Your cancer

Living with the disease

Breast Cancers

What is it ?

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.

Patient Testimonial

Hanane, 45 years old, shares her experience with breast cancer. 

Discover her testimony and her recommendations in this fight against cancer. 

Breast cancer : the disease

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).

Hormone-sensitive breast cancers :

these cancers have hormone receptors on their
surface, making them sensitive to anti-hormonal treatments.

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% of all breast cancers.

Triple-negative 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.

Early and personalized screening

 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:

  • Should she have regular testing? If so, from what age?
  • Which tests are required? (mammogram / ultrasound / MRI)
  • How frequently should she be tested?
  • What preventive measures can she take?

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

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.

It is important to have a precise analysis of the tumor,
which may also include an in-depth 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. 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.

The symptoms

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:

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)

A lump or swelling
of 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 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.

Diagnostic Process

Breast cancer is diagnosed using the following procedures:

  • 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.

Depending on the size and type of cancer, it may be necessary to complete additional exams, including:

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

Risk factors

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

Treatments

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.

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