The Challenges of Managing Breast Cancer: A Practical Guide to Learning the Different Types, Diagnoses and Best Practices | S Moda: magazine about fashion, beauty, trends and celebrities

Breast cancer is a heterogeneous disease that goes by many names. Advances in oncology in recent decades have meant that this generic name, which refers only to the area of ​​the body in which it occurs, is no longer true. “Today we know that This is a collection of clinical and pathological entities that have biological differences.so relevant that in some cases the treatment is completely different,” emphasizes Dr. César A. Rodríguez, head of the medical oncology service at the University Hospital of Salamanca and president of the Spanish Society of Medical Oncology (SEOM). .

The diagnosis is no longer limited to benign or malignant tumors, at an early or more or less late stage. Medicine approaches each case more broadly, taking into account its clinical, histological and molecular characteristics. “It happened by hand greater knowledge of breast cancer genomics, which has allowed tumors to be classified into what we call intrinsic subtypes.“,” notes the expert; allowing the development of more complex diagnoses and therefore more precise treatments.

“Just 10 years ago, to decide whether a patient undergoing surgery for breast cancer should receive chemotherapy, we relied on such gross factors as tumor size and the presence or absence of lymph nodes in the armpits. What happened was that we often gave chemotherapy to patients who would never have needed it because biologically these tumors were not as aggressive or as chemosensitive,” recalls Dr. A. Rodriguez. The application of genomics has led to a shift towards de-escalation strategies, where the question is no longer who needs chemotherapy, but who does not need it for treatment..

We are in a de-escalation strategy: we continue to use chemotherapy, but we have learned a lot more about who should not give it to.

Dr. Cesar A. Rodriguez, Head of the Department of Medical Oncology, University Hospital of Salamanca

He assures that even in cases of metastatic cancer, when the patient has relapsed, its use is also delayed, “because we have strategies for new biological treatments based on specific biomarkers that allow exhaust other treatment options before moving on to classical chemotherapy. “We use small molecules, biological therapies or, in some cases, immunotherapy,” he lists.

What types of breast cancer are there?

Breast cancer is divided according to molecular classification into three large groups. Luminal tumors the growth of which depends on hormones (estrogen or prostagerone), They account for about 25% and 50% of breast cancer cases. HER2-positive tumors are characterized by high levels of epidermal growth factor receptor type 2 (HER2), a protein that promotes the appearance of cancer cells; while third, triple negative tumors, which do not express HER2 receptors or hormones, are considered more aggressive and difficult to treat. “Their prognosis was poor because we had very few strategies and non-specific treatments, but even within this subgroup the situation is changing and we are starting to identify biomarkers,” the doctor emphasizes, a concept repeated throughout the conversation.

Biomarkers are the names of cancer: “It is a biological change in the tumor, such as a gene mutation or protein expression, that leads to a specific treatment,” the expert notes. All decisions about breast cancer, both early and late stages, are based on this catalog of biomarkers, which provide insight into the characteristics of the tumor and predict how it will respond to treatment. “This is what we would call personalized precision medicine.”

When should you get a mammogram?

Breast cancer is the most diagnosed tumor in the world as of 2021. The Spanish Society of Medical Oncology (SEOM) predicts that 36,395 new cases of breast cancer will be diagnosed in 2024. The numbers are increasing every year, but so is the survival rate: the five-year rate exceeds 85%. The fact that there is room for optimism is due, in addition to innovations, to the effectiveness of verification during early arrest. “Mammography is the best known and the only method that has been shown to be of benefit at the population level,” says Dr. A. Rodriguez.

Traditionally, women between the ages of 50 and 70 were recommended to have mammograms every two years. Due to the incidence at increasingly younger ages – the doctor points to factors such as lifestyle, low fertility or late motherhood – as well as increasing life expectancy. The European Commission and the NHS have extended the range from 45 to 74 years. “There are factors that are difficult to adjust at the population level, such as having children at an earlier age or prolonged breastfeeding when it is not possible to do this, for example, due to sick leave; But we can influence factors that we can compensate for at the individual level: eating healthy, exercising regularly, reducing alcohol consumption or avoiding obesity.”

Is breast self-exam beneficial? Although mammography cannot and should not replace it, it can be useful for a specialist in identifying warning signs. “In essence, they are very classic: the appearance of a lump that was not there before, redness of the breast that does not go away in a very short period of time, insufficient secretion from the nipple, retraction of the skin… If there are any signs indicating significant changes in the breasts, you should consult your doctor.”

What to do if there is a family history?

Knowledge of the existence of a hereditary mutation is information of great value to the family. Mutations in genes such as BRCA1 or BRCA2, which are responsible for, among other things, 20–25% of hereditary cancers, increase the risk of developing breast or ovarian cancer in women, especially young women. Or, in the case of men, the prostate. “Let’s not forget that 1% of breast cancers affect men. In Spain there are more than 350 men every year for whom very little is done,” insists A. Rodriguez. However, having a family history does not mean that cancer is inherited.

Genetic tests are also not performed on everyone. In case of suspicion, genetic counseling departments, a multidisciplinary team consisting of, among others, genetic counselors, oncologists, physicians or surgeons; they care about examine genetic load to assess whether genetic testing criteria are being met. “If it is determined that there is indeed a risk, then a blood sample should be taken, preferably from a person who has already had a tumor, since the mutations are present in the germ line, there is no reason to go to the tumor. “The search has also expanded, revealing the range of genes such as ATM, CHEK2, TP53 or PALB2. These are not as common, but are relevant when it comes to prevention with treatment.

According to the Spanish Society of Medical Oncology, about 5% and 10% of breast cancer cases are hereditary, which influences treatment strategies.

Which method is most appropriate for my diagnosis?

“Breast cancer is a dynamic disease,” says Dr. Cesar A. Rodriguez. “When we treat a tumor, there may be changes in its biology that cause the treatment at time A to no longer work at time B.” Development of advanced diagnostic methods such as liquid biopsy and massive sequencing, represent a significant change, allowing for more personalized monitoring tailored to the needs of each moment.

“Liquid biopsy allows us to do with a simple blood sample what we previously had to do with a puncture of a sometimes complex or inaccessible organ: find circulating DNA of tumor cells, which allows me to analyze changes in genomics and know what treatment is best for that tumor in this particular moment,” says the doctor. In addition to bulk sequencing, which can quickly analyze hundreds of genetic mutations, oncology works with a much broader panel of “potential points at which we can get a therapeutic outcome.” Currently, the use of both methods is limited to cases of metastatic cancer.

What are the main problems?

Breast cancer continues to be the leading cause of death among Spanish women. “This is because at the moment when the disease recurs, and this happens with metastases, in the vast majority of cases it is already incurable,” the expert notes. “The good news is that it is the development of new, more specific and less toxic treatments that can significantly increase survival and do so with a much better quality of life than in past decades.”

According to Dr. Cesar A. Rodriguez, in order to one day achieve chronic cancer, two fundamental aspects are necessary. On the one hand, this requires making decisions in Cancer treatment is always carried out by a multidisciplinary team. which involves all specialists involved in the diagnosis, treatment and monitoring of the disease. “It has been shown to improve prognosis and treatment outcomes.” On the other hand, it focuses on the physical and emotional consequences of the disease, requiring Comprehensive long-term care plans for cancer survivors. “It is imperative that the disease not only be cured, but that it does not leave repercussions in all dimensions of these women’s lives.”