In metastatic breast cancer, “treatments are targeted at breast cancer cells even if they are in other organs” such as the liver, bone or lung, explains oncologist Mahasti Saghatchian at Why Doctor in a program devoted to the subject.
Breast cancer is the most common in France and the leading cause of death in women. Fortunately, thanks to advances in screening, the death rate has largely decreased. In 4 or 5% of cases unfortunately, patients are screened too late and at the time of diagnosis “we realize that there is disease outside the breast: we then speak of metastatic cancer” or stage 4, explains doctor Mahasti Saghatchian to Why doctor on the show Question to the Experts. However, metastatic breast cancers occur especially in the event of a relapse (the risk of relapse is now estimated at 20% after a cure for breast cancer). “What concerns us the most is the risk of relapse in the form of metastases, breast cancer cells that have moved into other organs, the liver, the lung, the bone”continues the specialist, insisting on the fact that even if breast cancer has moved to another organ, the treatment remains that of breast cancer.
“The treatments are targeted on breast cancer cells even if they are in other organs: liver, bone, lung. And whatever the location, it will mostly be localized to breast cancer cells. But what can vary according to the organ which is touched, it is the local gesture. When breast cancer gives metastases in the bone, it may be necessary to do surgery or radiotherapy of the bone to treat the metastasis locally. In this case, it is not necessarily targeted on breast cancer cells, it is the treatment of the organ itself. This varies greatly from one organ to another. We cannot perform surgery or radiotherapy on all organs or all locations”says Dr. Mahasti Saghatchian.
Management therefore differs depending on the location and number of metastases. “Above all, there are locations which are unfortunately more dangerous than others, which must be treated more urgently than others, which will require chemotherapy. Very often, for example, when you have metastases in the liver, as this can prevent the proper functioning of the liver, you are sometimes more inclined to do chemotherapy than anti-hormonal treatments or targeted treatments. And as far as the brain is concerned, we know that chemotherapy does not work very well at this level, so radiotherapy should be preferred.”
A “chronic disease”
As for the survival prognosis, it varies enormously from one patient to another and from one cancer to another. Professor Mahasti Saghatchian insists that women with metastatic breast cancer can lead normal lives. “Most of these patients are in very good general condition, especially at the beginning of their metastatic disease and for years. This is why the concept of chronic disease has developed a lot in recent years. Patients have to accept living with their cancer.”
“It’s different from when you have localized cancer: you are treated, you are operated on and you have more cancer”, explains the oncologist, recalling that less than 5% of women suffering from metastatic breast cancer can be cured definitively. Doctors speak of healing when the cancer has not re-evolved after the initial metastasis, twenty years later. Unfortunately, in the majority of caseswe will not be able to completely eliminate the metastatic cells and the patients will live with their cancer. If the latter does not evolve, it will not prevent them from living normally”continues Mahasti Saghatchian.
Especially since at present, most drugs used to treat metastatic breast cancer are taken orally and do not require hospitalization but just follow-up by consultation and telephone. The specialist concludes by calling on patients to practice mindfulness meditation to learn to live with their cancer.
In 2015, a pilot study published in the Journal of Cancer Survivorship had shown in particular that mindfulness meditation would limit the deleterious effects of chemotherapy in patients with breast and colon-rectum cancer. “Mindfulness meditation enables cancer survivors to better manage cancer-related cognitive impairment, which is reported by approximately 35% of this post-treatment population”, explained the researchers after following 71 patients. According to them, meditation improves cognition by focusing patients’ attention and improving the management of feelings and bodily sensations.
Below, the program Questions aux Experts with Dr. Mahasti Saghatchian:
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