Breast cancer

How common is breast cancer?

Breast cancer is the most common malignancy in women and the second most common cause of cancer death after lung cancer. It is estimated that about one out of ten women will develop breast cancer at some point in her life. The risk increases with age, particularly after menopause, but 1 in 4 breast cancers are diagnosed in women under 50. Less than 5% of all breast cancers are diagnosed in women under 35 years of age.

Who are more likely to get breast cancer?

The risk is higher for women who have a family history (mother or sister who developed the disease, especially if the onset occurred at a young age, as it may be associated with the presence of BRCA-1 and BRCA-2 mutated genes), women who have not given birth or who had their first child after the age of 30, and those who had early menarche or late menopause. Modern research also highlights the aggravating role of smoking, obesity and reduced physical activity in the development of breast cancer. Women who have undergone chest and mediastinal radiotherapy in childhood or adolescence (usually for the treatment of lymphoma) have an increased risk of developing breast cancer in adulthood. Use of birth control pills, especially before the first pregnancy, increases the risk of breast cancer. In addition, the use of hormone replacement therapy after menopause increases the risk of developing breast cancer. Finally, the risk of developing breast cancer is particularly high in women with two conditions called atypical lobular hyperplasia and atypical ductal hyperplasia. Breast cancer may also develop in men, but it is extremely rare.

When should a woman start having a mammogram?

Women with no symptoms and no family history of breast or ovarian cancer should have a mammogram every year after the age of 40, while breast ultrasound may complement breast screening, especially at younger ages when the breasts are denser (more glandular tissue and less adipose tissue). However, if there is clinical suspicion of breast cancer or a burdened family or personal history, the treating physician may refer the patient for mammography and breast ultrasound imaging screening earlier. In particular, when heredity is present, it is recommended to start mammography screening at 10 years before the age of the family member’s disease. Additional screening, if necessary, may be implemented by breast MRI.

Symptomatology

Are there any symptoms indicative of breast cancer?

Symptoms may be located in the breast and are usually non-specific, for example swelling, skin lesions of the breast such as redness, ulcers that do not heal, sclerosis or an orange peel-like appearance. Other symptoms involve lesions of the nipple that were not previously present (inversion or discharge of fluid). Palpation of a lump or hard area in the breast on self-examination is usually one of the first clinical signs that a woman should report to her doctor. In some cases there are symptoms due to metastases (e.g. diffuse bone pain) or palpable hard lymph nodes in the axilla.

How is breast cancer diagnosed?

Confirmation of the disease is implemented by cytological or histological examination. Most often this is an examination of material from the breast lesion obtained by fine needle aspiration (FNA) or by surgical biopsy from the lesion site or from an abnormal lymph node.

After being diagnosed with breast cancer, what happens next?

After diagnosis, most often further imaging is needed to determine the stage of the disease with some of the following tests: brain and abdominal CT scan, bone scintigraphy, brain MRI or PET-CT scan.

Which women with breast cancer should be tested for BRCA1/BRCA2 genetic mutations?

It is recommended to perform screening for mutations in the BRCA1/BRCA2 genes to women who developed breast cancer before the age of 45 or triple negative breast cancer before the age of 60 or in women with breast cancer regardless of age when there is a strong family history of breast, ovarian, pancreatic, or metastatic prostate cancer or when there is a personal history of ovarian cancer or second breast cancer. Women with breast cancer should also be screened when there is a known BRCA mutation in another family member. Screening is also recommended in male breast cancer patients.

What are the treatments available today?

Treatment options include surgery, chemotherapy, radiotherapy, hormone therapy and targeted therapies. Treatment is often a combination of the above methods and depends on the stage of the disease, the molecular analysis of the tumour and the overall health of the patient.

What are the subtypes of breast cancer?

Pathological examination of breast cancer biopsy includes three biomarkers, estrogen receptors (ER), progesterone receptors (PR), and HER2 protein. Based on the combined results of the expression of these three markers, breast cancer is divided into three categories, the hormone-sensitive subtype, the HER2-positive subtype, and the triple-negative subtype. The subtype and stage of breast cancer are the most important parameters guiding treatment.

What is the treatment in the early stage and locally extensive stage of breast cancer?

Screening with mammography has led to an increase in diagnoses of breast cancers at early stages. In these cases there is the possibility of radical treatment, the mainstay of which is surgery. It is worth noting that in many cases, chemotherapy and/or targeted therapies are indicated prior to surgery, leading to a reduction of the tumour before surgery. After surgery, depending on the characteristics of the tumour (size, subtype, degree of differentiation) and whether or not lymph nodes are infiltrated, chemotherapy and/or targeted therapies and/or radiotherapy may be indicated to reduce the risk of future cancer recurrence. Also, for the same reason, in many cases, long-term hormone therapy after surgery is indicated for the same reason.

What are the treatment options in cases of advanced breast cancer?

• Hormone therapy
• Targeted treatments
• Chemotherapy
• Immunotherapy