5843

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Review Article

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20254069

Breast cancer in the United States: current treatment and diagnosis strategies, risk factors and preventive methods

Dipongkar R. Sobuj1, M. Rokibul H. Bhuiyan2*, Tamanna Rashid1, Saiful I. Arif3, M. Rakib R. Rana4, M. Maniruzzaman4, Sabina Akter2,5, M. Sadikuj Jaman2

1Department of Chemistry and Biochemistry, Lamar University, Beaumont, Texas

2Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh

3Jahurul Islam Medical College, Bangladesh

4Department of Pharmacy, School of Science and Technology, Varendra University, Rajshahi, Bangladesh

5Department of Biochemistry and Molecular Biology, Patuakhali Science and Technology University, Patuakhali, Bangladesh

Received: 02 October 2025

Revised: 16 November 2025

Accepted: 17 November 2025

*Correspondence:

M. Rokibul H. Bhuiyan,

E-mail: mdrokibulhasanbhuiyan3@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Breast cancer is the most frequently diagnosed cancer in women and remains a leading cause of cancer-related deaths worldwide. Its burden affects women physically, mentally, and socially, making it a major public health concern. The development and outcome of the disease are influenced by several risk factors, including age, family history, genetic alterations, reproductive history, lifestyle behaviors such as physical inactivity, obesity, alcohol use, smoking, and exposure to radiation. In the United States, recent evidence indicates that breast cancer among younger women (ages 20–49) is rising, with variations by race, ethnicity, tumor stage, and hormone receptor status. Younger patients often face worse prognoses than older women. Treatment requires a multidisciplinary approach, guided by tumor biology, stage, and molecular markers. For early-stage disease, breast-conserving surgery with radiotherapy or mastectomy remains the standard, often combined with adjuvant systemic therapy based on nodal involvement, hormone receptor, and HER2 status. In metastatic disease, the focus shifts to prolonging survival and maintaining quality of life. Advances in chemotherapy, radiotherapy, endocrine therapy, targeted therapy, immunotherapy, and gene-based treatments continue to expand options. However, disparities in access and outcomes persist.

Keywords: Breast cancer, Risk factors, Epidemiology, Treatment, Prevention, Early detection, Women’s health

INTRODUCTION

Breast cancer is one of the most common malignant tumors affecting women and remains a leading cause of cancer-related death worldwide.1 It originates in breast epithelial cells and can grow into a tumor capable of invading surrounding tissue and metastasizing to distant organs. In some cases, breast cells undergo non-cancerous but abnormal changes, such as atypical hyperplasia, cysts, or intraductal papillomas, which may increase cancer risk later.2 Globally, breast cancer accounts for more than one million new cases annually, and incidence is rising, particularly in low- and middle-income countries.3 In the United States, breast cancer makes up approximately 30% of all cancers in women, with an estimated 300,590 new cases and 43,700 deaths projected for 2023. The lifetime risk for American women is around 1 in 8, while the risk of dying from breast cancer is 1 in 35.1

Genetic predispositions such as BRCA1/2 mutations account for 5–10% of cases while lifestyle and environmental exposures contribute to 20–30%.4,5 Age, reproductive history, and hormonal status also play critical roles in risk.6

Alarmingly, incidence among younger women (20–49 years) is rising, with these patients often presenting with aggressive tumors and poorer survival.7,8 Non-Hispanic Black women are more likely to develop aggressive subtypes such as triple-negative breast cancer (TNBC), contributing to disparities in outcomes.7

Given its complexity, breast cancer requires a multidisciplinary approach integrating surgery, radiotherapy, systemic therapies, and supportive care. This review summarizes current diagnostic methods, treatment strategies, risk factors, and preventive measures relevant to breast cancer in the United States (Table 1).

