Breast cancer

Summary/Epidemiology

Breast cancer affects about one in nine women in Europe. In Belgium, more than 10,500 new cases are diagnosed each year, of which 1% are in men. Two thirds of these cancers occur after the menopause, one third before it.

The diagnostic and therapeutic approach to breast cancer requires the participation of multiple specialists forming a multidisciplinary group, who, together and for each individual case, define the best strategy to adopt.

Risk factors

In 5 to 10% of cases, the occurrence of breast cancer is influenced by hereditary factors. In the case of a high hereditary risk, special care is recommended. This is called "Women at Risk" follow-up.

Breast cancer can also be promoted by hormonal factors. For example, early menstruation and late menopause increase the period of estrogen exposure and are risk factors for breast cancer. A late first pregnancy, the absence of a pregnancy, the use of prolonged hormone treatment at menopause, and obesity may also play a role.

Finally, the risk of developing a breast cancer is increased in some benign breast diseases, while some studies incriminate an excessive consumption of alcohol or fat, or a lack of physical activity.

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Diagnosis

Anatomopathology

Anatomopathological examination consists of a detailed analysis of the cells under the microscope. It makes it possible to distinguish between a benign lesion and a malignant or cancerous lesion. A diagnosis of cancer must always be confirmed by this type of analysis. The anatomopathologist therefore plays a major role in the diagnosis of cancer. This examination also helps to determine the exact type of breast cancer the patient has. Finally, it allows looking for the presence of hormone receptors and the overexpression of HER2. This information is nowadays essential to choose the most appropriate treatment.

Radiology

Radiological examinations (mammography, ultrasound, MRI, punctures and biopsies) play a major role in breast cancer screening. They are also very useful in the follow-up of patients, during treatment and later when they are in remission.

Screening

Breast cancer remains the leading cause of death in women between the ages of 50 and 69. One in 9 women may develop breast cancer and its early detection can greatly increase the chances of cure and survival. Early breast cancer does not give any symptoms. Screening is therefore very important. Learn more.

Symptoms

Initially, breast cancer does not cause any symptoms. It is diagnosed during screening. Later on, it can manifest itself by a small nodule, pain, a change in color, a retraction of the nipple, etc.

Treatments

Oncological treatment is discussed in multidisciplinary meetings. It may include surgery, chemotherapy, targeted therapy, hormone therapy, or radiotherapy.

Breast cancer surgery is a cornerstone of therapeutic management. It is part of a multidisciplinary approach and includes different components.

The treatment of the early stages of the disease is based on the principle of minimal and oncologically correct surgery to remove the tumor while restoring the morphology of the breast. It is performed by the gynecology team trained in breast surgery.

Depending on the patient's wishes, these interventions can be performed under hypnosis and local anesthesia in collaboration with our referring anesthesiologists (www.hypnose-saintluc.be).

For interventions requiring breast removal, our team favors, whenever possible and always respecting the patient's wishes and medical contraindications, immediate reconstruction. We collaborate with the plastic surgery team.

The plastic surgery team offers all types of breast reconstruction: implants, lipofillings, musculocutaneous flaps, and free flaps.

Our multidisciplinary team is also very experienced in the management of locally advanced diseases and in the surgical management of oligometastatic diseases. These complex surgical procedures are of course part of a multidisciplinary approach and surgery is very often performed after neoadjuvant treatment to ensure optimal control of the disease.

This type of surgery involves reconstructive surgery, thoracic and vascular surgery , and ENT oncologic surgery.

These options are often combined and vary according to the type of cancer. It is therefore important for all specialists to choose the most appropriate approach, taking into account the characteristics of the tumor and its extension.

If surgery is chosen, the procedure is as conservative as possible. It is sometimes preceded by chemotherapy. It can often be performed under hypnosis. After surgery, the multidisciplinary team meets again to decide on the next step in the treatment: radiotherapy, chemotherapy with or without radiotherapy, hormone treatment, etc.

The patient's general health status must also be taken into account. In particular, elderly patients benefit from a geriatric assessment and oncogeriatric consultation in order to adapt the cancer treatment and address geriatric frailties if necessary.

Chemotherapy can have a harmful effect on fertility. This is an important aspect to consider since breast cancer is likely to affect young women. Various techniques, such as embryo and oocyte cryopreservation, now make it possible to preserve the function of the ovaries and the chances of pregnancy. These techniques have been developed by the multidisciplinary team of the Cliniques Universitaires Saint-Luc in charge of infertility and are offered to patients treated in our center.

