- Mammogram and breast ultrasound with axillary ultrasound
- Micro or macro needle biopsy of any tissue abnormality observed during clinical examination or by imaging
- An MRI
Tissue samples/biopsies are analyzed by a pathologist.
There are over 2.26 million new cases of breast cancer a year It is important to note that the incidence of breast cancer has been increasing for the past 20 years, but with decreasing mortality. It was responsible for 685,000 deaths in 2020.
This cancer most often develops after the age of 60, and the risk increases with age.
However, it also affects younger women, with 20% of breast cancer cases occurring before the age of 50.
About 5% of breast cancer cases occur due to genetic background (e.g., BRCA or PALB2 mutations.)
Many countries have national screening programs. It is usually detected by self-examination and/or a mammogram.
On a more optimistic note, the survival rate of breast cancer patients has improved, largely due to advances in 1) screening and 2) treatment and early management.
Hanane, 45 years old, shares her experience with breast cancer.
Discover her testimony and her recommendations in this fight against cancer.
There are three main types of breast cancer which may differ in prognosis, evolution, and treatment.
They are classified according to the presence of receptors (sensors)
on the surface of cancer cells (e.g., hormone receptors and the HER2 receptor).
These cancers have hormone receptors on their surface, making them sensitive to anti-hormonal treatments.
These have a strong overexpression of the HER2 receptor on their surface, making them sensitive to anti-HER2 treatment.
These represent between 10 and 15% of all breast cancers.
Neither hormone receptors nor HER2 are found on the surface of cells.
Chemotherapy is usually indicated due to the cancer’s aggressiveness nature.
An additional type is intra-ductal carcinoma, which are non-invasive cancer cells that do not pose a risk of metastasis. Nonetheless, they must be treated so that they do not ultimately become invasive cancer cells.
There are tools and algorithms to determine individual breast cancer risk based on personal medical, gynecological, mammogram density, and genetic data. These tools make it possible to determine an individual’s risk and develop a screening program:
The earlier the cancer is diagnosed and treated, the better the prognosis. A successful outcome requires the right combination of surgery, chemotherapy and/or radiation therapy, with a sequence specific to the individual. In some situations, for example, it is important to begin chemotherapy prior to surgery to give the patient the best chance of full recovery. It is critical that each case be evaluated by a multi-disciplinary team, including the surgeon, oncologist and other experts. If a mastectomy is required, patients should consider immediate reconstructive surgery when possible. A specialist plastic surgeon familiar with reconstruction techniques is recommended.
There are different types of breast cancer, and the treatments will likely differ depending on the presence of hormone receptors, HER2, or other mutations or molecular profiles. This helps to optimally adapt the treatment to each patient. For cancers that are more aggressive and resistant to treatment, this approach may also open the patient to clinical trials with new targeted molecules and innovative treatments.
With adequate screening, breast cancer can be diagnosed before symptoms appear. Breast cancer can also appear as a palpable lump in the breast.
Symptoms associated with breast cancer include:
Screening is done by mammogram, complemented by an ultrasound examination if the breast tissue is dense. Screening usually begins at 40 years of age, although this can vary based on an individual’s risk assessment. For high-risk patients, for example those with a known genetic mutation, a breast MRI (Magnetic resonance imaging) is also recommended.
Breast cancer is diagnosed using the following procedures:
Tissue samples/biopsies are analyzed by a pathologist.
Depending on the size and type of cancer, it may be necessary to complete additional exams, including:
Risk factors can be genetic, hormonal, or related to lifestyle,
including:
Age
A family history of breast cancer, with possible genetic predisposition
History of breast cancer or precancerous lesions
Overweight or obesity
(after menopause)
Alcohol consumption
Hormonal treatments, and in particular when taken over a long period (e.g., hormonal contraception or hormone replacement therapy)
Previous history
of radiation therapy
When diagnosed at a localized stage, the treatment goals are to eliminate the cancer and to reduce the risk of it spreading to other organs and/or relapsing.
Several types of treatment are used, either alone or in combination: surgery, chemotherapy, radiation therapy, hormone therapy and targeted anti-HER2 therapy.
Treatments are adapted based on the cancer’s type and stage.
Surgical removal of the breast (mastectomy) is sometimes necessary, but there are reconstruction techniques that can be done either immediately or later.
If the cancer has spread to other organs (metastasizes), treatment is primarily drug-based using chemotherapy, hormone therapy, or targeted therapy.
Radiation therapy or surgery may also be suggested.
Here, the treatment goals are to prevent the disease’s progression and prolong survival while controlling cancer-related symptoms.
