Breast cancer is more prevalent in women than other types of cancer. Breast cancer is a major cause of concern for women in Pakistan, ranking third among all cancers. It is the second largest cause of cancer-related deaths among women (Alimirzaie et al.; Ditsch et al., 2022). According to the World Health Organization (WHO), breast cancer accounts for 16% of cancer-related deaths worldwide. The incidence of breast cancer increases with age, and specific lifestyle choices, genetics, and environmental factors play a role in the risk of breast cancer (Alimirzaie et al.; G. Q. Chanihoon, Z. Khalid, et al., 2022). Early detection of breast cancer is critical for accurate diagnosis (Ditsch et al., 2022).
When a radioactive substance is distributed uniformly throughout the body, the test scan is considered normal (. Q. Chanihoon, H. I. Afridi, A. Unar, et al., 2022). This indicated that the patient was unlikely to have a significant bone condition. When the scan revealed darker "hot spots" or lighter "cold spots" in the bones, the results were considered abnormal. Hot spots are areas where radioactive material accumulates (Ditsch et al., 2022). However, the cold spots were locations that did not gather at all. The term "abnormal" refers to a scan in which cancerous involvements are seen and signals that people have a bone condition, such as cancer, arthritis, or infection of the bone in addition to the breast (Alimirzaie et al.; Ditsch et al., 2022), as shown in Figure 1.
Although mammography is the only known imaging modality for the early diagnosis of breast cancer, evidence supporting the routine screening of women with HIC indicates that the greatest benefit is seen in women aged 35–69 years (Andre et al., 2022; Ditsch et al., 2022). For younger women, the high rate of false-positive mammograms and invasive diagnostic procedures associated with them negate the economic benefits to society. Breast cancer is the most frequent type of cancer and the primary cause of cancer-related death among women in low- and middle-income countries (LMIC), despite the reduced mortality rates in high-income countries (Wang et al., 2022). The Pakistani government began the National Program for Family Planning and Primary Healthcare in 1994, training and deploying more than 100,000 lady health workers (LHW) who live in their own communities to provide primary healthcare services in urban and rural slums. According to a recent study conducted at the Aga Khan University Hospital in Karachi, Pakistan, more than half of women diagnosed with breast cancer had locally advanced/metastatic illness (stage III/IV). According to the same study, more than 25% of women in Pakistan under the age of 40 years were diagnosed with breast cancer and 37% were diagnosed with triple-negative breast cancer(Bianchini, De Angelis, Licata, & Gianni, 2022; Talib, Amersi, Harit, & Saleh, 2019).
Breast cancer-related deaths can be reduced by 30% by screening patients. Even before a lump becomes palpable, screening mammography can detect distressing lesions, such as microcalcifications, architectural distortion, and asymmetry. Mammography was performed to examine the breast using low-energy X-rays. Ultrasonography distinguishes solid lesions from cystic lesions. When mammography is used in conjunction with ultrasound, diagnostic accuracy improves. In younger age groups, ultrasound offers higher sensitivity for detecting breast lesions than mammography (less than 40 years)(Bano et al.).
Bone scanning is an excellent technique for visualizing and documenting aberrant metabolic activity in bones (Hamaoka et al. 2010). A bone scan can also be used to identify whether the cancer has migrated to the bones from other parts of the body, such as the prostate or breast, or whether it has spread to the bones from another part of the body. The process begins with the injection of radioactive material into the veins. Subsequently, the drug was allowed to work through the body for two–four hours (Veitch et al., 2022). Depending on the cause of the bone scan, Tc-99 MDP was used. Ten milliliters of the radiotracer was administered intravenously, and 3 h after injection, static images of the entire body were taken in the anterior and posterior projections (Donohoe et al., 2017; Lovero et al., 2022).
