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BREAST CANCER: Where are we today?

Breast cancer is the most frequently occurring cancer in women worldwide, with a frequency of 12%, namely in 1 in 8 women, and the second cause of death from cancer after that of the lung.

Mortality has been greatly reduced in the recent years, which is mainly attributable to diagnosis of the disease at an earlier stage with the wide application of screening, as well as the progress in therapeutic approach.

Risk Factors & Calculation of Personalized Risk of Development of the Disease

It is important for every woman to be aware of the aggravating factors which increase the risk of developing the disease, the value of prevention, self-examination, early diagnosis, and the effectiveness of modern therapy.

Nowadays, for each woman, the individual, personal risk of developing the disease can be calculated, provided that the special doctor weighs her individual risk factors.

Indeed, on the basis of family history, some women may have an indication to be tested for a gene mutation (BRCA1, BRCA2) which significantly increases the likelihood of developing breast cancer. If there is such a gene mutation, prophylactic mastectomy – with a simultaneous reconstruction – can reduce the risk of developing the disease by 95%.

Several risk factors have been identified today, to the extent that although it is still difficult to talk about primary prevention, current data suggest that more than 50% of emerging cases could be prevented, if the knowledge of risk factors, such as diet or the consumption of alcohol was applied as a change in people’s behaviour.

However, we can talk about secondary prevention, which is based on self-examination, clinical examination by a specialist and mammography, with the final result of early diagnosis and effective treatment.

Diagnosis of Breast Cancer

The diagnosis begins with the finding of a lesion, either by the woman herself during self-examination or during clinical examination by the specialist, or, finally, during screening mammography which is of particular importance, since early stage breast cancer does not cause any pain or other symptoms and may be so small, as not to be able to be palpated.

Here, it should be emphasized that no woman interested in her life is entitled to an unspecified lesion in her breast.

The identification of the nature of the lesion is performed through biopsy.

Of course, any suspected alteration is not cancer, and modern medicine obviously requires timely detection of breast cancer, yet without women undergoing unnecessary biopsies and surgical operations.

For this reason, the classification of radiological findings should be strictly based on the BI-RADS (Breast Imaging Reporting and Data Systems) evaluation system of the American College of Radiology (ACR) in one of the 6 categories based on the possibility of the presence of malignancy.

The finding by the special doctor – surgeon of a lesion which was classified as a BI-RADS 4-5 category (namely a high probability of malignancy) should lead to biopsy.

The modern technique of biopsy (core biopsy) is performed simply, under local anesthesia, with a needle, often under ultrasound guidance, especially when it comes to non-palpable lesions. The method is well tolerated by the patient, causes a subtle scar and identifies the nature of the suspected lesion, and in particular, if it is actually breast cancer.

If it is actually breast cancer, the specialist proceeds to the so-called staging of the disease, which is determined by the extent of the lesion, the spread of the disease to the regional lymph nodes (especially the axillary nodes) and its transmission to distant areas (distant metastases).

Henceforth, the therapeutic decision making should be personalized for each patient (tailored therapy) in collaboration with all experts (surgeon – oncologist – radiotherapist) following an interdisciplinary oncology conference (IDC – InterDisciplinary Conference).

Treatment of Breast Cancer

Management generally involves therapy of the local-regional disease through surgery and radiotherapy and treatment of the systemic disease of the whole organism with chemotherapy, hormone therapy or other targeted, biological therapy, while psychological support is also needed in collaboration with groups and associations of patient support.

Surgical removal of the tumor remains, of course, the par excellence treatment in most cases. Breast surgery has evolved a lot, especially in the last decade. In the past, the treatment for breast cancer was mastectomy, a true amputation procedure. Then, the technique of immediate or delayed reconstruction after mastectomy began to be applied. Nowadays, in most cases of early diagnosis, the breast conservation technique can be applied by removing only the tumor within healthy – safe oncological margins, with modern oncoplastic methods, which is a combination of an oncologically proper removal of cancer and plastic surgery reconstruction. This is extremely important for a woman, because it gives her the same therapeutic results without having to undergo an amputative surgical operation, both physically and mentally.

Also, formerly, axillary lymph node clearance was traditionally applied to achieve radical therapy ultimately. Today, however, the sentinel lymph node biopsy technique is applied, namely, the detection of the first (axillary) lymph node in which the disease can be spread. As long as the sentinel node does not harbor metastasis, the classical axillary lymph node dissection can be omitted, thus greatly simplifying the procedure and relieving the patient of possible complications such as lymphedema (swelling), pain, numbness, loss of sensitivity and mobility of the upper extremity.

Results

Thus, with the impressive progress achieved in the last two decades, survival from the disease diagnosed in the initial stage (0) is considered as of 100%, in early stages it is between 81% and 92%, while, on the other hand, when the disease is diagnosed in advanced stages, survival ranges from 54% to 67% and finally 18% when there are metastases in distant areas of the body. It seems, then, that when breast cancer is detected early, the final outcome is excellent so that today, we can talk about complete healing.

In conclusion, screening can now lead to timely detection of breast cancer at an early stage, thus saving the patient and still maintaining or   reconstructing her breast.

ANTHIMIDIS GEORGIOS

GENERAL SURGEON

Master’s   Degree (Surgical Oncology)

Doctor of Medicine of AUTH (Senology – Thesis in Breast Cancer)

www.anthimidis.gr