Prevention and the appropriate treatments have been shown to reduce the damage that breast cancer can cause. Thanks to prevention, care and a greater degree of breast cancer awareness, the survival rate is clearly progressively increasing.
The expertise in the different 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, breast cancer control, quality of life.
That's why the IEO Breast Program, which brings together all those Divisions and Units involved in the prevention, prognosis, diagnosis and treatment of breast cancer was created. Breast cancer treatment is multidisciplinary. It is not enough to refer to surgery, radiotherapy or pharmacotherapy alone, without integrating the various disciplines.
The most common breast cancer symptoms
One should never wait for breast cancer symptoms to appear. Early diagnosis means identifying problems before they appear as symptoms or signs. 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 breast cancer. However, it is always wise to report it to your referring physicianfor your reassurance.
Breast cancer awareness: the importance of prevention
At the 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 breast cancer. 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 breast cancer 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 of breast cancer 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.
DIAGNOSIS OF BREAST CANCER
Diagnosis of breast cancer 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. It is important to regularly undergo breast examinations before symptoms of breast cancer appear.
Mammography
Mammography, i.e. an X-ray of the breast, is useful for detecting the presence of nodules, microcalcifications or other indirect signs of breast cancer. It is based on X-rays that imprint the image onto a plate (or computer) after passing through the breast. The X-ray dose you receive during mammography is not harmful to your health. It is performed from the age of 40, every year or every two years.
Ultrasound
Ultrasound makes use of high-frequency sounds to detect the presence of a nodule and its consistency, solid or liquid, defining whether it is benign, doubtful or malignant in nature. Ultrasound is completely harmless from a biological point of view and is carried out every year from the age of 30; it is stopped when the radiologist recommends it.
Breast MRI
Breast Magnetic Resonance Imaging (MRI) makes use of a magnetic field to create the image of the tissue with mammography and ultrasound, or when prostheses or images near a surgical scar are to be displayed in detail. It is indicated when necessary or is planned as part of early diagnosis in women who have a high breast cancer risk due to family history or when the mammary structure appears complex using the other image investigations.
Fine-needle biopsy
Fine needle biopsy is a test during which a sample of cells from a breast nodule is taken using a thin needle and a cytological examination is thus obtained.
Needle-biopsy
Needle biopsy is a technique that takes a sample of tissue from an area or from a suspected nodule in order to obtain a histological examination accompanied by all the biological characteristics of the malignant tissue.
Self-examination
Self-examination is not a tool for early diagnosis and not enough to keep your health under control. The optimum early diagnosis is achieved when breast cancer is discovered when not yet palpable (with diagnostic tests).
Genetic test
The genetic test is a blood test that allows an assessment of whether there is a mutation in one of two genes known to be the most frequent in highly increasing the risk of breast cancer and/or ovarian cancer: the genes are called BRCA1 and BRCA2. Patients receive genetic counselling in which they may discuss the consequences of a positive, negative or uncertain result of the test.
Clinical breast examination
The clinical breast examination completes the diagnostic testing and concludes the process in view of further and future controls (healthy breast) or the necessary care (presence of breast cancer or suspected lesions). During the examination, test results are checked, the breast, underarm and supra clavicle lymph nodes are palpated, and treatment is prescribed, should it be useful to resolve doubt or certainty of breast cancer.
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 breast cancer 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.
Type of breast cancer
Breast cancer can begin in different areas of the breast — the ducts, the lobules, or in some cases, the tissue in between.
There are different types of breast cancer, including non-invasive, invasive, and metastatic breast cancers, as well as the intrinsic or molecular subtypes of breast cancer.
- Ductal Carcinoma In Situ (DCIS)
- Invasive Ductal Carcinoma (IDC)
- IDC Type: Tubular Carcinoma of the Breast
- IDC Type: Medullary Carcinoma of the Breast
- IDC Type: Mucinous Carcinoma of the Breast
- IDC Type: Papillary Carcinoma of the Breast
- IDC Type: Cribriform Carcinoma of the Breast
- Invasive Lobular Carcinoma (ILC)
- Inflammatory Breast Cancer (IBC)
- Lobular Carcinoma In Situ (LCIS)
- Male Breast Cancer
- Molecular Subtypes of Breast Cancer
- Paget's Disease of the Nipple
- Phyllodes Tumors of the Breast
- Metastatic Breast Cancer
Ductal Carcinoma In Situ (DCIS)
Ductal carcinoma in situ (DCIS) is non-invasive breast cancer because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue.
