Breast cancer accounts for a third of all cancers diagnosed in women. In fact, almost every woman in Israel knows, even from a distance, someone who has had breast cancer, due to its high incidence.
But not all forecasts are bleak. The good news is that breast cancer mortality rates are declining and the quality of life of patients and patients with the disease is constantly rising. Also, the earlier the detection, the greater the chances of cure, with the aim being to detect the disease before the metastatic stage, in which the treatments focus on prolonging life and improving their quality. We asked Dr. Shlomit Strolov Shachar, a senior physician in the Breast Cancer Unit at Ichilov Hospital, to answer some important questions on the subject.
The numbers show that the risk of developing breast cancer is significant. To what extent is it influenced by magnetics?
“About ten percent of cancers originate from genetic carriers. In Israel, carriers for mutations in the BRCA gene Very common: One in 40 Ashkenazi women is a carrier of the mutation. This means that the risk of breast cancer is almost six times higher, “she explains.” The surprising fact is that only half of them have a family story, which means that about half of them do not know about it. It is very important to know that a genetic carrier test for Ashkenazi women has recently been added to the health basket – even if the Ashkenazi origin is partial. I highly recommend that any woman with a full or partial Ashkenazi background, even if there is no family history, insist on the test and ask her for a family doctor. It is a simple blood test, and if it is positive, there are more extensive tests and also preventive treatments that can save lives. “.
What is the chance of metastasis among those diagnosed with breast cancer, and how is it diagnosed?
“Most cases of breast cancer that are first diagnosed are not metastatic,” emphasizes Dr. Strolov Shachar. If metastatic disease is suspected, according to the type of cancer and the stage of diagnosis, the attending physician will ask to perform an imaging of each body such as PET CT in order to verify the diagnosis and decide on the method of treatment. “Today there are many types of treatments and medications and each patient will receive a customized protocol for her.”
How do you decide which treatment to give to each patient?
“Today we know how to check for changes in different tumors, and tailor treatments specifically to the patient. In general, treatment decisions for breast cancer are divided into three main groups: breast cancer positive for estrogen and / or progesterone (about 70% of patients), breast cancer positive for HER2 (About 15% of patients), and negative breast cancer for the three receptors – estrogen, progesterone and HER2 (approximately 15% of patients). Other treatments are suitable for each group. ”
What are the currently accepted drugs for metastatic breast cancer?
“As mentioned, we examine the tumor itself, the changes in it, and adjust specific drugs. There are anti.hormonal, chemical and biological drugs that are given as needed. In estrogen.positive breast cancer we give endocrine (anti.hormonal,” slang “slang) treatment to prevent or Reduce the exposure of the cancer cell to estrogen; chemotherapy we give when we want to harm during cell division; there are also biological therapies that damage the cancer cell by a more specific mechanism, as opposed to chemotherapy that affects the cell division and therefore affects most cells.
The drugs today are very advanced and know how to specifically treat the changes we have diagnosed in the tumor itself. For example, anti.HER2 therapies That inhibit the intracellular pathway, or innovative antibodies to which chemotherapy is attached that reaches the cells that express HER2 thus acts more effectively against the tumor with fewer side effects to the healthy cells.
There are other biological drugs that work by inhibiting cell division, such as 4/6 CDK inhibitors – the enzymes responsible for cell division. The drugs inhibit the activity of the enzyme, thereby inhibiting the division of the cancer cell and the spread of the tumor. “Sometimes we choose immunotherapy – an antibody that is given intravenously and causes the immune system to activate against the tumor.”
What about the patient’s genetics? Does it affect the type of treatment chosen?
“Sometimes yes,” she replies, “for example, to mutant carriers in the BRCA gene With adverse metastatic breast cancer to HER2 has a dedicated treatment of parp inhibitors. Even in non.carrier patients, we will examine genetic changes in the tumor itself. There are tumor changes that allow for customized medicine. For example, about 40% of patients with estrogen.positive breast cancer have a change in the pik3ca gene, and tumors with this change can be matched with specific treatment in addition to anti.estrogen therapy, which increases the response rate to endocrine therapy and the duration of response, inhibiting cancer cell division.
How does the personalization of the drugs affect the duration and quality of life of the patients?
“The wide range of treatments available to us in recent years can significantly extend the lives of patients and allow them a good quality of life alongside treatment, and the more correct the drug adjustment for each patient, the better the results,” says Dr. Strolov Shachar and concludes: It is important to remember that alongside the correct treatment protocol, it is advisable to choose a doctor and support staff with whom communication is good. Most hospitals in the country today have a support system that includes a youth clinic, a clinic for the elderly, complementary medicine, psychological treatment, rehabilitation after treatment and more. In light of the rapid advances in new therapies, some of which are truly groundbreaking, it is possible to integrate into innovative clinical trials, and it is always worthwhile to examine all the treatment options and research options that can be obtained. The innovations are developing rapidly and that gives us all great hope. ”
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