Table 1: Summary of breast cancer in the United States: diagnosis, treatment, risk factors, and prevention.
Table reproduced from source PDF page 2

CURRENT TREATMENTS

Surgery

Surgery remains the cornerstone for localized breast cancer. Breast-conserving surgery (BCS) plus radiotherapy provides equivalent survival to mastectomy, with 10-year recurrence rates as low as 2–5% and superior cosmetic outcomes.9 Contraindications include multicentric disease, diffuse microcalcifications, and inability to receive radiotherapy.10 Sentinel lymph node biopsy (SLNB) has replaced axillary dissection in most clinically node-negative patients.11 For local recurrence, mastectomy remains standard.12

Chemotherapy

Chemotherapy reduces recurrence risk by ~30% in early breast cancer.13 Neoadjuvant chemotherapy (NAC) allows downstaging, facilitating breast conservation.14 Standard regimens include anthracyclines and taxanes, while platinum agents show benefit in TNBC.15 Capecitabine maintenance improves outcomes in TNBC following standard therapy.16 Dose-dense regimens every 14 days provide superior outcomes compared to conventional schedules.17

Radiotherapy

Adjuvant radiotherapy is standard after BCS, reducing local recurrence and mortality.18 Hypofractionated radiotherapy offers equivalent control with fewer side effects.19 Partial breast irradiation is suitable for carefully selected low-risk patients.20 Post mastectomy radiotherapy (PMRT) is strongly indicated in patients with ≥4 positive lymph nodes.21 Regional nodal irradiation improves disease-free survival but carries risks of cardiopulmonary toxicity.22

Endocrine therapy

Endocrine therapy is fundamental for hormone receptor (HR)-positive breast cancer. Tamoxifen for 5–10 years significantly reduces recurrence and mortality.23,24 For high-risk premenopausal women, combining ovarian suppression with tamoxifen or aromatase inhibitors (AIs) improves survival.25 In postmenopausal women, AIs are superior to tamoxifen but increase bone-related side effects.26 CDK4/6 inhibitors combined with AIs markedly prolong survival in advanced disease.27

Targeted therapy and immunotherapy

HER2-targeted agents such as trastuzumab, pertuzumab, and T-DM1 have revolutionized outcomes in HER2-positive disease.28 Immunotherapy with checkpoint inhibitors like pembrolizumab and atezolizumab improves survival in PD-L1–positive TNBC.29 Gene therapies and adoptive cell approaches (CAR-T, TCR-modified T cells) remain experimental but promising.30

DIAGNOSIS

Diagnosis involves mammography- standard for screening and early detection using low-dose X-rays.31 Ultrasound, differentiates cystic from solid lesions and guides biopsies.32 Biopsy, gold standard for diagnosis; includes core needle, vacuum-assisted, and excisional methods.33,34 Lymph node biopsy, determines nodal spread, guiding staging and management.35 Fine needle aspiration (FNA), useful for distinguishing cysts but limited in confirming invasiveness.36

Prevention

Screening included regular mammograms and clinical exams improve early detection and outcomes.37 Healthy lifestyle included maintaining normal body mass index (BMI), regular exercise, reduced alcohol intake, and smoking avoidance lowers risk.38 Breastfeeding included protective against breast cancer.39 Education included awareness campaigns improve early presentation and detection, and genetic counseling was recommended for women with strong family history or BRCA mutations.40,41

RISK FACTORS

Personal history such as previous breast cancer increases recurrence risk.42 Family history such as strong family clustering elevates risk.43 Inherited mutations- BRCA1/2 and TP53 mutations significantly increase lifetime risk.3 Age/hormonal factors such as early menarche, late menopause, nulliparity, and HRT increase risk.44 Lifestyle factors like obesity, alcohol, smoking, poor diet, and inactivity are associated with higher incidence.4,8 Breast density as dense breasts increase both risk and diagnostic difficulty.6

DISCUSSION

Breast cancer incidence in the U.S. reflects both advances in detection and ongoing challenges in prevention and equity. While mortality has declined due to screening and improved therapies, younger women and racial minorities continue to experience disproportionately poor outcomes.1,7,8,18,19 Advances in systemic therapies—including endocrine, HER2-targeted, and immunotherapy—have reshaped management, but disparities in access and treatment remain critical barriers.8,23,30

Future research is moving toward precision oncology, using molecular profiling, AI-driven diagnostics, and gene-editing tools to personalize care.30 Preventive strategies—including lifestyle interventions, expanded access to genetic counseling, and widespread education—remain underutilized but essential to reducing incidence and improving equity in outcomes.37-41

CONCLUSION

Breast cancer in the United States remains a major health concern, with increasing incidence in young women and persistent disparities in survival. Significant progress has been achieved through advances in surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy, yet challenges of treatment resistance and unequal care access remain.

