Help the development of the site, sharing the article with friends!
The approach to the treatment of advanced breast cancer has changed dramatically over the past 20-25 years. Most of all, our understanding of the biology of breast cancer has made tremendous progress. As a result, the treatment of patients was individualized, says Agnieszka Jagiełło-Gruszfeld, MD, PhD.
1. What do the terms "advanced breast cancer" and "metastatic breast cancer" mean?
Metastatic breast cancer is the stage of the disease in which it has distant metastases to various organs (e.g. lungs, bones, liver, brain). Advanced breast cancer is a slightly broader term, it covers a group of patients with metastatic breast cancer and situations where, although no metastases to distant organs are observed, the cancer is locally very advanced, e.g. breast ulceration has occurred, massive regional metastases have appeared. (i.e., axillary) lymph nodes. This term also applies to patients with the so-called inflammatory cancer, when the only symptom of breast cancer is the redness and thickening of the skin on the breast, making it appear to be inflamed and not cancerous.
2. How did the epidemic affect breast cancer diagnosis in the short term? How could it have an impact in the long term?
Unfortunately, the pandemic adversely affected the diagnosis of breast cancer. We can see that many women present themselves in more advanced stages of the disease than before the pandemic. This is due to many reasons. One is the fear of exposing yourself to an appointment at medical facilities, where you can expect numerous contacts with people potentially infected with the virus. Another objectively difficulties with performing diagnostic tests. Finally, there is also the fear of undertaking oncological treatment in the age of a pandemic. Patients are concerned that, for example, after receiving chemotherapy, they may become infected with Covid-19 more easily, or become much more seriously infected.
3. What has changed in the treatment of advanced breast cancer over the years?
The approach to the treatment of advanced breast cancer has changed dramatically over the last 20-25 years. Most of all, our understanding of the biology of breast cancer has made tremendous progress. As a result, the treatment of patients was individualized. The possibilities have emergedtargeted therapy among patients with HER2-positive cancers, which allowed for a significant extension of survival in this group of patients. The results of therapy in patients with hormone-dependent cancers also improved significantly. We offer a wide range of hormone therapy and hormone therapy in combination with molecularly targeted drugs. Finally, in the group of patients with triple-negative cancers, we can use immunotherapy.
Besides, the whole philosophy of approaching a patient with advanced breast cancer has changed. Therapies that have been known for a long time, but have been administered in the form of multi-drug, toxic regimens, are now being used. Now we are trying to treat patients in such a way that the treatment is well tolerated, i.e. we give drugs in small, metronomic doses. It has been proven that this approach is equally effective and much safer for the patient. The possibilities of local treatment (surgery and radiotherapy) are also used to a much greater extent, especially in the group of patients with the so-called oligometastatic disease - these are patients who have distant metastases, but they are few and their dynamics is low.
4. Why should the patient have a specific biological tumor subtype?
I cannot imagine how it would be possible to treat breast cancer today without knowing the biological subtype of breast cancer. We have a large assortment of drugs that are effective only in a specific biological subtype of this cancer and, in turn, completely useless in other cases. So implementing any systemic therapy without knowing what type of breast cancer we are dealing with is now an unforgivable mistake.
5. Is cancer treatment painful?
Where did this idea come from! Cancer therapies, of course, have side effects, as do all medications, but they are not painful. In the treatment of metastatic breast cancer, in many cases we can use drugs administered orally in the form of tablets or capsules. Other medicines are given into a vein as an infusion (drip) into a vein. We also have drugs that are given as subcutaneous injections (which the patient can take on their own) or intramuscularly.
6. Which he alth care facilities provide the optimal standard of care? What should the patient pay attention to when choosing a center?
It has been proven many years ago that in the case of diseases in which we have many treatment options, and at the same time the knowledge about their treatment develops very dynamically, much better results are achieved in dedicated centers that specialize in the treatment of a specific disease.At the same time, such a facility must have a full (or almost full) therapeutic range that can be used in a given disease. In the case of breast cancer, this role is played by institutions with the so-called Breast Cancer Unit. You don't need to have specialist knowledge to understand that such centers offer the highest standard of breast cancer treatment. It is important that patients, when making a decision about treatment, go to such centers, which systematically increase in Poland.
7. What is the impact of the patient on the choice of treatment method? What information should she provide to the doctor so that he can adjust the treatment regimen to his needs?
The patient should be a partner in therapy decisions. He should present to the attending physician his preferences regarding therapy, as well as provide information on accompanying diseases, medications taken, etc. Of course, sometimes it is not possible to meet all the patient's expectations regarding the therapy, but it is worth discussing your expectations and confronting them with the actual possibilities.
8. Is it possible to be socially, physically and professionally active in advanced breast cancer?
In most cases - yes. Many patients suffering from metastatic breast cancer work professionally, engage in physical activity and fulfill their social roles, which we strongly encourage them to do. Staying at home with the disease, giving up social contacts usually has a very negative effect on the mental state of patients, deepens depression and, as a result, worsens the results of cancer treatment. Of course, it cannot be concealed that there is a certain group of patients who have to introduce certain restrictions in their lives resulting from cancer (e.g. in professions related to manual work, practicing extreme sports, numerous business trips, etc.), but it makes no sense to give up attractions of life just because you have cancer.
Interview with Agnieszka Jagiełło-Gruszfeld, MD, clinical oncologist.
About the Advanced Breast Cancer Campaign. I know more
Educational campaign "Advanced Breast Cancer. I know More! " is addressed to both women diagnosed with advanced breast cancer and their relatives: family, friends and acquaintances. The initiator and organizer of the campaign is Novartis in cooperation with social partners: Federation of "Amazons" Associations, Polish Amazons Social Movement, Onkocafe-Together Better Foundation, Rak'n'Roll Winning Life Foundation and OmeaLife Foundation Breast cancer does not limit.
If you are struggling with the advancedbreast cancer or the disease has affected a loved one, go to the website: www.zaawodowanyrakpiersi.pl
See also:
Basic information about advanced breast cancer
Treatment of advanced breast cancer
Map of treatment centers in Poland