Prevention and the appropriate treatments have been shown to reduce the damage that breast cancer can cause. Thanks to prevention and care, the survival rate is clearly progressively increasing.

Attending a Centre of Excellence like IEO for prevention, early and accurate diagnosis of breast cancer and its biological characteristics, and treatments maximises the probability of complete cure.

The expertise in the diverse areas of Radiology, Surgery, Medical Oncology, Radiotherapy, Chemoprevention, Nuclear Medicine and other specialties involved in the management of breast cancer patients work together in order to define the best approach for every single case. Personalised diagnosis, treatment and follow up is the strategy that allows us to achieve optimal results in terms of cure, disease control, quality of life.

That's why the IEO Breast Program, which brings together all competent Divisions and Units in the prevention, diagnosis and treatment of breast cancer was created. Breast cancer treatment is multidisciplinary. It is not enough to speak only about surgery, radiotherapy or pharmacotherapy without integrating the various disciplines.

Non-palpable breast lesions

Very few precancerous lesions are known. Recognising these lesions helps intervene before the cells acquire tumour characteristics. Precancerous forms are called ductal intraepithelial neoplasia and lobular intraepithelial neoplasia (both formerly called carcinoma in situ). They are not capable of causing metastasis and their treatment is specific and personalised.

Diagnosis is usually radiological (often the lesion is small), and management is multidisciplinary, involving a breast surgeon, anatomy cess s and is well tolerated. Tpathologist, specialist radiologist, medical oncologist, pharmacoprevention expert and sometimes    a radiation therapist. Nuclear Medicine Physicians have a key role in localising the non-palpable breast lesions.

Ductal carcinoma and lobular carcinoma

The most frequent types of breast cancer are ductal carcinoma (in particular infiltrating ductal carcinoma) and lobular carcinoma. They are so-called because they derive from the ducts and lobules of the breast, respectively. There are other, less frequent types for which definition is important for treatment choice.

The most common symptoms of breast cancer

Breast cancer should not be discovered by symptoms. Early diagnosis means identifying problems before they appear as symptoms. Medical attention should be sought when one can see or feel:

• one or more nodules of the breast – by nodule we mean a circular hardening, a part that is differently textured from the rest of the breast, or a real lump, whether mobile or fixed.
• swelling or thickening of the breast or underarm area
• changes in the shape or size of the breast
• secretion of fluid from the nipple - the liquid can come out spontaneously (spots on the bra or clothing) or when the nipple is squeezed or touched, and may have different colours (white, transparent, yellow, green, bright red, dark red)
• changes in appearance of the skin, nipple or areola, such as dimples or retraction, swelling, redness, heat, cracking.

Breast pain is not usually a symptom of the disease. It is better to report it anyway for your reassurance.

Risk factors for breast cancer

Being predisposed to the development of breast cancer is associated with several factors.

• genetic factors are relatively rare, but of particular interest
• epidemiological factors of relative importance: family history, early age menstruation and late age menopause, no pregnancy or first pregnancy after the age of thirty, little or no breastfeeding, obesity and alcohol consumption.

Despite their importance, these risk factors are not sufficient to explain all cases of the disease.

Seventy per cent of breast cancer cases occur in women presenting no known risk factors, which is why it is right and appropriate that all women are informed about prevention, thereby deciding to adopt it with the help of specialist centres. Based on current knowledge, risk factors do not necessarily have an impact on the rate and type of early diagnosis, except in cases of genetic mutation. Prevention can save the lives of all women, regardless of risk factors.

The importance of prevention in breast cancer

At IEO, the primary prevention of breast cancer is promoted by integrating different approaches. A specific area of oncology is dedicated to prevention by studying and applying new strategies aimed at identifying individuals or family groups at high risk (genetic, familial, metabolic), people with precancerous lesions and patients of IEO at high risk of developing a second cancer. Personalised check-ups and close supervision of those who are at high risk forms part of the clinical activities of this specific area.

Primary prevention can prevent the onset and development of a disease. Primary prevention takes the form of adopting a behaviour (or taking a substance) that can reduce the risk of getting a disease. Breast cancer primary prevention is based on lifestyle and - still at the experimental stage - on taking certain substances in very high risk cases documented by positive genetic test. A correct lifestyle involves constant and regular exercise at least three times every week (60 minutes per session), abstaining from smoking and alcohol consumption and proper nutrition.

