Breast Cancer: Frequently Asked Questions
La Dr. Mª Esther Suárez Agustín, specialist in Gynecology and Obstetrics at the Women's Unit of the Ruber International Hospital, offers us the keys to better understanding breast cancer.
What is the prognosis, what types exist, how it can be prevented, and what treatments are available? These are some of the frequently asked questions answered by the doctor, who also shares the latest advances in the field of gynecological oncology.
What is breast cancer
Is malignant tumor which most frequently occurs in women worldwide, although its incidence varies greatly from one country to another.
What is its incidence and prevalence?
Every year, about 100 new cases are diagnosed in the world. 2.000.000 new cases of breast cancer, And in Spain had almost 33.000 cases (2019 data) .
The evolution in the last 10 years has shown an upward curve with an increase in incidence of approximately 20%, but fortunately Mortality has been declining at a significant rate, of almost 1.5% annually.
Its prevalence is very high, reaching to represent 17% of all malignant tumors.
A woman's lifetime risk of developing breast cancer is estimated to be 1 in 8.
And prognosis?
The prognosis varies greatly depending on whether the diagnosis is made in the early stages (at the onset of the disease) and the type of tumor involved. The initial size of the tumor and whether the axillary lymph nodes are involved are also important factors.
Breast cancer is not a single entity, so depending on its histological type and molecular profile, the treatment and prognosis will vary.
Generally Overall survival in Spain is over 90%., with the data always being better when the diagnosis has been very early.
What is the profile of a breast cancer patient? Can men also get this type of cancer?
The etiology or cause of cancer It's mom's in most cases unknownWe know that there are risk factors that increase the likelihood of developing it (some are modifiable, others are not), but many patients do not have them.
Of course Men can also present itIn fact, of the total number of breast cancer cases diagnosed, 1% affect men.
What are the main types of breast cancer?
There are several subtypes which have different clinical and prognostic characteristics. Apart from the histological type and degree of tumor differentiation, at the molecular level they are distinguished by: whether they are hormone-dependent or not (they have estrogen and progesterone receptors), whether they have the HER-2 amplification gene, and whether they have a higher or lower proliferation index (Ki 67).
Can breast cancer be prevented?
Yes, it can be prevented, but only by acting on known risk factors that are modifiable. It is also very important to population awareness so that they can attend the screenings carried out by the organizations involved (with mammograms for asymptomatic patients) and so that they are alert to any alarming symptoms such as lumps, secretions, etc., and go to your specialist
What are the risk factors, modifiable and non-modifiable?
Factors not modifiable They are: age, sex, race, endogenous sex hormones with age of first period and age of menopause, fertility, breast tissue density, personal and family history of breast pathology and of course genetics.
Factors modifiable and therefore on those who you can act: exogenous sex hormones, obesity, alcohol, tobacco, reproductive factors, physical activity and lifestyle.
How is it diagnosed? What improvements have been made in this field?
When there is a palpable nodule or other symptoms, a series of tests are carried out to determine the exact diagnosis and the possible extent of the disease. In this regard, diagnostic imaging in breast pathology has experienced many important advances: the use of mammography with tomosynthesis, ultrasound, magnetic resonance imaging or PET-CT for certain indications.
Interventionism with the implementation of techniques of percutaneous biopsy To confirm the diagnosis, it avoids unnecessary surgical biopsies. Initially, FNA (fine needle aspiration biopsy) was performed, and currently, the most commonly used techniques are CNB (core needle biopsy) or VAB (vacuum-assisted biopsy).
How important is early detection?
The most important thing is to be able to perform the diagnostic techniques described above on early lesions that are not even palpable, and that can be detected through early detection programs. The earlier the stage at diagnosis, the better the prognosis.
What role does technology play?
Fundamental in the diagnosis, with the use of mammograms, ultrasounds or magnetic resonance imaging, etc.Equally important in treatment, where nuclear medicine methods are used surgically, for example, to detect sentinel axillary lymph nodes. And no less important in systemic control and disease monitoring with bone scans, X-rays, CT scans, PET-CT scans, and so on.
How is the disease addressed in the different units?
In the breast units there are multidisciplinary committees where experts from various breast-related specialties participate. Initially, they focused on diagnosis and treatment, involving radiologists, gynecologists, plastic surgeons, medical and radiation oncologists, nuclear medicine specialists, and pathologists.
But the care goes much further and it involves Functional Units that also include psychosocial support, education or information to family members with the help of specialized nursing, physiotherapists and geneticists.
Pregnancy and breast cancer: Is it possible?
