What methods are currently used to treat early breast cancer? And what is their effectiveness? The statistical data inspire optimism, because thanks to education and extensive screening tests, a group of patients with cancer diagnosed early has a better chance of winning the disease. We are talking about the treatment of early breast cancer with Dr. Katarzyna Pogoda from the Department of Breast Cancer and Reconstructive Surgery of the Oncology Center - Institute in Warsaw.
- What does early breast cancer mean and how many women in Poland does it affect?
Katarzyna Pogoda:All breast cancer patients are divided into two main groups. One, very large part, over 90% of patients, suffer from non-advanced breast cancer. The rest, i.e. about 6-7%, are patients with advanced, metastatic breast cancer. The first group of women diagnosed with early surgical or locally advanced breast cancer are women who are treated with the intention of a cure. We can use various methods of treatment - surgery, radiotherapy, chemotherapy, targeted therapies or hormone therapy.
- What are the types of cancer and their prognosis?
Katarzyna Pogoda:In order to treat breast cancer well, certain hormone receptors should be determined: estrogen and progesterone, and the HER2 receptor. With these receptors and the Ki-67 proliferation index, we are able to tell how a given patient needs to be treated.
The sick can be divided into 3 groups. The most numerous group, over 70%, are women suffering from hormone-dependent breast cancer, i.e. in their breast cancer we find the presence of hormone receptors, and the HER2 receptor is negative. The second group of patients, approx. 18-20%, are patients with HER2-positive breast cancer - in this case it is important to use anti-HER2 therapy. The smallest group of patients are patients with diagnosed triple-negative breast cancer, which means that all three receptors are negative. It is a very aggressive cancer that requires intensive chemotherapy.
The prognosis of patients differs depending on the type of tumor, i.e. the expression of the aforementioned receptors. The aggressive subtypes are triple negative and HER2 positive breast cancer. In these cases, disease recurrence and distant metastases occur more frequently. In women who are hormone-dependentbreast cancer after surgery, radiotherapy or chemotherapy, we use hormone therapy for 5 or even 10 years.
These ladies are additionally secured during this time, although then a relapse may also take place. An important factor in patients with breast cancer is the condition of the regional lymph nodes, i.e. the axillary lymph nodes. If there were metastases in greater numbers, the risk of relapse is higher.
- You said that HER2-positive breast cancer belongs to the group of poor prognosis, but is there any chance of its cure?
Katarzyna Pogoda:Yes, over the years modern therapies have changed the perception of treating this type of cancer. Treatment has changed a lot, and the availability of modern drugs for the treatment of HER2 positive breast cancer has improved. It is difficult to compare the current research results to those that were carried out e.g. 10 years ago.
In the past, all women who could be operated on and when the tumor was not large - started with surgery. The so-called conserving treatment, i.e. only a small part of the breast with this tumor was excised or mastectomy was performed. In recent years, in the treatment of HER2-positive and triple-negative breast cancer, we start with the so-called preoperative therapy.
If we detect cancer larger than 2 centimeters in a woman or regional lymph nodes (axillary, supraclavicular) are clinically suspicious, we check with a biopsy whether there are indeed cancer cells. Then we can start treatment with preoperative therapy. Even in the case of such small, 2 cm long tumors, the patient receives chemotherapy combined with anti-HER2 therapy.
On the other hand, international recommendations say that in the case of such therapy, it is worth adding a second drug that also blocks the HER2 receptor - then the treatment is more effective in terms of tumor reduction, and the treatment itself is called double lock. In such therapy, the idea is for the tumor to disappear completely, that is, after the therapy, when the surgeon has operated on the small fragment where the tumor was located, there simply are no cancer cells. Then the prognosis in these patients is usually better.
To achieve a complete pathological response, it is worth reaching for a double blockade, which is more effective than one anti-HER2 drug alone in combination with chemotherapy.
- However, it is important that this cancer is detected early?
Katarzyna Weather:Of course, prevention is of great importance. The smaller the tumor, the greater the chance of recovery. Breast cancer isthe most common cancer of women for many years in Poland and in European countries. It is a type of cancer where prevention is really important because early detection is associated with better treatment outcomes.
In Poland, mammography is a test that is dedicated to the prevention of this disease - dedicated to women aged 50-69. Mammography is best done in one center so that subsequent tests can be compared with each other. Younger ladies who especially have a burdened family history, such as mom, sister or aunt who have had breast cancer or ovarian cancer, do well to have a breast ultrasound scan. The week after menstruation is the best time for this test. Remember that younger women also suffer from breast cancer.
- There is a lot of talk about double blocking in the world, but do women in Poland have access to it?
Katarzyna Pogoda:When it comes to perioperative treatment, it is sometimes referred to. Personally, I think a little too little. Fortunately, from September 1, 2022, double blockade treatment is reimbursed not only for women with advanced Her2-positive breast cancer, but also for patients in the early stages of the disease.
Science is moving much forward and we should take advantage of it. In the clinic where I work, we inform you about this possibility and some women decide to undergo this type of therapy. As doctors, we do our best to cure these women.
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Author: MoonDog
Dr Katarzyna Pogoda- works at the Department of Breast Cancer and Reconstructive Surgery at the Oncology Center - Institute in Warsaw. She specializes in clinical oncology and passed the ESMO exam in clinical oncology (2015). She opened a doctoral thesis on patients with triple-negative breast cancer. Her research work to date concerned patients with breast cancer with metastases to the brain and patients with triple-negative breast cancer (publications in foreign and Polish journals). She also conducts research on the care of young breast cancer patients and the quality of life in breast cancer patients.
He is a member of the editorial board of Medycyna Praktyczna - Onkologii. Scholarship holder of ESMO and ESO grants. In 2014, she completed a research internship at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in B altimore as part of the Avon Global Breast Cancer Clinical Scholars Program. In 2022, she completed the studies conducted by the European School of Oncology and Ulm University with a very good result, obtaining the Certificate of Competence of Breast Cancer. He is a member of ASCO, ESMO,PTOK and PTO. On behalf of the Clinic, she cooperates with the Breast Cancer Group at EORTC (member of the Steering Committee, Liasion with Quality of Life Group, currently during the 2-year Early Career Investigator Leadership Program training).