Facts and myths about breast cancer. What should you know about this neoplasm?

You think you’re young so he doesn’t concern you? Are you breastfeeding, so are you protected against it? If you get sick, thanks to a mastectomy (i.e. complete removal of the breast) you will not only get rid of it, but you will also be sure that it will not come back? Or you will not undergo surgery at all because you will surely get angry and affect other organs?

More and more are being said about breast cancer, incl. through patient organizations, educational campaigns, forums and websites, but there are still many myths about him. We asked experts – oncologist Dr. Agnieszka Jagiełło-Gruszfeld from the Oncology Center – Instytut im. Maria Skłodowskiej-Curie and the oncologist surgeon – prof. dr hab. n. med. Rafał Matkowski from the Lower Silesian Cancer Center about the myths about breast cancer, which they most often encounter when working with oncological patients.

Breast cancer is a sentence [MYTH]

Compared to other cancers, the cure rate is very high in breast cancer. 5-year survival rates in countries with the highest standards of oncological treatment can be as high as 90%! In Poland, access to modern and effective therapies is also improving, thanks to which patients can be better treated, and in some cases even cured. However, for this to be possible, patients must see a doctor as soon as possible – the earlier the stage of the tumor, the greater the chance of a cure. Moreover, the possibility of a complete cure for breast cancer depends on the biological subtype, the determination of which is crucial for the entire therapeutic process. The subtypes with the highest risk of recurrence are triple negative and HER2 positive breast cancer. Fortunately, in Poland, in the case of HER2-positive breast cancer, effective immunotherapy is available against the HER2 receptor in combination with chemotherapy, which significantly improved the prognosis of patients with this subtype. In the case of diagnosis of early breast cancer, patients are often treated with systemic treatment before surgery, i.e. neoadjuvant therapy, which is in line with the recommendations of many scientific societies. Such therapy allows, among others to quickly assess the effectiveness of treatment and reduces the size of the tumor, which is of great importance when deciding on the type and scope of surgery.

See also: Women with the so-called thick breasts have a chance to win over breast cancer

Thanks to modern therapies, even patients whose cancer is in an advanced, incurable stage can survive for many years and, despite the disease, enjoy a good quality of life. New treatment options have led to the fact that even metastatic breast cancer, formerly rapidly killing the patient, has now become a chronic disease that is manageable for many years, such as diabetes, hypertension and heart disease.

Breast cancer is one of the leading causes of death among women [FACT]

Breast cancer is the most common malignant tumor among women. It accounts for approximately 23% of all cases in Poland and is responsible for approximately 14% of deaths due to malignant neoplasms in women. It is estimated that around 1,7 million women are diagnosed with breast cancer each year. Over 500 people die because of it.

Mortality from breast cancer has been increasing recently in Poland [FAKT]

In Poland, breast cancer is diagnosed in 19 thousand. women, which means that every day over 50 Polish women learn about the disease, and 15 die every day.

While the number of cases in Europe is increasing, but mortality is decreasing, in Poland, with more patients suffering from breast cancer, mortality is also increasing. According to the report of the National Institute of Health-PZH in Warsaw published in 2019, the death rate from this cancer increased by 2010% in 2016-7,2. Unfortunately, the forecasts for the coming years are not optimistic – it is estimated that the mortality rate will continue to increase. This negative trend may have many reasons – from the still low awareness of prevention, to the issues of organizing care for patients and access to modern therapies. The latter is improving – an example is the extension of access to the so-called of double blockade in early HER2 positive breast cancer.

Thanks to the development of modern medicine, we can talk about breast cancer not only as a chronic disease, but also a curable one. An example is the HER2-positive subtype, which affects approximately 18-20% of women with breast cancer. On the one hand, it is an aggressive subtype that is rapidly expanding and metastasizing, but on the other hand, it responds well to HER2-directed therapy. Until now, patients had the opportunity to use the so-called single blockade – a drug that appeared several years ago and which changed the treatment and improved the prognosis of patients with HER2-positive breast cancer. It blocked the HER2 receptor located on the surface of the tumor, preventing it from transmitting signals that stimulate excessive cell division and multiplication. Today, this drug is combined with another and together they form the so-called HER2 dual blockade. Such a combination not only inhibits tumor growth, but also leads to tumor shrinkage, and in some cases even to its complete disappearance! After the implementation of double blockade, the percentage of patients achieving the so-called pCR by up to 15-30% in relation to the so-called single lock. PCR (Patological Complete Response), the so-called the complete pathological response is that in the histopathological examination of the removed breast or its fragment, and in the lymph nodes, there will be no cancer cells. Patients who achieve a complete pathological response have a better prognosis and a greater chance that breast cancer will not recur. They are also more likely to undergo less extensive surgical procedures, i.e. sparing treatment instead of mastectomy and sentinel node excision instead of complete removal of axillary lymph nodes.

