Breast cancer is cancer most common in women, representing more than a third of all new cases of cancer in women (more than 58,000 new cases per year, or one in eight women, and more than 12,000 deaths per year, according to public health data France). It can also affect men, although this remains very rare (less than 1%). The incidence of this cancer has been increasing for 20 years, although mortality is decreasing.
This cancer most often develops after age 60.
Indeed, the risk increases with age, even if it can affect very young women with 20% of breast cancers occurring before the age of 50.
Approximately 5% of breast cancers occur in a family genetic context (BRCA or PALB2 genetic mutation for example).
There are national screening programs. The one applied in France concerns women aged 50 to 74 for whom a mammogram is proposed every two years. Given the participation rate is still too low, 4 out of 10 cancers are still diagnosed at an intermediate or advanced stage.
Survival of breast cancer patients has improved in part due to advances in screening.
Early treatment and advances in treatments have also made this possible.
In addition, survival after localized breast cancer is currently estimated at 88% at 5 years.
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There are three main types of breast cancer including prognosis, progression
and support may be different. These three subtypes are classified according to
the presence of certain receptors (sensors) on the surface of cancer cells
(hormone receptors and the HER2 receptor).
have hormone receptors on their surface making them sensitive to anti-hormonal treatments.
They represent 75% of breast cancers.
have a strong overexpression of the HER2 receptor on their surfaces making them sensitive to anti-HER2 treatment
(between 10 and 15% of breast cancers).
for which neither hormonal receptors nor HER2 are found on the surface of cells,
and for which chemotherapy is most often indicated, due to the aggressiveness of this type of cancer.
There are also intraductal carcinomas, which correspond to cancer cells but which do not infiltrate the breast and do not give rise to the risk of metastases, but which must be treated otherwise they develop into an infiltrating cancer.
Today there are tools and algorithms to determine individual risk of breast cancer. The latter is measured using personal medical, gynecological, mammography density, and genetic data. This makes it possible to determine for each woman whether or not it is necessary to follow monitoring and screening according to her level of risk:
The earlier the cancer is diagnosed and treated, the better the prognosis will be. Furthermore, recovery requires the right combination of surgery, chemotherapy and/or radiotherapy, with a sequence that will depend on each situation. In certain situations, for example, it is very important to start with chemotherapy before operating on the patient to give her the best chance of recovery. It is therefore imperative that there be a multidisciplinary discussion and reflection involving surgeon and oncologist from the start of the process. Patients must also be able to benefit from immediate reconstruction surgery, in all situations where this is possible, if they have to undergo breast removal. For this, the use of a specialist plastic surgeon knowledgeable in reconstruction techniques is necessary in order to be able to offer the best surgical options to the patient.
There are different types of breast cancer, with different treatments depending on the presence of hormone receptors, HER2, or other mutations or molecular profiles. It is very important to have a precise analysis of the tumor supplemented, in certain cases, by more in-depth complementary molecular and biological analyzes to optimally adapt the treatment to each particular case. For certain more aggressive and treatment-resistant cancers, this also allows access to clinical trials with new targeted molecules and innovative treatments.
Through screening, cancer can be diagnosed even before symptoms appear. However, it can also appear as a palpable mass in the breast, although these masses are most often non-cancerous.
Symptoms associated with breast cancer may be:
Screening is done by a mammographic examination, sometimes combined with an ultrasound if the breasts are dense. Its benefit is demonstrated from the age of 40, however the age of start and the frequency of mammograms can be adapted according to risk factors or individual risk assessment tools. For very high-risk patients with familial mutations, a breast MRI is also recommended.
The diagnosis of breast cancer requires imaging tests:
The sample, taken by means of the biopsy and analyzed in the laboratory (this is anatomopathology), is necessary to confirm the diagnosis of cancer, and indicate the type of cancer.
In order to have a complete diagnosis, and depending on the size and type of cancer, we may also need to complete the assessment with an extension assessment:
Risk factors for breast cancer can be genetic, hormonal or lifestyle-related, although this does not completely explain the occurrence of breast cancer for a given woman.
They include in particular:
Age
A family history of breast cancer, with possible genetic predisposition
A history of breast cancer
or precancerous lesions
Overweight or obesity
(after menopause)
Alcohol
Hormonal treatments, particularly taken over a prolonged period (hormonal contraception or hormone replacement therapy)
A history of radiotherapy
at wall level
When cancer is diagnosed at a localized stage, treatment has a curative objective, but will also have the benefit of reducing the risk of relapse and spread to other organs.
A combination of several types of treatments is used: surgery, chemotherapy, radiotherapy, hormonal therapy and targeted anti-HER2 therapies.
Each treatment modality is adapted to each patient depending on the type and extent of her breast cancer.
It may sometimes be necessary to remove the breast (mastectomy), but in this case there are reconstruction techniques that can be done immediately or later.
If the cancer has spread to other organs (metastases),
treatment is essentially medicinal based on chemotherapy, hormonal therapy, or targeted therapies. Radiotherapy or surgery for metastases may be offered for certain cases.
The goal of treatment is to prevent disease progression and prolong survival while controlling cancer-related symptoms.