If diagnosed during pregnancy can be treated, and in general, treatment is the same as outside of pregnancy and should not be unnecessarily delayed. Chemotherapy is contraindicated in the first trimester due to the risk of fetal malformations and miscarriage, but it can be used safely in the second and third trimesters. Obstetric monitoring with fetal ultrasounds should be more exhaustive, and whenever possible, an attempt should be made to terminate the pregnancy no earlier than week 36-37, and 2-3 weeks after the last cycle of chemotherapy.
An Pregnancy after breast cancer does not worsen the prognosisIf hormone therapy is necessary after surgery, it is recommended to complete the 5-year course and then wait 3 to 6 months. If this is not necessary, it is recommended to wait at least 6 months after completing chemotherapy. In any case, the procedure should always be individualized and discussed with the obstetrics and oncology team.
Never forget, when diagnosing a young woman, to offer her the possibility of chemotherapy before starting treatment. cryopreserve eggs in case you want to use them in the future and become a mother once your oncological problem is resolved.
Do all women with breast cancer undergo surgery? What types of surgical interventions are available?
Today yes, all patients are operated onDepending on the case, sometimes surgery is the first step, and then the need for chemotherapy, radiotherapy, hormone therapy, immunotherapy, etc. is decided. In other cases, greater benefit is obtained with primary systemic treatment, such as in Her-2 positive tumors, triple negative tumors, some large ones in an attempt to reduce them, etc.
At the surgical level, the usual thing is to perform conservative surgery, removing the lesion with safety margins and ensuring a good final aesthetic result; in these cases, subsequent radiotherapy treatment is essential.
La mastectomy It is performed when there are contraindications for conservative surgery or at the patient's request.
Why are lymph nodes in the armpit sometimes removed in addition to the tumor/breast? What is a sentinel node?
In order to address the complete treatment of breast cancer, it is necessary stage the lymph nodes at the armpit level, that is, determining whether these cells are affected and to what degree at the time of diagnosis; this will subsequently determine the adjuvant treatment to be followed, including radiotherapy to the axillary region and chemotherapy.
The sentinel lymph node is the first lymph node to receive lymphatic drainage from the primary breast tumor. Sentinel lymph node biopsy (SLNB) provides minimally invasive lymph node staging, with less morbidity than a total lymphadenectomy.
Is breast reconstruction performed in all cases? Is it possible to do it immediately after tumor removal?
It is attempted in most cases where total removal of the mammary gland (mastectomy) is indicated, although each case must always be individualized, depending on whether there is another associated pathology, age, or various factors.
Of course Reconstruction can be done immediately, in the same surgical procedure in which the tumor is removed and the condition of the axillary lymph nodes is assessed. If this is not the case, it can always be performed at a later date, when circumstances warrant.
How is breast reconstruction performed?
In essence it can be an immediate or deferred reconstruction and can be carried out by means of placement of implants or with autologous tissue of the patient herself.
Reconstruction options will depend on the type of tumor, the patient's body weight, the shape of the breast, and, of course, the patient's wishes, always in consultation with the plastic surgeons.
What care and healthy lifestyle habits should a person with breast cancer follow?
Both during and after treatment, you should maintain good hygiene and health habits and therefore promote a healthy body mass index by following a diet low in fat and rich in vegetables, fruits, grains, legumes, fish, and preferably white meat. Tobacco, alcohol, and sugar consumption should be restricted, and this healthy diet should be accompanied by exercise and physical activity, without forgetting, of course, leisure time and enjoying free time.
The Future: What's Next for Breast Cancer?
In the field of breast cancer there is continuously evolving With the emergence of new drugs, and especially immunotherapy, clinical trials are continually emerging where researchers can continue their work.
At the clinical level, with the integrated approach of the Breast Units, All options are individualized for each patient., trying to provide the most optimal treatment and solution for each patient.
The onset of genetic platforms with molecular techniques, help the clinician make decisions regarding which patients will or will not benefit from chemotherapy treatment, which is not free of adverse side effects.
Likewise, being able to detect patients with genetic mutations that predispose them to breast cancer allows us to provide special, individualized monitoring and, if necessary, adopt preventive measures, such as risk-reducing (prophylactic) mastectomy.
What would you say to someone who has just been diagnosed with breast cancer?
Which encouragement, as there are many people and organizations involved working to overcome the disease. And although the journey may not be easy, in the end, everyone's optimism and attitude are essential.
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Article written by the Dr. Mª Esther Suárez Agustín of the Women's Unit of Ruber International Hospital.
If you found this article interesting and would like to be seen by a professional expert in Gynecology and Obstetrics, the Women's Unit at Ruber International Hospital has a specialized unit in this area. You can request more information by calling the following numbers: 91 387 51 72/73/74 or make an appointment for an in-person consultation, always with the best specialists.