Addressing the physical and emotional needs of breast cancer patients
By Roberto Gennari, MD, MSc, Director, Breast Cancer Program, Fondazione Istituto G. Giglio di Cefalù, Italy
Breast cancer claims the lives of more European women than any other cancer. Every woman now has a statistical risk for developing breast cancer in her lifetime. According to the European Breast Cancer Coalition, one in eight women in the EU-28 will develop breast cancer before the age of 85.
In patients with a positive family history, the risk of developing breast cancer is even higher and the number of first-degree relatives with breast cancer affects the lifetime risk. For carriers of the BRCA-1 and BRCA-2 gene mutations, this risk may be as high as 56-72 percent and 38-85 percent, respectively.
Until 50 years ago, the treatment for breast cancer was mastectomy. However, with so many women now facing the risk of breast cancer, the importance of improved and high-quality treatment options that meet both patients’ physical and emotional needs, cannot be underscored enough. More specifically, patients are looking for treatment options that can provide them with both the clinical result of cancer eradication and good aesthetic outcomes.
These needs have resulted in a growing trend in oncoplastic breast surgery, which has been made possible by advancements in breast screening that allow cancer to be detected earlier than was previously possible. Over the years, techniques have evolved in the oncoplastic breast surgery field with the aim of reconstructing defects with local tissue rearrangement. The result of this is that today breastconserving surgery (BCS) is one of the standard options selected for breast cancer patients, with survival rates similar to those of patients receiving a mastectomy (MST).
The benefit of oncoplastic procedures, such as BCS, is their ability to resect the breast cancer with negative histologic margins while preserving the contour of the breast. Merging the fields of oncologic and reconstructive surgery, oncoplastic surgery utilizes a spectrum of aesthetic enhancing techniques to address tissue defects and optimize cosmesis through breast cancer surgery. In addition, it provides the opportunity to address patients’ pre-existing breast reshaping desires.
By providing optimal local control while maintaining or reconstructing a cosmetically acceptable breast, women can enjoy a better quality of life both emotionally and physically. Not only can they feel healthier with their cancer removed, but they can also feel a sense of normalcy and comfort that is associated with maintaining the natural look of their breasts – something that is truly invaluable to patients.
While breast cancer treatment and surgery has come such a long way with the introduction and growing use of oncoplastic surgery, room for improvement still exists as we look to the future.
For example, in BCS, standard breast radiotherapy requires treatment to the whole breast followed by an additional boost treatment to the tumour bed, which needs to be adequately localized to ensure precision. Several studies showed that the use of clips during BCS provides accurate and reliable localization of the tumour bed borders, but one area of concern is that the borders of the tumour bed can be relocated as part of the surgery to close the cavity resulting from tumour removal. This can potentially make it difficult for the radiation oncologist to subsequently target the original tumour bed with a precisely focused radiation boost. As such, any other method that could ensure increased and more optimal targeting for radiation treatment, while also working to maintain the natural shape of the breast, would be very interesting, especially if it could also provide longterm benefits, such as more accurate, lifelong monitoring of the tumour bed.
In conclusion, breast cancer treatment methods and technology can continue to improve by becoming even less invasive and more favorable for cosmetic results, while also delivering precise, targeted and effective treatments to our patients. It is important that professionals in the breast cancer treatment field maintain a holistic view and discuss oncoplastic surgery in combination with, not separately from, the subsequent – and very critical – radiation treatment. Advancements in cosmetic outcomes should not set back radiation treatment – they should both improve together.
Roberto Gennari, MD, MSc,
Director, Breast Cancer Program,
G. Giglio di Cefalù, Italy