Everything You Need to Know About Breast Cancer

What is breast cancer and what causes it?

Breast cancer originates in a single cell of the mammary gland that begins to divide uncontrollably; this cell mass escapes the control mechanisms of the organism and acquires a series of properties due to dynamic changes in its genome that confers it greater biological aggressiveness, causing it to spread to other parts of the body where it can compromise the function of the organs and even in some cases the life of the person.

The causes are not well established. Approximately 8 to 10% of the cases are associated with pathogenic germline mutations (BRCA) and on other occasions they are associated with risk factors such as fibrocystic mastopathy, menarche, late menopause, nulliparity, late first pregnancy, etc. o It is more frequent in Caucasians and African-Americans, and is also associated with obesity and a sedentary lifestyle.

How can breast cancer be prevented?

We have to talk about early diagnosis or secondary prevention, that is to say, to be able to detect it in time so that we can reverse the health of people with less toxic treatments. This early detection is done in the pre-symptomatic phase, before the woman notices any alteration and is normally done with mammograms that are universally done from the age of 45-50 years; sometimes mammographic studies are done at an earlier age depending on family aggregation or other individual risk factors.

Healthy lifestyle habits, Mediterranean diet or physical exercise are protective factors against the risk of breast cancer, as has been reported in the epidemiological studies of the GEICAM Breast Cancer Research Group.

How can it be detected early?

The way to detect it early is through a good adherence to the screening programs that are done universally to women from 45-50 years of age.

In addition, if a woman experiences any physical changes in her breast, such as skin reddening, retraction of the nipple-areola complex, breast or armpit lumps, breast asymmetries, mastodynia (breast pain)… she should consult her gynecologist or primary care physician.

Is self-examination effective and how should it be performed?

It is controversial, it can generate confusion. In general it can be a complementary tool, but it is not a main tool in the management of secondary prevention of breast cancer, as mammography is.

But they are usually monthly check-ups that consist of self-exploration of the breast in case you detect any lump, change in the skin… and if you detect any change from one to another you should consult your doctor.

What is a screening examination like?

Screening is done with mammography and ultrasound in the pre-symptomatic phase. If abnormalities appear in the breast then the specialist doctor may indicate additional tests.

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What are the advantages of early detection of cancer?

What we are looking for with early detection is to reverse the health of people with treatments that are effective and not very toxic, that is to say, to reduce the morbidity caused by the treatments.

The earlier it is detected, the easier it is to treat the cancer, with more conservative surgeries, without major anatomical changes and with good cosmetic results, without very mutilating surgeries such as mastectomies, and with less intense and less toxic treatments.

What treatments are available?

There are five treatments for breast cancer, two are local and three are systemic.

The local treatments are those that aim to control the disease loco-regionally, in the breast and in the axilla: surgery and radiotherapy. Surgery is always essential in the integral management of early breast cancer; it should be as conservative as possible, but guaranteeing safety.

And radiotherapy completes the local treatment, particularly when conservative surgery is performed or when there is a lot of loco-regional involvement.

Systemic treatments are endocrine or hormone therapy, chemotherapy and biological therapy.

Endocrine therapy is used when the tumor expresses estrogen receptors, which is in 65%-70% of cases. These are hormonal therapies that are relatively non-toxic and very effective in increasing survival.

Chemotherapy attempts to eliminate the micro-metastases that we do not see, that is, the cells that have escaped from the local and regional area, from the breast and the axilla, and that we cannot detect but that we know may be there; these metastases can be eliminated with chemotherapy. Chemotherapy is usually used to treat very aggressive hormonal tumors, or “triple negative” and HER+ tumors.

Biological treatments are currently used to treat the HER2+ subtype; they are monoclonal antibodies that specifically target a protein called HER2, which appears in 15%-20% of breast cancer tumors and which has managed to significantly improve patient survival.

Can immunotherapy be used for the treatment of this type of tumor and can it be combined with chemotherapy?

Immunotherapy represents a very significant evolution in the treatment of some oncological diseases such as melanoma, lung cancer or kidney cancer, among others.

Currently, we know that breast cancer is usually a cold tumor, which means that it generates less activity of the immune system and, for this reason, there have not been great advances in immunotherapy, unlike other tumors. The immune response is usually inversely proportional to the expression of the hormone receptor, so that triple-negative tumors tend to have greater activation of the immune system and it is precisely in this subgroup where, in the coming months, there will be great advances in incorporating immunotherapy in the treatment of this disease.

Yes, it can be combined with chemotherapy; moreover, the results are very encouraging.