Also read: Male breast cancer: diagnosis always comes as a shock

Each detected tumor is a cancer [MIT]

Not every lesion in the breast is necessarily cancer. Most of the changes found in the breasts are benign and do not require treatment (e.g. a cyst, fibroadenoma or a fatty lobe) and do not pose a threat to the woman’s health and life. However, each change in the breast should be immediately consulted with a doctor who will decide on any additional tests.

Cancer is afraid of the knife [MYTH]

Because of this myth, many women are afraid to undergo surgery. They believe that when a surgeon “touches” the cancer, it will become active and rapidly metastasize to other organs. This opinion is not supported by scientific evidence. On the contrary, surgery is one of the most important steps in the treatment of breast cancer. Currently, surgery is often postponed until preoperative neoadjuvant treatment is carried out, which may bring greater benefits to the patient. After preoperative treatment, the scope of surgery may very often be less extensive and therefore less disastrous.

Thanks to the discovery of the subtypes of breast cancer, treatments are more precisely selected. It is already known that poor prognosis subtypes (such as HER2-positive) achieve significantly better results when treatment is started with chemotherapy in combination with targeted therapy, whereby the tumor may shrink. Only after this stage, a surgical procedure is performed: mastectomy or conserving procedures depending on the size of the tumor and the stage of the tumor. It can be summed up this way: surgical treatment works “locally”, and preoperative and postoperative therapy (so-called adjuvant or adjuvant therapy) affect the entire body, so even if there are micrometastases – the therapy should destroy them, which cannot be achieved by independent surgery.

Mastectomy is the only effective treatment for breast cancer [MIT]

There is a belief among patients that if they have breast cancer, which develops rapidly and metastasizes, mastectomy will not only get rid of the cancer, but also ensure that it will never come back. Meanwhile, the optimal treatment is surgery, very often in combination with systemic treatment (before and / or after surgery), and depending on the individual situation – complementing the therapy with radiotherapy. Often – especially in patients with HER2-positive cancer or the so-called triple negative – preoperative systemic treatment, i.e. chemotherapy (plus targeted treatment in the HER2-positive subtype), followed by surgery. Such a breast cancer treatment regimen can allow a woman to keep her breast, which is of great importance for her sense of femininity and self-confidence, so you should not be afraid of this method of treatment. Currently, in most cases, surgery alone is not used without systemic therapy (hormone therapy or chemotherapy often combined with other groups of drugs).

Treatment (neoadjuvant) with double blockade is now available for Polish women [FAKT]

It’s true – the double blockade was included in the September list of reimbursed drugs, and since November it has been available for women with early HER2-positive breast cancer. Patients will now receive 2 HER2 blockers (in combination with chemotherapy), which may improve the prognosis in this group of patients. This means a chance for a larger group of patients to undergo breast-conserving surgery and not to perform axillary lymphadenectomy (i.e. complete removal of the axillary lymph nodes). This translates into fewer complications, shorter recovery time and better cosmetic effect after surgery.

Only a surgeon can order a biopsy [MYTH]

The biopsy is most often performed by a surgeon, radiologist or pathologist based on the result of a mammogram. However, all doctors, including GPs and gynecologists, can refer a woman with a breast tumor to an oncology center for diagnostic tests. This does not mean that a biopsy will be performed there immediately, but specialists from the center will conduct imaging tests (mammography and / or ultrasound) and on their basis they can determine whether the lesion is benign or suspected of being a malignant lesion. In the latter case, of course, the biopsy will be performed in a given center. Only the so-called core-needle biopsy has a diagnostic value, as the obtained material allows the assessment of the histological type and degree of cancer differentiation in most cases; determine the state of steroid and HER2 receptors and the proliferation index; histological confirmation of benign character in the case of mammographically detected lesions (e.g. microcalcifications) and prognostic and predictive factors using additional immunohistochemical or molecular tests. Knowing these factors before starting treatment for breast cancer is very important and significantly increases the chances of recovery and improves the cosmetic effect of the treatment and reduces the number of complications. It is a mistake to start breast cancer treatment without a prior biopsy!

On the other hand, the examination of the material collected with the use of fine needle aspiration biopsy (BAC) allows for microscopic diagnosis of cancer cells, but no longer allows for the differentiation of invasive and pre-invasive cancers, their subtypes or for a fully reliable assessment of HER2 status (only the assessment of the state of estrogen and progesterone receptors). Fine-needle biopsy is also associated with a higher risk of false-positive and false-negative results – it should not be used in the diagnosis of a breast tumor. In Poland and most countries with a high level of development of medical care, the guidelines in force for oncologists consider the fine-needle biopsy of the breast tumor and relying on its results in determining the treatment of breast cancer as a mistake. For this reason, the method is not recommended in patients qualified for systemic induction treatment. This method is only applicable to the determination of the stage of breast cancer (fine-needle biopsy of the lymph nodes) and the assessment of metastatic foci in patients with diagnosed primary breast cancer.