Prevention and early detection remain cornerstones of reducing disease burden. Public health strategies must integrate lifestyle modification, genetic counseling, and equitable screening access. Looking forward, personalized medicine and emerging immuno-genetic therapies hold promise for transforming breast cancer care, improving survival, and enhancing quality of life for women across the country.

ACKNOWLEDGEMENTS

Authors would like to thank Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi-6205, Bangladesh and Department of Pharmacy, School of Science and Technology, Varendra University, Rajshahi-6204, Bangladesh and Department of Chemistry and Biochemistry, Lamar University and Jahurul Islam Medical College, Bangladesh and all teachers who taught and inspired for graduate study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

  1. 1. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
  2. 2. Momenimovahed Z, Salehiniya H. Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Med Press). 2019;11:151-64.
  3. 3. Rebbeck TR, Friebel TM, Friedman E, Hamann U, Huo D, Kwong A, et al. Mutational spectrum in a worldwide study of 29,700 families with BRCA1 or BRCA2 mutations. Hum Mutat. 2018;39(5):593-620.
  4. 4. Jaman MS, Sayeed MA. Ellagic acid, sulforaphane, and ursolic acid in the prevention and therapy of breast cancer: current evidence and future perspectives. Breast Cancer. 2018;25(5):517-28.
  5. 5. Colditz GA, Bohlke K, Berkey CS. Breast cancer risk accumulation starts early: prevention must also. Breast Cancer Res Treat. 2014;145(3):567-79.
  6. 6. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69(6):438-51.
  7. 7. Johnson RH, Anders CK, Litton JK, Ruddy KJ, Bleyer A. Breast cancer in adolescents and young adults. Pediatr Blood Cancer. 2018;65(12):e27397.
  8. 8. Daly B, Olopade OI. A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and how to intervene. CA Cancer J Clin. 2015;65(3):221-38.
  9. 9. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-41.
  10. 10. Boughey JC, Attai DJ, Chen SL, Cody HS, Dietz JR, Feldman SM, et al. Contralateral prophylactic mastectomy consensus statement from the American Society of Breast Surgeons. Ann Surg Oncol. 2016;23(10):3100-5.
  11. 11. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-75.
  12. 12. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24(13):2028-37.
  13. 13. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 2012;379(9814):432-44.
  14. 14. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72.
  15. 15. Poggio F, Bruzzone M, Ceppi M, Pondé NF, La Valle G, Del Mastro L, et al. Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer: a systematic review and meta-analysis. Ann Oncol. 2018;29(7):1497-508.
  16. 16. Masuda N, Lee SJ, Ohtani S, Im YH, Lee ES, Yokota I, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med. 2017;376(22):2147-59.
  17. 17. Jaman MS, Alam MS, Rezwan MS, Islam MR, Husna AU, Sayeed MA. Comparison of total antioxidant activity between fresh and commercial mango juices available in Bangladesh. GSC Biol Pharm Sci. 2017;1(2):26-33.
  18. 18. Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med. 1995;333(22):1444-55.
  19. 19. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513-20.
  20. 20. Bhuiyan MRH, Maniruzzaman M, Akter S, Rashid MHB, Ehasanullah M, Jaman MS. Assessment of antioxidant and antineoplastic activities of Blumea lacera (Burn. F) leaves. Int Acad J Appl Bio-Med Sci. 2022;3(2).
  21. 21. EBCTCG (Early Breast Cancer Trialists' Collaborative Group); McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomized trials. Lancet. 2014;383(9935):2127-35.
  22. 22. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317-27.
