The breast is a glandular organ present in both sexes. It is made up of lobes and lobules linked by ducts and surrounded by fatty tissue. Breast cancer is caused by uncontrolled proliferation of certain cells of the mammary gland.
One in eight women worldwide develop breast cancer during their lifetime and it is considered to be the most common malignancy among women globally (excluding skin tumors) and second in frequency to lung cancer. In Spain some 22,000 cases a year are diagnosed; the majority between 35 and 80 years of age, with a maximum between 45 and 65 years of age.
Early diagnosis plays an important role in the success of cancer treatment. The early diagnosis increases the chances of curing the disease.
The main risk factors of breast cancer are:
- Age: the risk increases along with the age
- Personal history of breast cancer: a prior breast cancer increases the risk of developing a second cancer.
- Family history
- Hereditary factors: Certain gene mutations such as BRCA1 and BRCA2 increase the risk of breast and ovarian cancer. p53 increments the risk of cancer of the breast and brain as well as sarcomas.
- The late onset of menopause after age 55.
- Not having children or having the first after the age of 35
- Hormonal treatment for menopausal symptoms.
- Alcohol abuse
Personal habits that can decrease the appearance of a breast carcinoma are: exercise, weight control and moderate intake of alcohol.
The most effective way to avoid damage from the disease is early detection by a suitable control program.
The main tools for the diagnosis of this disease are:
- Schedule a visit with to a specialist in breast pathology
- A mammogram (breast x-ray)
- A breast ultrasound
- Functional magnetic resonance.
We have a specific consultation at iTAcC dedicated to early diagnosis and is equipped with all the necessary diagnostic tools in our Unit of Diagnosis and the Treatment of Breast Cancer. Our specialists can orientate the patient’s case in a personalized manner at any stage of the disease.
An accurate diagnosis originates from a complete medical history. This includes the patient’s family and personal history as well as follow-up tests that have been done thus far. The symptoms described by the patient should be evaluated along with the examination results. Then each case is focused in a personalized manner with a series of tests:
- Digital mammography: It is considered to be one of the most useful diagnostic tests
- Breast Ultrasound – Essential complement to a mammography.
- Functional MRI – a valuable diagnostic tool
- Fine needle aspiration (FNA). It has been displaced by the BAG (core biopsy) which has a greater diagnostic ability. It can be performed in stereotactic and image-guided conditions.
- The biological characterization of the disease is determined by a histopathological and inmuhistoquimico study which is of great importance in order to define treatment.
- Complete analysis including markers such as Ca 15.3.
- CT of the chest, abdomen and pelvis for determining the spread of the disease.
- A bone scan is used to determine if the bones have been affected by the breast cancer.
- PET-CT details the spread of the disease and its degree of metabolic activity. It is used as well in the detection of recurrences.
- Genetic studies in cases of suspected breast cancer with a familial determinant.
Not all tests are necessary. In iTAcC each test option is evaluated. We have specialists dedicated to the assessment, diagnosis and treatment of breast cancer. Our radiology specialists, gynecologists, surgeons, medical and radiotherapy, geneticists, oncologists and psycho-oncologists make up a team with a common objective: an accurate diagnosis to determine the treatment most appropriate for each breast cancer patient.
The treatment of breast cancer at iTAcC is multidisciplinary. Each case is personalized according to the symptomatology, biological characteristics of the tumor as well as the spread of the disease. All the physical and human resources to perform this treatment are present. iTAcC is an open institution working closely with doctors who are involved in your case.
In the multidisciplinary team at iTAcC professionals such as general surgeons, gynecologists and plastic surgeons are in charge of the treatment’s surgical stage. They work together to guarantee the best care for each patient. In the majority of cases specialists in medical oncology and radiation oncology should be coordinated in addition to surgery. They act either before or, usually after surgery. They define the most appropriate sequence in each case based on the information provided by pathologists, geneticists, radiologists, etc.
Breast conserving surgery is the global standard in the treatment of breast cancer. Mastectomy (removing the entire breast) is performed in very select cases. Surgery for breast cancer should be based on the following parameters:
- Partial mastectomy or lumpectomy.
- Intraopertatoria biopsy is done to determine resection margins.
- The sentinel node technique is employed in order to avoid the resection of axillary lymph nodes.
- Guided surgery for non-palpable tumors.
- Laying the foundation so that once the treatment has ended there are no aesthetic consequences for the patient.
The use of radiation in the treatment of breast carcinoma is indicated as a complement to conservative surgery. In this way, it has the same result as the radical mastectomy. It is also used after the resection of voluminous tumors or when the lymph node in the underarm is affected.
Advances in the field of radiation therapy in the last decade have brought us treatments with very low incidence of side effects. The intensity modulated radiation therapy (IMRT) is intended for tumors of the left breast and in cases when the chemotherapy includes anthracyclines or their derivatives. Our specialists recommend using image-guided radiotherapy (IGRT). This ensures the proper administration of treatment avoiding the uncertainties generated by other techniques. The team of specialists at iTAcC has treated more than 3,000 patients employing these techniques. It is one of the first teams in their implementation in the European Union. Its experience in this field has allowed for the development in Spain, of the partial breast irradiation technique (APBI), while adhering to “guidelines of the American Society Therapeutic Radiation Oncology.”
The use of chemotherapy in a patient with breast cancer is defined by the clinical, biological and genetic characteristics of the tumor. Its purpose is to eliminate subclinical microscopic disease which can be found away from the breast. After evaluating the clinical, biological, genetic and molecular parameters of each individual patient medical oncologists at iTAcC determine the drugs and the sequence of their administration.
Clinical research protocols at iTAcC are carried out in order to develop drug combinations and treatment sequences which improve the results in patients suffering from breast cancer.
Immunohistochemical analysis of a tumor helps to determine the existence of receptors on the surface of tumor cells. Hormone therapy involves the use of drugs that block the action of certain hormones on these receptors. It slows the growth of tumor cells and decreases the production of these hormones.
Biological and translational therapy
Certain types of breast tumors express an abnormal amount of receptor 2 of the epidermal growth factor (HER2). In these cases treatments such as Trastuzumab or Herceptin may be useful. Lapatinib is another type of biological therapy that acts by a different mechanism. It can be used if there is a recurrence of the tumor that expresses HER2 after treatment with Trastuzumab.
At iTAcC we have clinical investigation protocols which evaluate the activity of the new biological agents for treatment of HER2 positive tumors.
Our multidisciplinary team establishes a personalized control plan after treatment responding to the needs of each patient and the disease biology in order to rule out or detect a possible recurrence early on.