By Ioannis Misitzis, Surgeon, Director of Breast Clinical Surgery, Medical Psychic
Breast cancer, for a long time, is the most common cancer in women and an important factor of fear and anxiety. Its frequent occurrence, the constantly changing perceptions of how to deal with it, as a result of new scientific data, its frequent media coverage and sometimes the diffusion of personal experiences and dubious knowledge experience from social media have created myths and misconceptions, which sometimes make difficult to accept appropriate treatment.
For example, the necessity for urgent surgery to treat a breast cancer is a myth. The staging of the tumor and the recognition of its molecular characteristics also determines the strategy of its treatment. Tumors, such as triple negative and HER 2 positive, are more successfully treated with pre-operative chemotherapy.
There is a widespread misconception that puncturing a tumor causes the spread of cancer cells. Typically, the cancer has spread, before it is diagnosed. Nowadays, in specialized breast centers, the pre-operative diagnosis of a tumor through puncture is a rule. In all its forms, puncture biopsy is a simple test with minimal complications. Scientific studies document the safety and usefulness of the method.
It is also a myth that the mastectomy has an advantage over operations in which the breast is preserved. Since the 1980s, when lumpectomy began being applied as an intervention for the local control of the disease, with the addition of radiotherapy, it has been established as effective as mastectomy, also protecting the woman from traumatic mutilation and its psychological effects. Today, in 70% of cases, the breast is preserved, and recent data suggest better survival than mastectomy.
Surgeons are often confronted with the patient's request for bilateral prophylactic mastectomy in cases of unilateral breast cancer, for better protection. In patients with moderate risk, no oncological benefit has been shown to derive from this choice. On the contrary, women are burdened with more extensive surgery, with more complications, more morbidity and higher costs.
Proven, only people with BRCA1 and BRCA2 gene mutations benefit from bilateral prophylactic mastectomy.
It is beyond the current reality that the treatment for breast cancer surgery is sufficient. The personalized therapies that are being applied today require interdisciplinary collaboration. Surgeon, radiologist, oncologist, radiotherapist, pathologist, geneticist and psychologist have a role in the disease management strategy.
Every affected woman, of course, has the right to be informed and consent to the treatment options. But her updating should be accurate and by qualified and appropriately trained health care providers.