ESO - Certified Breast Cancer Specialist Master in Molecular Oncology
Why is it important to keep talking about breast cancer?
Breast cancer is the most common malignant disease in women worldwide, with approximately 2.3 million new cases each year. October symbolizes breast cancer awareness, but taking care of your health should not be limited to just one month. The most important message is that breast cancer, if detected early, can be successfully treated.
What are the most important risk factors for developing breast cancer?
The risk increases with age. Family history, inherited genetic mutations, early first menstruation, late menopause, certain reproductive and hormonal factors, higher breast density, excess body weight after menopause, regular alcohol consumption, and physical inactivity are important. However, it is important to know that breast cancer can also develop in women without identifiable risk factors.
What do we mean by primary prevention?
Primary prevention means reducing the risk factors that we can influence. Here we primarily consider regular physical activity, maintaining a healthy body weight, a balanced diet, avoiding alcohol and smoking. Breastfeeding is also associated with a reduced risk. Adopting this lifestyle does not provide complete protection or the elimination of the possibility of developing the disease, but it has a great impact as a personal investment in health care.
What is secondary prevention and when should screening begin?
Secondary prevention involves early detection of the disease, before symptoms appear. Mammography is the primary screening method; in many recommendations, screening begins at age 40, and the interval is determined according to the national program and individual risk. Ultrasound diagnostics is an additional method that may be indicated, and in women with high hereditary risk and dense breasts, magnetic resonance imaging and earlier initiation of monitoring are sometimes necessary. Being familiar with the normal appearance and feel of your breasts is extremely important, breast self-examination is also important and should be performed once a month, but it does not replace mammography.
What breast changes require a medical examination?
The appearance of a new lump in the breast or armpit, a change in the size or shape of the breast, indentation of the nipple, spontaneous discharge, redness, thickening or the appearance of the skin like “orange peel” are reasons for an examination. We should keep in mind that not every lumpy change is a malignant change, but it is also important to remember that early cancer often does not cause pain or other symptoms. Therefore, the recommendations say – you should not wait for the change to become painful.
What is the role of the inherited BRCA1 and BRCA2 mutations?
BRCA1 and BRCA2 are genes involved in the repair of DNA damage. Pathogenic inherited variants in these genes significantly increase the risk of breast and ovarian cancer, but a positive result does not mean that the disease will inevitably develop. Other genes are also important, such as PALB2, TP53, CHEK2 and ATM. Inherited mutations explain only a small proportion of all breast cancer cases.
Who should consider genetic testing and what happens after a positive result?
Genetic counseling and testing are considered in individuals with a strong family history, breast cancer at a younger age and under 60 years of age, triple-negative cancer, breast cancer in men, and other features that suggest a hereditary syndrome. The criteria depend on current professional guidelines. If a pathogenic mutation is confirmed, an individual plan is made for enhanced controls/screening, possible surgeries to reduce the risk, and counseling of family members. Preventive surgery is not automatically mandatory for every carrier.
How is the diagnosis made and why is a biopsy important?
Diagnosis involves a clinical examination, an appropriate diagnostic procedure – mammography and/or ultrasound – and, in case of suspicious findings, a core needle biopsy. The biopsy confirms the diagnosis and enables the determination of the tumor’s biological characteristics, including hormone receptors and HER2 status. Together with the stage of the disease, these information are the basis for selecting the most appropriate treatment.
How is breast cancer treated today? Does every patient receive chemotherapy?
Treatment is personalized and planned multidisciplinarly. It may include surgery, radiotherapy, chemotherapy, endocrine therapy, HER2-directed and other targeted therapy, or immunotherapy in appropriately selected patients. In some cases, systemic therapy is started before surgery, while in others it is administered afterwards. Not every patient needs chemotherapy, radiation, or mastectomy. The aim is to achieve the greatest possible benefit with the least possible burden of treatment.
What is the prognosis and what message would you like to share with women?
When the disease is detected early, the chances of successful treatment are very high. Even in advanced stages, there are therapies today that can control and turn the malignancy into a chronic disease while maintaining patients’ quality of life.
My message is: love yourself, get to know your body and listen to it, stay informed and do not postpone examinations. We should not fear finding out about the disease, but rather the missed opportunity to act in time. Early detection saves lives.