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Major breakthroughs in breast cancer treatment

Breast cancer is the most common cancer affecting women, accounting for one tumour in every four. And, during the course of her life, one woman in every nine will suffer from it. It’s also a global disease – more than one million cases of breast cancer are diagnosed worldwide every year, and the trend shows no sign of declining. In fact, the number of cases of breast cancer has been on the rise since the 1950s. And it now affects increasing numbers of younger women, under the age of 40. In a country like France, the frequency of breast cancer has increased by 60% in 20 years, which shows the burden this represents for public health. The only solution to reversing this trend is early diagnosis, combined with an effective therapeutic strategy. Like all cancers, breast cancer is the result of abnormal proliferation of cells that are themselves abnormal. In the case of breast cancer, the tumour develops in the mammary gland. And although the disease mainly affects women, it can also affect men. Rare before the age of 30, breast cancer occurs most commonly between the ages of 60 and 64, but continues to pose a threat until the age of 74…with the exception of sub-Saharan Africa where it strikes earlier – often between the ages of 35 and 40. In most cases it takes the form of a small lump that can be felt by palpating, once it has reached about a centimetre in size. Other possible indications requiring attention are a dimpling or indentation of the skin of the breast or redness or discharge from the nipple. It is important to check your breasts and armpits at least once a month, after your period. The technique is simple and painless. Breast self-examination is something you can do either lying down or standing. But lying down is preferable as it’s easier. Lie on your back and place a cushion or pillow under the shoulder on the same side as the breast you are going to examine. Carefully palpate each breast and armpit in turn. But be sure to use the flat of your fingers, not the tips.

• Palpate the skin and the hollow of each armpit;
• Examine the upper part of your breast by pressing lightly against the thorax and moving your fingers gradually towards the mid<dle of your chest;
• Next check the underside and outer side of the breast by palpating from the edge to the area around the nipple;
• Finally, check the nipple and then the upper and inner part of the breast;
• Once you have checked all these areas on one breast, move to the other and follow the same routine.

If you think you might have found something unusual, don’t panic! A small lump is not necessarily a cancer. It may simply be a benign cyst. A lump of fat, for example. But for peace of mind, go and see your doctor without delay because, like any form of cancer, prognosis depends to a large extent on how early it is diagnosed.

The earlier cancer is identified, the greater the chances are of being cured. Nowadays, diagnosis relies mainly on mammograms. Having a mammogram is painless and reliable but expensive when carried out on a mass scale. This means that while mass breast screening programmes are used in developed countries, many developing countries cannot allow themselves this luxury. And for many, mammograms therefore remain an impossible luxury… In many African countries, cancer treatment centres often lack what they need to treat patients properly. In Ethiopia for example, there is only one oncologist available for the country’s entire population. There are no mammograms or screening systems available and access to chemotherapy and hormone treatments is extremely difficult. As a result, the incidence of breast cancer and the mortality rate is on the increase in most of the countries of Africa and Asia. Of course screening is not on its own sufficient to bring about a decline in breast cancer cases. It is also essential to develop treatments. And in this respect, the news is encouraging. In addition to surgery, there has been considerable progress in chemotherapy during the last 15 years or so. The introduction in the early 1990s of Taxotere – a drug that blocks cell multiplication – marked an early and spectacular advance. But the recent advent of targeted therapies, as presented at the 43rd Annual Meeting of the American Society of Clinical Oncology held recently in Chicago, signals a new revolution in breast cancer treatment. As their name suggests, these therapies attack limited targets. These targets may be malignant cells that need to be destroyed or receptor site cells. With these new therapies, the aim may be to get cells to self destruct by re-establishing the cell death mechanism known as apoptosis, or indeed to starve them by preventing them from forming the blood vessels essential to their survival – a process known as neo-angeogenesis. Another effective weapon is the use of monoclonal antibodies which attach themselves to tumour cells and prevent them from metastasing. Nowadays, treatments usually rely on complex combinations involving the use of more than one of these weapons. But although they are increasingly successful, these therapies affect women in ways that are particularly distressing as they attack their very identity as women through secondary effects such as hair loss, including loss of the eyelashes and eyebrows. In circumstances like these it is often difficult for a woman to retain a good self image! And yet this is fundamental to combating the disease. In France, for example, a new discipline known as onco-aesthetics is being developed. The principle is simple: to offer sessions on aesthetic care to women being treated for cancer. It’s a serious matter and essential to the quality of patients’ lives. Patients receive advice on makeup, how to look after their hair, how to dress and how to choose the right accessories to go with particular types of clothing. It’s a kind of “beauty makeover” that can be really beneficial for those embarking on the daunting journey of breast cancer treatment.