BREAST CANCER | “There are breast cancer patients who no longer require chemotherapy in the early stages of the disease.”
He breast cancer It is the most common tumor among women and is estimated to affect one in eight throughout their lifetime. And while experts warn that the incidence has risen in recent years, they also emphasize that survival rates are improving thanks to research, improvements in diagnostic methods and new treatments. On occasion World Breast Cancer Daywhich took place on October 19 last year, we spoke with the doctor Francisco Carabantesoncologist at the Regional Hospital of Malaga, who has been fighting this disease for almost three decades.
What recent advances provide greater optimism in the fight against this disease?
There have been many changes in recent years. The first, recognizing that breast cancer is a heterogeneous disease, it is not one disease, but several diseases. A molecular classification of breast cancer has been made and we have begun to differentiate the different molecular subtypes. Luminal subtype A and B, Her2 subtype and basal-like or triple negative subtype. And each has a different therapeutic approach because the natural history of each type is also different. In other words, the first step was to recognize that we were faced with a disease that was not one, but many different diseases. And when we learned that these were different diseases, research began on each of the subtypes, and diagnostic and therapeutic advances were included in each of the subtypes. Today the truth is that in all cases we have made great strides in treatment.
Speaking specifically about treatment, what new treatments are available right now?
For the luminal subtype, the latest advances we’ve had are the introduction of discipline inhibitors, which have, frankly, changed the therapeutic paradigm, both in advanced disease and in early disease. Later, in the luminal subtype, we also learned to better select and optimize patient treatments, such that there are patients who no longer require chemotherapy in the early stages of the disease. Using genomic platforms, we have learned to identify patients who, when diagnosed with early-stage breast cancer, require chemotherapy and who do not require chemotherapy.
How do all these new treatments improve patients’ quality of life?
It’s about making the experience better first, and of course if you’re improving patient survival, obviously it’s about making sure quality goes along with that. The idea is to optimize treatment so that whatever is done in the search for a cure leaves patients with little impact, meaning their quality of life is preserved. This is also one of the goals when we research and optimize patient care: to improve survival with the highest possible quality of life.
Another new treatment we’ve heard a lot about in recent years is immunotherapy. Is it used in cases of breast cancer?
Yes, there is a subtype that is triple negative, in which immunotherapy has already been included with already demonstrated good results in terms of improved survival, which has been included in the therapeutic armamentarium. Of the groups that we talked about in breast cancer, this is triple negative, where it has been demonstrated to be useful in both metastatic situations and early situations. We have already included it in the initial course of treatment, and we have been able to treat more patients with immunotherapy. But its indications are currently limited to this group of patients who have triple-negative breast cancer. Research is also being conducted on other subtypes.
Dr. Francisco Carabantes at a consultation at the Regional Hospital / Opinion
What is the survival rate for breast cancer today?
It all depends on the situation in which we diagnose the tumor. In the earliest stages, survival rates today can exceed 90% with early diagnosis. So, look at the survival rate that can be achieved. I remember that 30 years ago the survival rate could be about 60-70%. Keep in mind that by being able to make a better diagnosis today, we can diagnose tumors earlier. Previously, the incidence of tumors presenting for consultation at a later stage due to larger tumors or with more metastases was higher than today. Thanks to the screening programs that exist now, the truth is that diagnosis is getting earlier and earlier, and this is also helping to improve survival.
What is the incidence of breast cancer in Malaga?
It’s growing. The truth is that this is what we see year after year as breast cancer rates rise. Now in Malaga we can diagnose up to more than 1,200 new cases per year. In Andalusia we are talking about 6,000 cases or so. And in Spain, the forecast for this year is more than 36,000 new cases.
Diagnosis is becoming earlier and this is helping to improve survival.
And what is the reason for this increase?
You see, this is due to various factors. On the one hand, aging and increasing population. Also, it is obvious that having more diagnostic resources is the reason why we have more cases. And it can also help get rid of bad lifestyle habits that we may have today. It’s kind of a mixture of all of these.
Breast cancer is always associated with women, but can it affect men too?