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. “Invasive ductal carcinoma” refers to cancer that invades the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.
IDC Type: Tubular Carcinoma of the Breast
Tubular carcinoma of the breast is a subtype of invasive ductal carcinoma. Tubular carcinomas are usually small (about 1 cm or less), they tend to be low-grade, meaning that their cells look somewhat similar to normal, healthy cells and tend to grow slowly.
IDC Type: Medullary Carcinoma of the Breast
Medullary carcinoma of the breast is a rare subtype of invasive ductal carcinoma. Medullary carcinoma doesn’t grow quickly and usually doesn’t spread outside the breast to the lymph nodes.
IDC Type: Mucinous Carcinoma of the Breast
Mucinous carcinoma of the breast is a rare form of invasive ductal carcinoma. In this type of cancer, the tumor is made up of abnormal cells that “float” in pools of mucin, a key ingredient in the slimy, slippery substance known as mucus. Even though mucinous carcinoma is an invasive breast cancer, it tends to be a less aggressive type that responds well to treatment.
IDC Type: Papillary Carcinoma of the Breast
Invasive papillary carcinomas of the breast are rare, accounting for less than 1-2% of invasive breast cancers. In most cases, these types of tumors are diagnosed in older women who have already been through menopause.
IDC Type: Cribriform Carcinoma of the Breast
In invasive cribriform carcinoma, the cancer cells invade the stroma (connective tissues of the breast) in nestlike formations between the ducts and lobules. Invasive cribriform carcinoma is usually low grade, meaning that its cells look and behave somewhat like normal, healthy breast cells.
Invasive Lobular Carcinoma (ILC)
Invasive lobular carcinoma (ILC), sometimes called infiltrating lobular carcinoma, is the second most common type of breast cancer after invasive ductal carcinoma. Although invasive lobular carcinoma can affect women at any age, it is more common as women grow older.
Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer. Inflammatory breast cancer usually starts with the reddening and swelling of the breast instead of a distinct lump. IBC tends to grow and spread quickly, with breast symptoms as worsening within days or even hours.
Lobular Carcinoma In Situ (LCIS)
Lobular carcinoma in situ (LCIS) is an area (or areas) of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later on in life. LCIS is not a true breast cancer. Rather, LCIS is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future.
Male Breast Cancer
Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.
Molecular Subtypes of Breast Cancer
There are five main intrinsic or molecular subtypes of breast cancer that are based on the genes a cancer expresses:
- Luminal A :breast cancer is hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), HER2 negative, and has low levels of the protein Ki-67, which helps control how fast cancer cells grow.
- Luminal B breast cancer is hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), and either HER2 positive or HER2 negative with high levels of Ki-67.
- Triple-negative breast cancer is hormone-receptor negative (estrogen-receptor and progesterone-receptor negative) and HER2 negative. This triple-negative breast cancer is more common in women with BRCA1 gene mutations. Researchers are unsure why, but this type of triple-negative breast cancer also is more common among younger women. Using chemotherapy to treat triple-negative breast cancer is still an effective option. In fact, triple-negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of breast cancer.
- HER2-enriched breast cancer is hormone-receptor negative (estrogen-receptor and progesterone-receptor negative) and HER2 positive
- Normal-like hormone-receptor positive (estrogen-receptor and/or progesterone-receptor positive), HER2 negative, and has low levels of the protein Ki-67.
Paget's Disease of the Nipple
Paget's disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola (the dark circle of skin around the nipple).
Phyllodes Breast Cancer
Phyllodes tumors of the breast are rare, accounting for less than 1% of all breast tumors. Phyllodes tumors can occur at any age , the tumor cells grow in a leaflike pattern.and they tend to develop when a woman is in her 40s.
Metastasized Breast Cancer
Metastasized breast cancer is breast cancer that has spread to other parts of the body. The metastasized breast cancer (also called stage IV or advanced breast cancer) is not a specific type of breast cancer, but rather the most advanced stage of breast cancer. Metastasized breast cancer is breast cancer that has spread beyond the breast to other organs in the body (most often the bones, lungs, liver or brain).Although metastasized breast cancer has spread to another part of the body, it is considered and treated as breast cancer.