Your cancer

Living with the disease

Breast Cancers

What is it ?

Breast cancer affects more than 279,000 people in the United States each year (according to Cancer Statistics, 2020). It is the 1rst most common cancer in women with 276,800 new cases and the 2nd case of death by cancer in women with 42,170 death. This cancer is frequentless for men with 2,680 new cases and 520 death. Of note, the incidence of breast cancer has been increasing for the past 20 years, but with decreasing mortality.

This cancer most often develops after the age of 60, and the risk increases with age. That said, it can affect younger women, with 20% of breast cancer cases occurring before the age of 50.

About 5% of all breast cancers occur based on a family genetic background (e.g., BRCA or PALB2 mutations.)

There are national screening programs: the screening program in France concerns women aged 50 to 74 years for whom a mammogram is offered every two years. Due to a participation rate that is still too low, 4 out of 10 cancers are still diagnosed at an intermediate or advanced stage.

But there is good news. The survival of breast cancer patients has improved,
in large part due to advances in 1) screening and 2) advances in treatment and early management.
Survival after localized breast cancer is currently estimated at 88% at 5 years.

Breast cancer : the disease

There are three main types of breast cancer which may differ in prognosis, course, and management; these
three subtypes are classified
according to the presence of receptors (sensors) on the surface of cancer cells
(e.g., hormone receptors and the HER2 receptor).

Hormone-sensitive breast cancers :

these cancers have hormone
receptors on their surface,
making them sensitive to anti-hormonal treatments.
They represent 75% of breast cancers.

HER2 positive breast cancers :

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 percent of all breast cancers.

Triple-negative breast cancers :

neither hormone receptors nor HER2 are found on the
surface of cells. Chemotherapy is most often
indicated due to the aggressiveness 

There are also intra-ductal carcinomas,

which are cancer cells but which do not invade the breast tissue
and do not pose a risk of metastasis. Nonetheless, these cells must be treated
so that they do not ultimately become invasive cancer cells.

Early and personalized screening

 There are tools and algorithms to determine individual breast cancer risk based on personal medical, gynecological, mammogram five density, and genetic data.
These tools make it possible to determine individual risk and the surveillance
and screening necessary :

  • Does she have to take exams and yes from what age?
  • Which exams are required ? (mammography / ultrasound / MRI)
  • How frequently is the screening ?
  • What are the possibilities for prevention ?

Rapid and optimal initial management in the event of a cancer diagnosis

The earlier the cancer is diagnosed and treated quickly, the better the prognosis. In addition, 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. A full discussion with a multi-disciplinary perspective with surgeon, oncologist and other therapy experts is thus critically important. In cases of a mastectomy, patients should consider immediate reconstructive surgery when possible. This will require a specialist plastic surgeon familiar with reconstruction techniques to offer the best surgical options to the patient.

A precise (anatomopathological) tissue analysis should be considered,
possibly associated with a molecular profile and biological analysis.

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. It is important to have a precise analysis of the tumor, often supplemented by more in-depth complementary molecular
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.

Symptoms

With screening, cancer can be diagnosed even before symptoms appear.
However, breast cancer can also appear
as a palpable lump in the breast. Often, these lumps are non-cancerous.
Symptoms associated with breast cancer can be :

Thickening of the skin
of the breast
(sometimes localized to an area)

Change
in breast size
or shape

Discharge from the nipple
(sometimes bloody discharge)

Lump or swelling
in the armpit

Retraction of the skin
of the breast or nipple

Redness of the skin
of the breast
or nipple

Change in the appearance
of the nipple
(sometimes eczema in the nipple)

Screening

Screening is done by mammography,
and is sometimes coupled with an ultrasound examination
if the breast tissue is dense.
Screening usually begins at 40 years of age,
although this can vary based
on risk factors or individual risk assessment tools.
For patients with a high risk typical of those with familial mutation,
a breast MRI (Magnetic resonance imaging) is also recommended.

Diagnostic Process

In addition to screening, diagnosis of the presence of breast cancer requires other testing procedures, including :

  • Mammography and breast ultrasound
    with axillary ultrasound
  • Micro or macro needle biopsy of any tissue abnormality
    observed during clinical examination or by imaging
  • An MRI exam may also be performed
  •  

The tissue sample(s) taken by biopsy will be analyzed
in the pathology laboratory to confirm the diagnosis and type of cancer.

In some cases, depending on the size and type of cancer,
other diagnostic procedures may be required.
For example :

  • Thoraco-abdomino-pelvic scanner and bone scintigraphy
  • PET-Scan
  • Complete blood tests

Risk factors

Risk factors for breast cancer can be genetic,
hormonal, or related to lifestyle. Unfortunately, this does not fully explain
why breast cancer occurs for any particular individual.
These risk factors include :

Age

A family history of breast cancer,
with possible genetic predisposition
History of breast cancer
or precancerous lesions
Overweight or obese
(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

Treatments

When diagnosed at a localized stage,
the treatment goal is to both
eliminate the cancer and reduce the risk of relapse and its spread to other organs.
Several types of treatment are used, either individually or in combination :
surgery, chemotherapy, radiation therapy, hormone therapy
and targeted anti-HER2 therapy.

The specific treatment will be adapted to each patient depending on the type and extent of the cancer.

Surgical removal of the breast (mastectomy),
but in this case 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 for metastases may be offered in some cases.
The goal of treatment is to prevent disease progression and to prolong survival while controlling cancer-related symptoms.