Secondary prevention is early detection. Discovering a tumour while still at an early stage, small and still non-palpable, means a high probability of complete cure with surgical and pharmacological treatments of minimal intensity and minor discomfort. However, if diagnosis is later there are still effective treatments available. An initial stage tumour has a higher chance of a full and complete recovery, but even those with a more advanced breast cancer have a good chance of controlling the disease in the long term with care and adequate follow up.

How to recognize breast cancer

Diagnosis is based on diagnostic tests and clinical breast examination. Whether it is prevention (early detection) or follow-up visits after treatments already received for breast cancer, these procedures are fundamental for all women.

The preventive bilateral mastectomy is not seen as a tool of standard prevention; the basis for effective prevention is personalisation. Depending on the rapport between the patient and the referring physicians, it may be possible to take the decision to remove both breasts in very high risk cases (positive genetic test) and in cases of particular requirements discussed with the person. The clinical breast examination is performed at the outpatient clinic of the Breast Division or at the outpatient office of one of IEO breast specialists. 

Breast cancer preventive nutrition

Thanks to the SmartFood project, healthy-eating based on scientific findings is explained and disseminated via events, publications, courses, and personalised advice. Ten recommendations for women's health were presented at the IEO women’s health event.

Personalized care for breast cancer treatment: excellence at IEO

The treatment of breast cancer is based on surgery associated with radiation therapy and pharmacological treatment, according to the specific situation. An element of excellence that characterises the IEO Breast Program is exact biological knowledge of each individual tumour before starting treatment. Breast medicine is a discipline that combines different competencies and specialisations that together determine every therapeutic decision and study or control for each patient.

A crucial moment in the personalisation of care is the multidisciplinary discussion among the members of the Programme: each single case is discussed in its specificity with the biological characteristics of the disease, physical characteristics and personal and family medical history and with distinguishing psychological needs and expectations.

The discussion occurs after surgery in the majority of cases, or before each type of therapeutic approach if the tumour has a diameter or local extension that requires a decision to be made between primary surgery or secondary surgery following drug treatment: for this, every time breast cancer is considered to be locally extended (for example if the diameter exceeds 2 cm), we proceed to the next microbiopsy with group discussion to determine the orientation toward surgery or neoadjuvant drug therapy.

Knowing the biology of the tumour is crucial so that every patient is given indications with the highest probability

of efficacy on the tumour with the least detriment to their quality of life.

IEO breast surgery leads the world in terms of operations performed each year. Seventy per cent of the  cases performed are quadrantectomy, or partial resection, i.e. removal of the breast lesion with a certain  amount of the surrounding healthy tissue. In 30% of cases, mastectomy must be performed, which is removal of the entire breast followed by immediate reconstruction via plastic-reconstructive surgery techniques.

ROLL

When the tumour is not palpable (micro calcifications or very small nodules), localisation techniques are used to avoid errors and unnecessary removal of healthy tissue: ROLL (Radioguided Occult Lesion Localisation), invented at IEO, is the most widely-used technique around the world with the best results, but it is possible to opt for preoperative skin marking of the part to be operated on.

Radiotherapy and mastectomy for breast cancer

When mastectomy is required, in the majority of cases IEO can provide immediate reconstruction using techniques that depend on the individual situation: cooperation between breast experts and plastic-reconstructive surgeons allows us to achieve the best aesthetic result following breast surgery. Breast-conserving surgery and, more rarely, mastectomy may be followed by radiation therapy.

Pharmacological treatments for breast cancer

The pharmacological treatments, that is chemotherapy and/or endocrine therapy and/or the so called receptor medications, depend on the histological examination related to surgery.

Updating page

Based on careful evaluation of results provided by scientific research, it has been possible to identify specific risk factors and protective factors in nutrition for specific cancers. Experts have classified the results into four levels: "convincing evidence", "probable evidence", "limited evidence" and a last level for those effects for which the evidence of their association with cancer is highly "unlikely." Probable and convincing evidence classification is based on recommendations.

In breast cancer, convincing evidence has shown alcoholic beverages as an increasing factor for the risk of both pre- and postmenopausal development. Being overweight and obesity have been identified as risk factors, in particular for the postmenopausal onset of cancer, while an excess of abdominal fat showed “probable evidence” of increased risk. Among the preventive factors for the onset of this disease is persuasive evidence related to the beneficial role of breastfeeding, while physical activity prevents the risk in particular for postmenopausal development.