  23. 23. Bhuiyan MRH, Maniruzzaman M, Akter S, Mehjabin S, Rana MRR, Jaman MS. Drug promising effect for diabetic mice of Carica papaya leaves. Eur J Pharm Res. 2022;2(3):1-5.
  24. 24. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet. 2013;381(9869):805-16.
  25. 25. Pagani O, Regan MM, Walley BA, Fleming GF, Colleoni M, Láng I, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014;371(2):107-18.
  26. 26. Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol. 2010;11(12):1135-41.
  27. 27. Sledge GW Jr, Toi M, Neven P, Sohn J, Inoue K, Pivot X, et al. MONARCH 2: Abemaciclib in Combination With Fulvestrant in Women With HR+/HER2- Advanced Breast Cancer Who Had Progressed While Receiving Endocrine Therapy. J Clin Oncol. 2017;35(25):2875-84.
  28. 28. Swain SM, Baselga J, Kim SB, Ro J, Semiglazov V, Campone M, et al. Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med. 2015;372(8):724-34.
  29. 29. Schmid P, Adams S, Rugo HS, Schneeweiss A, Barrios CH, Iwata H, et al. Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2018;379(22):2108-21.
  30. 30. Park JH, Rivière I, Gonen M, Wang X, Sénéchal B, Curran KJ, et al. Long-term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia. N Engl J Med. 2018;378(5):449-59.
  31. 31. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-614.
  32. 32. Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299(18):2151-63.
  33. 33. Maniruzzaman M, Bhuiyan MRH, Jaman MS, Haque MS. MicroRNA dynamics, PTEN/PI3K/AKT signaling, and their relationship to breast cancer: prospects for pharmaceuticals and natural product application. Breast Cancer Res Treat. 2025;209(3):467-85.
  34. 34. Dillon MF, McDermott EW, Quinn CM, O’Doherty A, O’Higgins N, Hill AD. Diagnostic accuracy of core biopsy for ductal carcinoma in situ and its implications for surgical practice. J Clin Pathol. 2006;59(7):740-3.
  35. 35. Jaman MS, Maniruzzaman M, Rana MRR, Bhuyan MRH, Akter L, Ahmad S, et al. Overall summary of Gulf country employees from Bangladesh, preliminary evaluation for abnormal kidney, liver, and virally infected individuals using low-cost tests like CBC parameters. Chem Sci Int J. 2024;33(4):19-33.
  36. 36. Willems SM, van Deurzen CHM, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol. 2012;65(4):287-92.
  37. 37. Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2016;164(4):244-55.
  38. 38. Bhuiyan MRH, Mamun AA, Sharker B, Jaman MS. Anticancer activity and therapeutic uses of catechins on breast, prostate and lung cancer: future perspective and clinical proofs. J Clin Cas Rep, Med Imag Heal Sci. 2023;3(3).
  39. 39. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet. 2002;360(9328):187-95.
  40. 40. Jaman S, Islam N, Maniruzzaman M, Hossain F, Bhuiyan RH, Emaul N. Preventive and therapeutic effect of ellagic acid, sulforaphane and ursolic acid on colon cancer: from cellular response to molecular mechanism of action with future perspectives. Int J Clin Med Case Rep. 2023;1:1-20.
  41. 41. Daly MB, Pal T, Berry MP, Buys SS, Dickson P, Domchek SM, et al. Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(1):77-102.
  42. 42. Jaman MS, Mamun AA, Sharker B, Maniruzzaman M, Rana MRR, Hasan MN, Bhuiyan MRH. Curcumin, diallyl sulphide, quercetin and gallic acid uses as anticancer and therapeutic agents for breast cancer: current strategies and future perspectives. Eur J Med Health Sci. 2023;5(3):32-48.
  43. 43. Jaman S, Sawgat R, Alam S, Islam R, Husna AU, Sayeed MA. Association of mean platelet volume and platelet distribution width with HbA1c. J Endocrinol Diab. 2017;4(4):1-6.
  44. 44. Jaman MS, Rahman MS, Swarna RR, Mahato J, Miah MM, Ayshasiddeka M. Diabetes and red blood cell parameters. Ann Clin Endocrinol Metabol. 2018;2:001-9.