Overall, the 5-year survival rate is around 99% for localized BC, 86% for regional disease, and 27% for metastatic BC (BC stage IV).
Advanced metastatic BC (20–30% of the cases) remains incurable, and the available treatments are meant to slow its progression and to relieve the symptoms derived from the disease. At present, patients with early-stage tumors, which account for 70–80% of the total cases, are successfully treated. Conversely, BC mortality rate is higher in low-income countries due to the limited access to treatments and the late stage at diagnosis. The incidence of breast cancer (BC) has been raising over the last years, with an annual increase of 3.1% and significant variations between countries: North America, Australia, New Zealand, and Northern and Western Europe show the highest incidence compared to lower income regions, with a distribution pattern that reflects the availability of detection methods and the risk factors associated to the disease.
A better understanding of the mechanisms regulating these interactions is crucial to develop strategies aimed at interfering with key BCSC niche factors, which may help reducing tumor heterogeneity and impair metastasis.
Multiple types of immune cells, stromal cells, and the extracellular matrix (ECM) form an intricate communication network with cancer cells, exert a highly selective pressure on the tumor, and provide supportive niches for BCSC expansion. The complexity of the TME is reflected in its number of players and in the interactions that they establish with each other. It has become evident that the tumor microenvironment (TME) is a major player in regulating the BCSC phenotype and metastasis. However, the cellular hierarchy in breast tumors is rather plastic, and the capacity to transition from one cell state to another depends not only on the intrinsic properties of transformed cells, but also on the interplay with their niches. Breast cancer stem cells (BCSCs) are a specialized subset of cells that sustain tumor growth and drive metastatic colonization. Tumor progression involves the co-evolution of transformed cells and the milieu in which they live and expand.
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