Breast cancer is one of the most ancient cancers. Cases of breast cancer are reported in Egypt, in about 1600 B.C., and this disease is purported to have killed Theodora, the wife of Emperor Justinian as well as Ann of Austria, the mother of the King of France Louis XIV.
Breast cancer is the most frequent form of cancer in women of the western world. Breast cancer is encountered in one out of eight women, i.e. 13% of the female population has a life time risk to develop the disease. As far as age is concerned, all ages are vulnerable to the disease, from the age of 20 to 90 years, and chances increase with age especially after menopause, almost fourfold. Unfortunately, 25% of the cases concern young women, not over 45 years of age. Breast cancer is also the most frequent form of cancer during pregnancy and lactation. It is worth mentioning that in 100 cases of breast cancer one case concerns a male, usually aged 60-70 years.
Only 20%-30% of the women with breast cancer have a family history and the history does not suggest heredity in most of the cases. Actually, heredity is responsible only for 5-10% of all cases of breast cancer, that is, a congenital problem in the DNA genes is inherited. Women with a hereditary history present an 8 times higher probability to have the disease and the appearance of two or more different cancers is possible. In hereditary cancers, the mutated gene is transferred to the offspring via the genetic material (ovum / sperm) and every child has a 50% probability to inherit the defective gene if one of the parents is a carrier and 75% if both parents are carriers.
Every woman, independently of her family history, should have repeated screenings in organized “One-Stop” Breast Units by Oncology Surgeons, Radiologists, Cytologists and Pathologists even if there are no symptoms, as this will show the disease in its very early stage. These units guarantee reliable diagnosis and full therapy, resulting in a 25% decrease in the mortality rate during the last ten years.
Screening, known as the “triple test”, includes: (i) clinical examination by doctors specialized in breast diseases, (ii) imaging by digital mammography, ultrasound and MRI scan of the breast, and (iii) fine needle aspiration (FNA) or core biopsy (under local anaesthesia) to allow cytology and histology of the specimen, respectively. When the three tests give consistent results, a definitive positive or negative diagnosis can be given 99% of the time. 70% of the tumours discovered by screening are asymptomatic, while 30% are at an early stage, therefore measure less than one centimetre. Also, approximately 20% of these tumours are not infiltrating (DCIS). Finally, the positron emission tomography (PET) scan, is the most recent technology used in special cases for the clinical staging of the disease.
The timely diagnosis of the disease results in an excellent prognosis in 80%-90% of the cases. However, in addition to better prognosis, there are also other advantages stemming from the early detection of the cancer by screening. For instance, the small dimensions of the lump allow the removal of a small fragment from the breast and mastectomy is avoided, and provided there are no metastases in the lymph glands of the axilla, no combined chemotherapy is usually needed.
Concerning the evolution of therapeutic methods, new drugs guarantee targeted therapies which electively suppress the development of the cancer cells and do not allow them to spread, without mandatorily killing them, in contrast with chemotherapy, which attacks all cells without exception. Targeted therapy renders chemotherapy more effective in smaller and thus less toxic doses. Hormone therapy is a kind of targeted therapy aiming to restrict the action of oestrogens which stimulate the proliferation of the tumour cells. Also, the monoclonic antibodies, always in conjunction with chemotherapy, are added to the arsenal fighting the disease, either preventing the rate of proliferation and the aggressiveness of the cancer cells or used against the vascularisation of the tumour, causing the shrinkage of the tumour due to bad blood supply.
Consequently, women should not be afraid of breast cancer as, in spite of the alarming increase in the frequency of this disease, improvements of the diagnostic technology and strengthening of the therapeutic arsenal contribute to the progressive decrease of the number of deaths due to this disease. Thus, mortality due to breast cancer decreases by 2% annually. Furthermore, factors such as a healthy diet, control in hormone use, limiting stress, avoiding irradiation, less alcohol consumption, a normal body weight and exercise are important factors considerably preventing the development of the disease.
Oncology and Vascular Surgeon