Finally, breast reconstruction after tumor removal is also very important. It requires the cooperation of esthetic surgeons who are familiar with modern techniques that allow them to carry out sometimes complex operations.

Research and innovation

The multidisciplinary breast cancer team is involved in numerous international studies related to new treatments. These include chemotherapy, hormone therapy, and more recently, therapies that specifically target tumor cells while sparing surrounding healthy cells, called "targeted therapies", and immunotherapies, which stimulate the patient's immune system to fight the disease more effectively. See the studies currently underway HERE.

The treatment of breast cancer involves a number of different areas, including research. Thanks to the support of the Saint-Luc Foundation, Dr. Françoise Derouane is trying to better understand why drug treatments work well in some breast cancer patients, while they are less effective in others. To achieve this, she creates organoids, sort of miniature reproductions of a breast cancer, and analyzes them to better decipher their complexity. Explanations in images opposite.

Breast cancer and pregnancy

In very rare cases, breast cancer can be diagnosed during pregnancy. This is obviously an extremely stressful situation for the patient and her partner. Our multidisciplinary team is fortunate to be able to call upon the expertise of a team of obstetricians specialized in the management of pregnant patients with cancer. Contrary to popular belief, many treatments can be administered during pregnancy without impacting the mother or her child. It is important to consult quickly in these situations so that our multidisciplinary team can propose the best strategy, both for the treatment of the cancer and for the future of the pregnancy.

Breast cancer and sexuality

Breast cancer and its treatments also have an impact on sexuality and intimacy.

However, the medical team does not address these potential difficulties from the outset.

First, the announcement of the diagnosis and the shock of this announcement sometimes force the patient to face a lot of practical questions or fears that relegate sexuality or any intimacy to the background.

Surgical treatments, whether they are conservative surgeries or mastectomies, can affect body image and self-esteem.

Radiotherapy with its daily sequences requiring the patient to uncover her chest every day to face the machines and the medical staff can have an impact on body image as well.

Chemotherapies cause dryness of the mucosa, including the vaginal mucosa (disturbance of arousal), and have an impact on libido (disturbance of desire) and the quality of orgasm or sexual satisfaction. All this is related to the fatigue caused by the treatment or to the disturbance of the menstrual cycle, etc.

Hormone therapies can also have an impact on the menstrual cycle; there will be physical effects such as vaginal dryness and/or psychological effects such as decreased libido.

Our multidisciplinary team can call upon a sexologist specialized in the management of patients with breast cancer, and this whether the patient is in a couple or not.

Breast cancer and physical activities

The regular practice of physical activity decreases as soon as the cancer is announced and this decrease persists throughout the management of the cancer.

Maintaining a good general condition is, however, a key factor in improving well-being, relieving fatigue, reducing anxiety and depression, as well as decreasing weight gain and cardiovascular risk.

It is also worth noting that maintaining physical activity is now recognized as an important positive prognostic factor in women treated for breast cancer.

Evaluation of the quality of the results and the quality of life of the patients

The tools available today for the diagnosis and treatment of breast cancer are both powerful and complex. Therefore, their use requires quality control.

A dashboard with various indicators ensures that the right treatments are chosen. Data on the number and types of surgical treatments, the incidence of recurrences, and the incidence of complications related to chemotherapy or radiotherapy are kept and regularly analyzed.

The surgery is also evaluated on the basis of several criteria. Examination of the data collected makes it possible to compare the activity of the multidisciplinary team with that of other international reference centers and to ensure that the strategy followed is not associated with an abnormal number of adverse effects, complications, or recurrences.

Finally, European guidelines have been defined for the diagnosis and treatment of breast cancer. They relate to the clinical pathway that each patient has the right to expect. Thus, according to these guidelines, every woman with breast cancer must be managed within one month of her diagnosis. Time limits are also defined for the different steps of assessment and for the sequencing of treatments. Compliance with these standards is important because it has an influence on the evolution of the disease: a delay in the initiation of treatment can have a deleterious effect. Meeting the European standards therefore allows the optimization of the patient's clinical course.

Controls are essential to guarantee the quality of the care provided. It is in this context that the Breast Clinic has obtained European accreditation (Eusoma).

More recently, it appeared that it is essential to monitor not only the quality of treatment results in terms of recurrence risk, but also in terms of patients' quality of life. Within the framework of the ICHOM program, the Breast Clinic is currently developing an online quality of life data collection tool. Concretely, in the near future, new patients treated for breast cancer in our institution will be asked to fill out questionnaires at regular intervals, the objective of which will be to measure the impact of the treatments administered on their quality of life. These data will allow us to further improve the proposed management.