By Ioannis Misitzis, Breast Surgeon, Director of Breast Unit, Psychiko Clinic
There are 4,500 new cases of breast cancer per year and 2,500 deaths from this cause in Greece, according to estimations.
However, the application of new therapies, targeted at a molecular level, the wider application of asymptomatic screening to the female population and the improvement of imaging methods that allow detection of the disease at an earlier stage, have led to a downward trend in mortality from breast cancer.
Today, 20 – 40% of diagnosed breast cancers are in situ Carcinomas and full healing is achieved.
Screening guidelines are the result of lengthy and extensive studies in all the advanced countries of the Western world. The goal is to detect cancer as early as possible and to limit compounding interventions and examinations, so that screened women are medically covered and not burdened by unnecessary radiation, hassle, anxiety and cost.
The most appropriate and contemporary method of monitoring is to personalize the risk of developing breast cancer for each woman by a qualified physician or center.
The decision on the starting age for screening, the frequency and the procedure of the tests are the result of a discussion between the physician and the patient and is based on woman's health record and her potential, after analyzing and understanding the benefits and consequences of any choice concerning monitoring.
Mammography with its variants (digital, tomosynthesis, diagnostic) is the basic test for the early detection of breast cancer. Ultrasound, magnetic resonance imaging and cytology provide further information. MRI has a special place in examining dense breasts of young women with high risk for breast cancer.
In addition, women who, on the basis of their heredity and personal health record, will be assessed as high risk have particular follow-up scheduling. Women with established pathogenic mutations in the BRCA1 and BRCA2 genes (risk of developing breast or ovarian cancer up to 60-70%) have particularly increased risk over their lifetime.
The decision for gene testing in order to detect pathogenic genes is a complex process and a result of detailed discussion between the woman and the appropriate staff in order for her to get information and understand the gravity of that knowledge. Knowing of this increased risk involves a great psychological burden with individual, family and social parameters, putting the woman in the position where she needs to decide on major amputations (mastectomy and ovariectomy) at a young age, live with constant fear of cancer and worry relatives who share the same genetic material.
The generalization of screening has resulted in the detection of more cancers at an earlier stage involving improved survival and smaller, simpler surgical interventions.
Currently, 75% of breast cancer cases are treated with breast preservation methods that have an excellent cosmetic effect. In addition, the introduction of the lymph node biopsy allows the majority of women to avoid lymphatic cleansing of the armpit and maintain the full function of their respective upper extremity.
In conclusion, early diagnosis of breast cancer often ensures full healing and allows for the preservation of the woman's breasts. According to the most recent recommendations (American College of Obstetricians and Gynecologists, June 2017), individualizing the risk for breast cancer and designing personal screening for each woman is the most effective way of screening.