Skeletal scintigraphy suggested FOCAL bone disease (possible) involving the skull (middle), although radiological linkage was required. The distribution of radiotracers across the remainder of vertebrate dosolumbers is consistent with degenerative alterations (Han, Oh, & Lee, 2022). As the material permeates the body, bone cells migrate naturally to locations that require repair. Radioactive tracers in the material track these cells and accumulate in the areas of bone injury. It is absorbed in areas of strong blood flow (Chen et al., 2022). When a radioactive substance was uniformly distributed throughout the body, test findings were considered normal. This indicates that you are unlikely to have a significant bone condition (G. Q. Chanihoon, Unar, et al., 2021b). When the scan reveals darker "hot spots" or lighter "cold spots" in the bones, the results are considered abnormal (Bhatnagar, Wu, & Liu, 2015; Chanihoon, Afridi, Talpur, Kazi, & Baig, 2022), as shown in Figure 1. Hot spots are areas where radioactive material accumulates. However, the cold spots were locations that did not gather at all. Abnormal results may suggest the presence of bone diseases such as malignancy, rheumatoid arthritis, or bone infection (Figure 2). Bone scanning is an excellent technique for visualizing and documenting aberrant metabolic activity in bones. A bone scan can also be used to identify whether the cancer has migrated to the bones from other parts of the body, such as the prostate or breast, or whether it has spread to the bones from another part of the body. Radioactive material is injected into a vein and absorbed by bones during a bone scan. Subsequently, the patient was observed for several hours. The chemical contains a trace amount of radiation, and practically all of it is eliminated from the body in two or three days(G.-Q. Chanihoon, Ahsanullah, Memon, Aandridi, JAFAR, 2022; ubarak, 2016).
Biopsy is a procedure in which a doctor takes a small piece of tissue for microscopic examination. This may have occurred at the physician's office. However, surgery or other procedures are occasionally required to obtain tissue samples. The type of biopsy that you undergo is determined by the location of the suspected tumor (G. Q. Chanihoon, Unar, et al., 2021a; Yu, Liang, Yuan, & treatment, 2010). CT can reveal the shape, size, and location of a tumor. They can even visualize the blood vessels that supply the tumor without requiring the patient to undergo surgery (Mangrio et al., 2022). CT scans are frequently used by physicians to assist in guiding the needle to remove a small piece of tissue. PET scans are most frequently used to identify cancer cells that metabolize at a faster pace than non-cancerous cells(Kirova et al. 2006). Cancer cells appear as bright spots on PET scans owing to their high chemical activity. Therefore, PET is beneficial for the detection of new or recurrent malignancies. U/s enables physicians to detect malignancies in body parts that do not appear well on X-rays (Moy et al., 2010).Ultrasound is an imaging test that uses sound waves to create pictures of organs, tissues, and other structures within the body (also called sonograms) (Parveen et al., 2022). In contrast to X-rays, ultrasound does not use radiation. Additionally, ultrasound can depict the moving components of the body, such as a beating heart or blood flowing through the blood veins. Ultrasound screening is efficient in detecting cancers that are not observed on mammography in women with dense tissues (Umar & Atabo, 2019). Ultrasound has been proven to dramatically boost the identification of clinically significant, tiny, mostly invasive, node-negative tumors, such as those listed in Table 4. Both breasts displayed typical tissue composition, comprising glandular and adipose parenchyma. A soft tissue density lesion was present in the upper outer quadrant of the right breast, with definite margins. However, no conclusive evidence of a suspected tumor or breast architectural distortion was observed in the left breast (G). Q. Chanihoon, Afridi, Kazi, Talpur, & Baig, 2021). No microcalcifications, skin changes, or nipple alterations were observed in the left breast. Enlarged lymph nodes were observed on both sides of the axillary region. Based on these findings, the suspicion of cancer in the right breast is high, and a true cut biopsy would be recommended for further evaluation. The BIRAD 4 classification indicates suspicion of malignancy, as shown in Figures 3 and 4.
