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Arrive early. This is the first “commandment” to overcome breast cancer. With more than 54,000 cases a year, it is the most frequent malignancy in women. But luckily, thanks to science, more and more people are able to treat themselves better, through a treatment that must be “tailored” for each patient and that sees the surgeon as a fundamental ally, alongside the woman. The second password is therefore equally clear: personalization. “Just think that today 25-25% of cancer cases affect very old people and a similar percentage is observed under the age of fifty: we must find, and we are able to do so, a therapeutic response tailored to each woman” – explains Lucio Fortunato, Director of the Complex Operational Unit Center of Breast Care of the San Giovanni-Addolorata Hospital in Rome “, on the occasion of the second national Consensus Conference on Neoadjuvant Chemotherapy promoted by ANISC (Italian National Association of Breast Surgeons).
The right times for the operating room
Every woman must have her own care. Case by case. Suffice it to say that in some cases it is better to wait for the operation, preceding it by a systemic “neoadjuvant” therapy, and then proceed. In these situations, the multidisciplinary team following the woman can see the need for one chemotherapy therapy that allows to reduce the size of the tumor, before it is admitted to the operating room. “This strategy has maximum significance for the most“ exuberant ”tumors (in practice more invasive)” explains the Dr. Fortunato. “In Italy, today, the neoadjuvant chemotherapy (i.e. to be practiced before the breast tumor removal operation) for some types of tumors more sensitive to this approach, i.e. those that express particular biological characteristics, it is carried out in about 17% of cases, against a European average that reaches almost to 30%. Neoadjuvant chemotherapy, when suggested, always indicates the Dr. Fortunato “It allows to reduce the number of mastectomies and axillary emptyings, even in cases initially with lymph node metastases but which obtain a complete remission at the post-treatment histological examination. It is important to reason on a case-by-case basis, based on the characteristics of the patient and her tumor, in order to be able to give the woman the most suitable answer in terms of the treatment path “. It must be said that, in this sense, surgery remains a key step in the treatment and in recent years it has become increasingly precise and respectful of a woman’s quality of life and her femininity. “That’s right” confirms the expert. “We first went from mastectomy to quadrantectomy and today we are able to be even more precise and limited in the intervention, when obviously the tumor is of limited size, which means getting to the cure as soon as possible. And even when mastectomy is necessary, we are able to carry out conservative interventions often guaranteeing the preservation of the nipple areola complex and immediate reconstruction in the same operating session to offer and still have maximum attention to the quality of life of the woman “. This logic of “attention” is also reflected in the analysis of “sentinel” lymph node, which is the first drainage able to indicate the stage of the disease. “If at one time all the lymph nodes of the axillary cavity were removed, today more and more we rely on the sentinel lymph node (a sort of signaling device that indicates the presence of the pathology in the lymph node itself) and even if this is positive, it is often possible avoid resorting to more extensive intervention “.
Screening saves lives
In any case, two pressing invitations come from surgeons on the occasion of this national ANISC event. The first is to refer to Breast Centers, the Breast Units, structured to offer a multidisciplinary and dedicated approach. The second is instead the call to screening as a tool to quickly recognize a possible tumor. “On this front, there is still a difference between the north and the south of our country: 5-year survival reaches 91% in the north and 85% in the south of the peninsula, also because it is necessary to optimize the opportunities for early diagnosis everywhere” – concludes the Dr. Fortunato. The skills to further improve the prognosis of this cancer are there and already today, compared to thirty years ago, we have gained a 30% five-year survival “. In short: we can still improve to give life not only to the years, but also to the quality of life for women facing breast cancer.
In collaboration with Roche SpA
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