An enemy that can be defeated

Breast cancer may be the most common type of cancer among women in the Western world, but mortality from the disease has decreased significantly in recent years. It is estimated that from 1989 to 2015 mortality has decreased by 40%. This fact is attributed to many factors, such as the awareness of women, and the diagnosis of the disease at an earlier stage (early diagnosis). A better knowledge of the biology of breast cancer also plays an important role. The factors are complemented by the most effective strategies to deal with it, in the initial stages, and the pharmaceutical progress to deal with the disease.

Women’s awareness of the disease has taken on great dimensions in recent years, mainly from the media, the State, the competent bodies and doctors.

The causes of the disease

The etiology of breast cancer has not been fully elucidated, but environmental factors such as body weight and exogenous estrogen intake, as well as genetic factors, appear to contribute to its occurrence. Obesity is an important aggravating factor for the occurrence of the disease, especially in postmenopausal women.

Suspicious genes

Cases of breast cancer are sporadic. However, there are 5% of genetic breast cancers that carry mutations of the BRCA1 and BRCA2 oncogenes.

Genetic testing for BRCA1 and BRCA2 oncogene mutations, which predispose to the hereditary breast and ovarian cancer syndrome, is already in practice. A number of other mutations have been implicated in breast cancer, but some of them are very rare and for others their role in the risk of developing the disease has not been clarified.

Screening in high-risk women

In breast cancer, since there is no primary prevention (e.g. vaccines), efforts are being made by the medical world to identify high-risk women with the aim of early diagnosis of the disease.

Screening for average-risk patients includes annual screening with a digital mammogram starting at age 40 and a clinical breast exam approximately every three years for women between the ages of 20 and 30 and annually for women age 40 and older.

Sta people at high risk for breast cancer women included:
– With personal history, lobular cancer in situ, atypical epithelial hyperplasia or breast cancer.
– Age ≥ 35 years and 5-year probability of occurrence with various mathematical models used.
– Probability of occurrence during the patient’s lifetime using mathematical models.
– Extremely dense breasts in a mammographic examination.
– Individuals with a known mutation in the BRCA1/BRCA2 genes.
– With a first-degree relative (parent, child, sister, brother) with a BRCA1/BRCA2 mutation.
– With family syndromes
– Personal history of previous chest radiation between the ages of 10 and 30 years.
– With Hodgkin lymphoma treatment or allogeneic hematopoietic stem cell transplantation.

Screening for high-risk women includes:
a) Clinical examination every 6-12 months from the age of 25 or 10 years before the age of onset of breast cancer in the youngest relative.
b) Annual checkup with MRI from 25 years and addition of annual mammography from 30 years.
c) Breast ultrasound if MRI cannot be performed and as a complementary examination of mammography (dense breasts).

Women at high risk for developing breast cancer (such as family history, genetic predisposition, personal history of breast cancer) should discuss with their doctor the benefits and limitations of starting mammography screening earlier, the need for additional tests ( e.g. magnetic resonance imaging) or increasing the frequency of examinations.

In addition, in this population group the potential benefits of chemoprophylaxis (estrogen blockade – reduction of the probability of occurrence of hormone-dependent breast cancer by at least 50%) and prophylactic bilateral mastectomy (results in a reduction of the probability of occurrence of the disease by 90%-95%) should be discussed ) with or without restoration.

A curable disease

Breast cancer is now diagnosed at very early stages and at younger ages, which makes the disease curable. The development of diagnostic methods is continuous. The scientific training of doctors, the abundance of specialized doctors, the diagnostic tools (digital mammography, breast ultrasound and magnetic mammography) have led to the early diagnosis of the disease to almost 100%.

The treatment requires the cooperation of various specialties: radiologist, pathologist, surgeon, pathologist-oncologist, radiation therapist and others (plastic surgeon, psychologist, geneticist).

Information from the pathological examination of breast tumors results in the classification of breast cancer into molecular subtypes that constitute the revolutionary new strategy for treating the disease.

In a very few years, breast cancer will be a simple everyday disease and no woman, if she follows the medical rules, will be at risk from it.

The rules of treatment

Today knowing the opponent directly determines the strategy of the full response.

The basic rule for choosing the treatment is the molecular classification of the neoplasm and the presence of BRCA1/BRCA2 gene mutation.
The majority of breast cancers are molecularly hormone-sensitive tumors, i.e. they express hormone receptors. There is a molecular subtype that expresses the Her/2 oncogene and a subtype without the Her/2 oncogene and hormones, the triple-negative cancers.

There are subtypes such as Her/2 and triple negative cancer, where before each surgery, targeted drugs are given that lead to a significant degree of disappearance of the problem, and then the surgeon intervenes and surgically confirms the result.

There are new surgical techniques that, with the help of new targeted drugs, avoid mastectomy and preserve the breast in cases of late diagnosis, mainly in patients with hormone-dependent cancers.

Within each molecular subtype there are series of new drugs discovered due to the rapid development of knowledge of the biological behavior of breast cancer.
For the so-called hormone-dependent molecular subtypes for which there used to be two drugs, there are now at least five in the drug arsenal, with several more in testing.

In specific other subtypes the therapeutic lines of drugs have proliferated and new lines are being explored as the biology of breast cancer evolves.

A new weapon immunotherapy has already been added to breast cancer with excellent results currently in triple negative cancer in which new drugs are also being tested with great success.

It must be emphasized that the new drugs are completely individually targeted, without side effects and that medication is now started very early due to the new strategy, with excellent results.

Leave a Comment