“Panta rhei: towards individualized care”: this was the title of the speech by Dr. Wolfgang Gatzemeier, Deputy Director of the Operative Unit of Senology at Humanitas, during Mamazone 2017, the seventh edition of “Paziente diplomata”, a day dedicated to women with and without breast cancer, organized by Humanitas last 14 October.
The presence of breast cancer in women has been documented since ancient times, since the Egyptians, but real progress in treatment has been made over the past 150 years by moving from a more descriptive vision of the tumor to a more in-depth vision on a molecular and biological basis.
Breast cancer is the most frequent cancer in women, one thinks that one in 15 women fell ill in 1980, and one in 8 women develops it today: therefore, there is a real increase in the incidence, but thanks to early diagnosis and multidisciplinary treatment we also have a higher level of care. It is important to underline that we must talk about breast cancer because every woman is different, even from a biological point of view, just as every cancer is different both from a histological point of view as well as in terms of genetic profile and therefore of the molecular content.
Advances in the approach to breast and lymph node care and conservation
In the late 1800s breast cancer was thought to be a local-regional disease and therefore the extent and technique of surgery was the determining factor in obtaining the best results; the trend was towards radical mastectomy.
It was the Fischer brothers, an American surgeon and pathologist, who demonstrated at the beginning of the twentieth century that breast tumors can be systemic from the very beginning and that local treatment therefore does not change the survival of the patient. The combination of appropriate control therapy (without large mutilations) and systemic therapy is the way forward.
Professor Umberto Veronesi, together with the Fischer brothers, is also considered a pioneer in breast conservation. The progress that has been made in breast conservation has also guaranteed women an ever-increasing quality of life.
The next step was the preservation of axillary lymph nodes thanks to the sentinel node technique. It was thus possible to understand in which cases it was necessary to remove the lymph nodes and in which cases they could be saved, also avoiding lymphedema, one of the main side effects of this removal.
Systemic adjuvant therapies
Already in the 1800s we began to observe a hormone-sensitivity in tumors, then in 1968 Elwood Jensen identified the estrogen receptor on the cells, the basis for the hormone treatment we have today. Another big step was the discovery of a growth receptor, which allowed the treatment of women who had a certain expression of the receptor.
It was then Gianni Bonadonna who started the first study on adjuvant chemotherapy in breast cancer after surgery (in the 1970s at the Istituto dei tumori in Milan).
A multidisciplinary approach that focuses on women
Ten years ago we classified 3-4 tumors from a histological point of view, in ten years we will have many subtypes of tumors and we also hope in the possibility of new drugs increasingly adapted to each subtype.
In any case, breast cancer treatment is multidisciplinary. The approach focuses on the woman and all figures who seek to maximize the results of therapy: surgeon, oncologist, radiotherapist, pathologist, geneticist, gynecologist for the preservation of fertility, physiotherapist, nuclear physician, radiologist, plastic surgeon, as well as breast care nurse, psychologist and social services.
Watch Dr. Gatzemeier’s full intervention, click here.