Toxic elements (Hg, Pb, and Ni) can deplete the glutathione and sulfhydryl groups linked to proteins, resulting in reactive oxygen species such as superoxide anions, hydrogen peroxide, and hydroxyl radicals (Burrell & Swanton; G. Q. Chanihoon, H. I. Afridi, A. Unar, et al., 2022). Even low levels of chronic Hg exposure cause endothelial dysfunction through increased inflammation, oxidative stress, poor antioxidant defense, and decreased bioavailability of nitric oxide, all of which increase the risk of cancer and other physiological conditions (Burrell & Swanton). Selenium-containing proteins (selenoproteins) are critical components of a variety of antioxidant systems (e.g., glutathione peroxidase) that actively protect physiological tissues from damage caused by free radicals and reactive oxygen species (Lashari et al., 2021; Tsang & Tse). Numerous mechanisms have been described in experimental research to suggest that these selenium systems may be beneficial in reducing the risk of cancer and other physiological diseases. Antioxidant defenses, for example, can help minimize the damage to arteries and tissues caused by reactive oxygen species, which can occur as a result of other physiological disorders such as cancer, hypertension, hyperlipidemia, and diabetes.
In recent years, scientists have focused their attention on the interactions between dangerous metals and essential biocomponents in the body. These interactions involve a variety of biometals, including zinc, copper, iron, selenium, calcium, and the highly toxic element mercury. The toxicity of Hg is due to its detrimental effect on cellular enzymatic systems, which is caused by the substitution of other essential metal ions (primarily Zn, Se, Cu, and Ca) in metalloenzymes, as well as its extremely strong affinity for biological structures with –SH groups, such as proteins, enzymes, and nucleic acids. The significance of Cd, Pb, Ni, Cu, and Fe–Zn interactions should be considered in light of the broad public exposure to dangerous metals (Tsang & Tse)and thewidespread deficiency of Zn and Se worldwide, mainly due to dietary variables (Berg et al.).
The hematological parameters and clinical characteristics of female breast cancer at all stages (T-I, T-II, T-III, and T-IV) were altered compared to the referents listed in (Table 2). Most women with breast cancer have hemoglobin levels (percent) between 5.29 and 9.15 percent, which are lower than those of healthy controls (G. Q. Chanihoon, H. I. Afridi, F. N. Talpur, et al., 2022). This could be attributed to poor diet and disease (Table 2). Other biochemical markers, such as hematocrit (HCT), mean corpuscular volume (MCV), MCH, and MCHC, were significantly lower in female patients with breast cancer than in controls (p 0.001). Serum ferritin and total iron binding capacity increased significantly in female breast cancer patients. CT, bone scan, ultrasound, and biopsy PET scans are also used to analyze biochemical changes during malignant transformation, as they allow the diagnosis of organ anomalies using the chemical eye. These results indicate that women with thick breasts have a higher number of malignant neoplasm cells than women with non-dense breasts (Ulaner et al., 2022). Bone scans, FNAC, biopsy, CT scans, and PET have all been used to accurately determine the presence of cancerous cells within the body as well as the extent to which these cells metastasize to other areas of the body, such as the axilla, shoulders, and arm, as noted in Table 2 (G. Q. Chanihoon, Z. Khalid, et al., 2022). Low hemoglobin levels are related to anemia, which contributes to fatigue in patients with cancer. Mean corpuscular volume (MCV) is a technique for determining the size of red blood cells (RBCs); RBCs transport oxygen from the lungs to each cell in the human body. Each cell in the human body requires oxygen to grow, reproduce, and maintain its health. RBCs that are too small or too large are indicative of anemia, vitamin deficiency, or other physiological conditions. A low MCH value is frequently associated with iron-deficiency anemia. Iron is required for the synthesis of hemoglobin (Brundha, Pathmashri, & Sundari, 2019). Your body uses a trace amount of iron from the food you eat to generate hemoglobin. Iron deficiency anemia results in low mean corpuscular hemoglobin concentration (MCHC). This is a hereditary blood disease characterized by a deficiency of red blood cells and hemoglobin in the human body (Bhadra & Deb, 2020).