Breast cancer: chemotherapy is no longer systematic
Used to reduce the tumor mass before surgery, or after the operation, with or without targeted therapy, or in the event of a relapse, the chemotherapy is not always required. The earlier the tumor is detected, the less time it has had to grow and diffuse cells in the body. Small tumors that cannot be felt at the palpation are generally less of a concern than others, although histological and molecular features are more important than size. Prognostic tests, such as the PAM 50 test, which has been successfully tested on thousands of patients, can detect tumors associated with a very low recurrence rate, for which chemotherapy is unnecessary. In addition, a European trial evaluates the usefulness of postoperative chemotherapy after 70 years. “Thanks to the Multidisciplinary Concertation Meetings (RCP) generalized from the cancer plan, which take place before starting treatment and after surgery, each woman benefits from the advice of a team of specialists, who offers the most suitable treatment. “, Welcomes Dr Anne Lesur, responsible in her institute for these meetings for more than 20 years.
Breast cancer: radiotherapy is better tolerated
After conservative surgery, it is necessary to deliver a radiotherapy to destroy any residual tumor cells, at the rate of 5 sessions per week for 5 weeks, ie 25 sessions in total. Thanks to the progress made over the past 15 years, the 10-year local relapse rate of tumors treated at an early stage has increased from 15% to 6%. And the side effects have diminished. “The doses are now personalized on a case-by-case basis thanks to the 3D scanner, this allows targeted irradiation which better preserves neighboring organs (heart, lungs, etc.) and the skin. In older women, one session per week for 5 weeks is sometimes sufficient, ”explains Dr Anne Lesur. In some cases, it is even possible to do a single irradiation during the procedure, just after the tumor has been removed. The radiotherapist then administers a high dose of radiation targeted at the area with a high potential for recurrence, thanks to the Intrabeam system which hospitals are starting to equip themselves with. This technique could eventually be used in around 20% of cancers.
Breast cancer: the role of hormone therapy is becoming clearer
Directed against hormone receptors for estrogen (RO) or progesterone (RP) present in 70% of breast cancer, hormone therapy is prescribed for 5 years after treatment, thus reducing relapses by half. “Whether it’s tamoxifen before menopause or anti-aromatases after, the benefit of hormone therapy is clear. But the women do not always understand its interest, whereas they feel cured… While some support it very well, others are embarrassed by hot flashes, weight gain, or joint pain… It is important to talk to your doctor, who will give appropriate advice to reduce these inconveniences, ”advises Dr Anne Lesur. According to recent studies, prolonging hormone therapy in some cases for ten years instead of 5 years could further reduce relapses by 25% and prolong survival.
Breast cancer: follow-up after treatment can be done at home
Thanks to advances in surgery, particularly the sentinel lymph node technique used for tumors of less than 2 cm, the lymph node chain is only removed when it is essential, hence less unnecessary sequelae of the “big arm” type. “. A few years ago, a breast cancer operation required 8 days of hospitalization, now 1 or 2 days is sufficient. Post-operative care then takes about half an hour a day, and can be done by a home nurse. A consultation is scheduled three months later, then once every 4 months for the first two years, then generally twice a year, then once a year. For each woman, a Personalized Post-Cancer Program (PPAC) is set up to ensure coordinated follow-up between the hospital team and the attending physician. “Doctors are increasingly interested in the impact of treatments on quality of life. More than 80% of women will live more than 10 years after their cancer. The Canto study, for example, will follow 20,000 women for ten years to understand and treat, even anticipate the impact of treatments on health, family and professional life, ”explains Dr Anne Lesur.