Surgical breast conserving treatment is as effective as mastectomy [FACT]

Breast conserving therapy (BCT) is a method recommended in all cases in which there are no contraindications to such treatment (e.g. inflammatory cancer; carrier of BRCA1 or BRCA2 gene mutations in premenopausal women is a relative contraindication to breast conserving therapy) and especially in women under the age of 35). Conservation treatment includes: breast conserving surgery; diagnostic and therapeutic treatment of the axillary lymph nodes; postoperative radiotherapy. Conservation treatment should be carried out only in centers where there is full cooperation of the surgeon, radiotherapist, radiologist and pathologist. If the patient qualifies for this form of treatment and the center is unable to provide it, she should be referred to another facility where this is possible. Many recent observations indicate that patients with the same degree of disease advancement after conserving treatment have a better prognosis (greater chances of recovery) than patients after mastectomy! The indisputable benefit of the sparing treatment is a better quality of life and a better cosmetic effect after surgery.

I am young, no one in my family was ill, I take care of myself, so I am not in danger of breast cancer [MYTH]

Unfortunately, breast cancer can occur at any age. The most cases are among women 50+, but it is also sporadic in 20- and 30-year-old women. As young women also suffer from the disease, early education – in primary or secondary schools – about the need for oncological vigilance and knowledge of the symptoms of breast cancer (breast tumor, skin ulcer, nipple blood loss and / or tumor in the armpit or neck area) is essential. ). It is important to realize that this is a disease where time counts, and early detection enables its complete cure.

Breastfeeding protects 100% against breast cancer [MYTH]

Breastfeeding reduces the risk of breast cancer but does not protect you 100% against it. Women who are breastfeeding should be alert to any changes in their breasts – many women treat the enlarging tumor as a consequence of breastfeeding. It should be remembered that breast cancer is one of the most frequently diagnosed tumors in pregnancy and in the postpartum period.

Prophylactic mastectomy protects 100% of women at risk from breast cancer [MIT]

Prophylactic mastectomy is considered in women with mutations in the genes that significantly increase the risk of breast cancer, ie BRCA1 and BRCA2, and other, less frequent, mutations. Bilateral prophylactic breast amputation reduces the risk of breast cancer by more than 90% in the group of women who are carriers of the BRCA1 / 2 mutation.

During a surgical procedure, it is never certain that the glandular tissue has been 100% removed. There are always a few% of the glandular tissue left after surgery, from which cancer can develop. So, prophylactic mastectomy is a mastectomy that reduces the risk of disease, not completely eliminates it. That is why it is so important to educate women after prophylactic mastectomy – that every change in the breast or armpit area should be reported to a doctor for consultation in an oncology center. In Poland, people with identified carriers of these genes are monitored in a specially developed and conducted in cancer centers program of care for carriers of pathogenic mutations that increase the risk of developing cancer. Therefore, it is important to know about family history of cancer.

Surgical treatment options for breast cancer in BRCA mutation carriers include: conserving treatment, amputation of the breast, possibly with a risk-reducing amputation of the other breast. The choice of one of these approaches depends on the risk of local recurrence, the risk of developing cancer of the other breast, the potential benefits of prophylactic breast amputation, and the factors that modify the risk of recurrence and cancer of the other breast.

There are no absolute contraindications to conserving surgery in BRCA mutation carriers. However, these patients should be informed about a higher risk of developing independent cancer of the same breast and cancer of the other breast. The risk is greater in younger women. Prophylactic second breast amputation reduces the risk of recurrence and developing a second independent neoplasm, and scientific evidence suggests that it may benefit overall survival.

However, it should be remembered that these operations can be a source of complications and significantly deteriorate the quality of life. Therefore, the decision to perform a mastectomy is individual and regardless of the procedure or not, the patient must be included in the follow-up program. Each carrier of these mutations must also consider surgery to remove the ovaries and fallopian tubes to reduce the risk of ovarian cancer. This operation has proven effectiveness, but because it can also lead to complications, the decision to perform it is always made individually.

Biopsy spreads cancer [MYTH]

There is no scientific evidence to support a core-needle biopsy of a breast tumor spreads cancer. On the contrary, since it appeared in the diagnosis, the results of breast cancer treatment have improved significantly. Currently, all scientific societies recommend this method as the basic method in cancer detection. However, it is not recommended to perform a fine-needle or surgical biopsy, which should only be performed when a core-needle biopsy is not possible.

