Breast cancer results from the uncontrolled growth of altered cells that form a mass in the mammary gland and then spread throughout the body (which we then call metastases*Tumors formed from cancerous cells that have detached from a first tumor (primary tumor) and moved to another part of the body where they have taken root.). Depending on the stage of the disease, there are basically two main categories of breast cancer.
Breast cancer is referred to as in situ when the tumor cells*Tumor cells are cells that proliferate in an anarchic manner, which leads to the formation of a disorganized cellular mass. We then refer to them as cancer cells. are confined to the interior of the structures through which a mother's milk passes to arrive at the mammary glands*The mammary glands (or breasts) are alveolar glands present in female mammals, the primary function of which is to secrete milk to feed newborns..
Conversely, it is referred to as invasive when the cells have proliferated outside these ducts (called galactophores) and penetrated neighboring tissues. Most often, the first of these two types of breast cancer cannot be detected by palpation; diagnosis is generally made thanks to screening using mammography*Test performed using an X-ray machine to see the structure of the breast and whether any tumors are present..
Symptoms of Breast Cancer
At the early stages of breast cancer, people experience no or hardly any symptoms. In most cases, the disease remains silent for several years. Every woman is therefore advised to check their breasts and nipples every month to detect any changes in their structure or shape.
See a doctor if you discover hardening (nodules*Lumps that can develop on the surface of a tissue or organ.), red patches, or discharge from the nipple. Over the age of 50, women are also advised to undergo regular screening. Most breast cancers are discovered during these mammograms.
Causes of Breast Cancer
The origin of breast cancer is not well understood. In some cases there is a causal link with a genetic mutation (more specifically affecting the BRCA genes). Women with these genes are at greater risk of contracting breast cancer, which is why women with a family history of breast cancer (when one or more close relatives have had the disease, namely their mother, sister, or daughter) are advised to seek advice from their doctor and undergo genetic testing.
Breast cancer is more common in menopausal women. The risk increases with age, which is why screening programs have been introduced in Switzerland for women aged 50 years and over.
Risk factors include a woman's first period starting before she was 12, menopause starting after the age of 55, and undergoing hormone replacement therapy for several years after the menopause (hormone therapy*Certain cancers can be stimulated by the presence of certain hormones. Hormone therapy aims to limit the action of these hormones to eliminate cancerous cells that are sensitive to them.). It also seems that women who have not had a child or who had their first pregnancy after the age of 40 are more at risk.
Other risk factors include smoking, being overweight, a diet too high in sugars and fats, consuming too much alcohol, and a hereditary predisposition (mutation of the BRCA genes). In contrast, having several children and breastfeeding for an extended period of time is a protective factor against developing breast cancer.
Preventing Breast Cancer
Although it is not possible to affect certain breast cancer risk factors – typically, a genetic predisposition – every woman can have some influence on so-called modifiable risk factors, that is to say their lifestyle. Engaging in regular physical activity, eating healthily, not taking up or stopping smoking, and limiting alcohol consumption are the main preventative measures you can take.
Progression and Possible Complications
The main risk is that tumor cells will spread beyond the location where they initially developed. Most commonly, this is into the breast structures (ducts) that carry milk when a woman is breastfeeding. This type of cancer is called ductal carcinoma. It is referred to as invasive if it spreads into the lymph nodes*Small glands involved in the immune defenses located in different parts of the body. The nodes can become swollen if there is a large amount of bacteria, virus, or other cancerous cells in the body. (in particular under the underarms on the same side as the affected breast) or to other parts of the body via the lymphatic and blood vessels.
Invasive cancers are classed in different categories depending on their size and in particular the number of lymph nodes invaded. Screening is particularly important as chances of recovery are much higher at an early stage of the disease.
Treating Breast Cancer
The choice of treatment strategy depends on several factors such as:
- the location of the cancer and its tissue-related and genetic characteristics,
- if there are any affected lymph nodes close to the breast and metastases,
- the size of the tumor,
- the age and health of the patient.
If a tumor is discovered, a sample is taken surgically from the area of breast affected (biopsy*Part of a tissue or organ is removed so that a number of tests can be performed on it.) for analysis.
Surgery can be required to treat breast cancer. In most cases it is possible to operate on the tumor while preserving the breast. This procedure is called a tumorectomy, and only a small amount of healthy tissue around the edges of the tumor needs to be removed. Removal of the breast (mastectomy*A surgical procedure to remove the breast in which the tumor is located.) is only required in a small number of cases. Radiotherapy*A medical treatment that uses radiation to destroy cancer cells and block their ability to multiply. to destroy the cancer cells through irradiation can be initiated after surgery to limit the risk of the tumor re-occurring locally. Sometimes this radiotherapy can be performed during the surgical procedure.
The prescription of medication capable of selectively destroying cancer cells completes this treatment arsenal along with chemotherapy*A drug treatment that targets cancer cells., immunotherapy, and hormone therapy. These different treatment methods can be combined in various orders depending on the patient's specific situation.
It is worth noting that reconstructive surgery is an integral part of breast cancer treatment. It can either be performed at the same time as the initial surgery, or later.
When Should You Contact the Doctor?
As chances of recovery are much higher when breast cancer is detected early, regular screening is advised and once over the age of 50, it is important to take part (by invitation) in the systematic screening program that has been set up in Switzerland. Through these examinations, breast cancer can be detected even when the tumor is smaller than 2 cm, which not only greatly increases chances of recovery, but also means that less aggressive forms of treatment can be used.
Generally, if you experience symptoms such as a nodule in the breast, a red patch, or nipple discharge, it is worth seeing your doctor.
Care at Hôpital de La Tour
The two main methods of diagnosis are a breast X-ray (mammogram) and taking a tissue sample to be analyzed under a microscope (biopsy). Although a mammogram can be used to detect a tumor at a very early stage, not all suspicious results necessarily indicate breast cancer. In all cases, a biopsy is crucial to making a definitive diagnosis. If a tumor is excised*A surgical procedure that consists of removing a part of the body that is harmful or useless (tumor, foreign body, etc.). surgically, it is important to determine the severity and extent of the disease. The sentinel lymph node method can be used, which entails removing the lymph node that is closest to the tumor (therefore at the level of the underarms) to check whether it contains cancerous cells.
The treatment strategy will be chosen based on the results of these examinations, taking into account the patient's opinion and health.
Multidisciplinary and Highly Specialized Care
Hôpital de La Tour offers multidisciplinary care highly specialized in breast cancer thanks to our comprehensive, state-of-the-art facilities and on-site specialists with the necessary expertise. To ensure every patient affected by this disease receives the best possible treatment, a multidisciplinary Tumor Board meets each week bringing together specialists from different disciplines. This gives specialists the chance to discuss treatment options, validate a protocol taking into account all opinions, and then put in place optimum monitoring.
Cases are presented for the first time before treatment, which often includes surgery, and for a second time after the treatment to evaluate the results, take additional measures if necessary, and organize follow-up care.
The Hôpital de la Tour specialists who sit on the Breast Tumor Boards are:
- the consultant surgeon for breast cancer: Dr Jean-Luc Anguenot
- one or two radiologists specialized in analyzing mammograms
- radiotherapy specialists
- a nurse from the oncology department
- the consultant oncologist for each case.
In order to promote cooperation and bring together the most expertise possible in the interest of patients, these boards take place in the form of videoconferences with specialists from the breast centers at the Geneva University Hospitals (HUG) and the West Lemanic Hospital Group (GHOL). The level of safety and quality requirements are therefore equivalent to those found in a university hospital.