In breast cancer, 1% of cancers occur in men. It’s also important to keep in mind that this doesn’t just apply to women. 99% are women and 1% are men, so men also have to notice and consult when there is a lump.
What are the main risk factors that can cause this disease?
We have learned that many factors play a role in the development of this disease. We have the first factor: being a woman. Being a woman and growing old. Aging itself is the most important risk factor for developing the disease. Next come the classic hormonal factors, such as early menarche, before 12 years, late menopause, over 55 years, delayed first pregnancy or no pregnancies. All of these changes that occur with hormones in the body are factors that contribute or have contributed to the development of breast cancer. And then genetic factors. Having a family history of this disease increases your risk. But today we also know that there are genes that are inherited and are very likely to predispose to the development of the disease. Today we can even analyze and find these genes. But these cases of hereditary breast cancer account for less than 10% of all breast cancer cases. Of course, factors that also contribute to the development of breast cancer are poor diet, obesity, alcohol and a sedentary lifestyle.
Dr. Francisco Carabantes / Opinion
Is recurrence common in breast cancer?
Well, as we improve survival, we reduce relapse rates. But, indeed, we still encounter a certain percentage of relapses. Relapses, depending on the tumor subtype, can occur from the first years or even 15 or 20 years after diagnosis.
He previously said that if the tumor is diagnosed in the early stages, survival rates can be as high as 90%. But how does this view change when the word “metastatic” is added to the diagnosis?
When we talk about metastatic disease, the goal that oncology has been pursuing for many years is what we call making the disease chronic. Because in a situation where a relapse has already occurred and distant metastases have appeared, we still do not achieve high cure rates. That is, the goal now is not treatment, but rather, maximizing survival with a good quality of life. And with new treatments, survival rates can be increased by years, and in some cases by many years.
What is the survival rate in these cases?
This is very variable and depends on the type of tumor. The luminal type does not have the same survival rate as the HER2 or triple negative type. In triple negative cases, we have now been able to improve survival with immunotherapy, but the therapeutic armamentarium we have in the luminal and HER2 types allows us to have much longer survival. We are talking about survival rates beyond four and five years. With triple negative, unfortunately, after five years, survival is significantly reduced compared to other subtypes. But the truth is that the rate of knowledge that exists now in oncology is extraordinary, and this knowledge is leading to us having more and more therapeutic options. And it doesn’t stop. New drugs are added every year. This is what people need to understand.
We managed to cure more patients with immunotherapy
Just a few weeks ago we heard the news that funding had been approved for two new drugs for patients with metastatic breast cancer. What new perspectives do these new drugs open up?
These drugs are monoclonal antibodies. They are actually conjugate drugs that combine monoclonal antibodies and chemotherapy. They load the chemotherapy into an antibody, the antibody goes to a protein, a target in the cell that recognizes and delivers the chemotherapy to the tumor cell, so the results are much better. We have already included these drugs in triple negative with improved results, and others have been used in HER2 with fantastic results. And subsequent trials showed that these two drugs may also be useful in the luminal subtype. So the luminal subtype, which we talked about earlier about discipline inhibitors, hormones and chemotherapy, further increases the therapeutic arsenal. And every line of treatment you add adds up to years of life. Thus, we are on the path to chronic metastatic disease.
Breast cancer is one of the most studied, but even so it seems that metastatic breast cancer is still fighting back, why is it still one of the biggest problems to solve?
As we have already said, we are faced with a disease in which many factors are involved. We’re talking about genes and genes that we still have a lot to learn about, but we’re learning more every year. Every year we get closer to achieving greater results and every year we get closer to what we understand today as healing. Currently the way of metastasis is to make it chronic as we get years. But we are, of course, not satisfied, research will continue until a cure is found. But it’s difficult. With an infectious disease, we know who the enemy is and you can isolate the germ. But with cancer, we are talking about many genes and many factors, and they are all interconnected. And when you act on one point, the cell learns and escapes from this drug in another way. That is, everything is much more complicated.
So, do we still have a lot to learn about breast cancer?
There’s a lot left to learn. But we have already learned a lot over these thirty years. And if I look back and look at today, the difference is terrifying.
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