After detecting the disease, you need to act quickly [FACT]

Breast cancer is a disease where time is of the essence. Cancer can progress quickly and metastasize, so action should be taken as soon as possible. This does not mean that the woman will undergo treatment the next day – for an oncologist, the most important thing is to collect all possible data on a given tumor (including subtype, degree of malignancy, state of receptors). Research may take up to several weeks, but this time is necessary to gather all the important information on the basis of which the best anti-cancer and supportive treatment strategy will be selected. At the same time, it is important to start such diagnostics not only quickly, but in the right center – preferably in a center where there is a so-called Breast Unit, in Oncology Centers or other centers that guarantee comprehensive care at every stage of the disease, from diagnosis through anticancer treatment, palliative treatment, psychological support and rehabilitation. If a woman performs some of the diagnostic tests elsewhere, it is possible that the center that will eventually receive treatment will want to repeat some or even all of the tests, which may extend the time to start treatment. The experience of oncologists shows that the problem is not the diagnosis, sometimes lasting several weeks, but the delay in reporting to the doctor from the first suspicions of the disease. Patients delay seeing a doctor, sometimes even for several years! Many people also neglect participation in the free Population Breast Cancer Detection Program, which has been conducted in Poland since 2006 for women from 50 to 69 years of age. Meanwhile, the so-called prophylactic mammography allows you to detect breast cancer at an early stage of development, when it does not show any symptoms apart from changes in the mammogram.

Changing the organization of care for patients with breast cancer, the so-called Breast Units helps to improve treatment outcomes [FACT]

Breast Units are modern centers that offer comprehensive treatment of breast cancer. They gather in one place experienced specialists in the field of oncological surgery, clinical oncology, radiotherapy, pathomorphology, diagnostics, and have appropriate rehabilitation facilities, as well as offer psychological support. Treatment decisions are made here by a team of doctors during the so-called a council in which not only the patient but also her relatives can participate. These centers have the best results in treating breast cancer.

In Poland, access to modern breast cancer therapies is limited compared to other European countries, although progress is already visible [FACT]

Until recently, Poland was in a worse situation than other European countries due to the lack of access to modern therapies for patients with early and advanced breast cancer. From September 1, drug programs include modern therapies for these two groups of patients, which both patients and doctors who hope to improve treatment outcomes are happy with.

There are still patients waiting for new therapies recommended by Polish and international guidelines for the treatment of breast cancer. An example is the group of women with advanced HER2-positive breast cancer and immunoconjugate therapy, which is currently only available under the so-called emergency therapy (RDTL). However, this is not an optimal solution, as it exposes the patient in the advanced stage of the disease to the loss of valuable time while waiting for the application to be approved. Rescue therapy is also not available for patients with an earlier stage of disseminated disease, where the treatment outcomes are better.

Education of patients with breast cancer is important from the moment of diagnosis [FACT]

After hearing a diagnosis of breast cancer, many women start looking for information on their own. Of course, this is not a bad thing, but with many websites, support groups and forums, it is difficult to verify which information is true and accurate. Under the influence of different content, women begin to fear the different stages of treatment and what they may bring.

It is especially dangerous to undergo some unconventional treatments, often touted and advertised on social media as safe and effective alternatives. Most of the unconventional / alternative methods are ineffective or harmful and usually reduce the chances of recovery.

Therefore, it is good that patient organizations create educational programs and campaigns aimed at women who are struggling with diagnosis. An example of such a campaign is “Heal HER2 + Breast Cancer”, which targets women with this aggressive cancer subtype that often requires combination therapy and neoadjuvant (preoperative) therapy. It is made up of three leading oncological patient organizations: the Federation of Amazon Associations, the Onkocafe Foundation and the Polish Amazonki Ruch Społeczny. The content posted on the website (www.wyleczrakapiersi.pl) or on the Facebook profile (Treat breast cancer HER2 +) is consulted with experts in the field of oncology and concerns not only the disease itself, but also diagnostics, communication and support. Such activities are needed – the doctor unfortunately has a limited time for each patient and may not be able to convey everything to her. Meanwhile, this education, from the moment of diagnosis, is of key importance. It allows a woman to prepare for treatment and what it will bring, and to be an active participant in making therapeutic decisions.

Substantive consultation – dr Agnieszka Jagiełło-Gruszfeld, Centrum Oncologii im. Maria Skłodowskiej-Curie in Warsaw and prof. dr hab. n. med. Rafał Matkowski, Head of the Breast Surgery Department at the Lower Silesian Oncology Center and the Medical University of Wrocław.