Breast cancer is the third most common type of cancer in Ireland almost 3,600 people are diagnosed every year.
This form of cancer is also becoming more common, with cases are rising by about two to four percent every year.
However, treatment for the disease has improved dramatically over the past number of years.
Here, Professor Janice Walshe, a medical oncologist, explains the diagnosis process and the pioneering new treatments available.
Diagnosis
Women can receive a mammogram through BreastCheck, or they may have gotten referred for a mammogram by their doctor after noticing a new lump or experiencing other symptoms. “If the mammogram results are abnormal, or a lump is felt but it’s not projecting onto the mammogram, a triple assessment is done,” Prof. Walshe says.
The breast is evaluated with imaging, which includes a mammogram and/or an ultrasound. A breast examination is then carried out by a surgeon, and a biopsy is performed on the lump or symptomatic area. “An ultrasound is used to guide us to the breast tissue in question, then a needle is used to take a tissue sample, which is sent to a histopathology lab who will read it.”
The lab will determine if the cancer is a breast cancer or another type of cancer which has deposited in the breast. They will then test for three receptors: estrogen, progesterone and HER2, and the presence or absence of those will determine the best type of treatment.
Treatment
There are three main types of breast cancer. Hormone sensitive, HER2 negative is usually treated with surgery upfront, followed by an Oncotype DX test. This is a gene expression test which will determine whether the patient needs chemotherapy. If chemo is required, this is done first, followed by radiation therapy or anti-hormonal therapy, which is the opposite of HRT.
HER2 positive breast cancer accounts for 17-20 percent of cases in Ireland. “This type is best treated with chemotherapy up front usually, unless the tumour is less than two centimetres. Chemo reduces the tumour within the breast and mops up the cells that have been sent into circulation by this breast cancer. The drug Herceptin is often used as well,” Prof. Walshe explains.
The final type, triple negative breast cancer, accounts for 12 percent of cases in Ireland. “There is a huge spotlight on this type of cancer at the moment in terms of clinical trials. It is associated with a more aggressive subtype and has a greater likelihood of recurring and causing secondary cancer.”
It has been recently discovered that this type of cancer is very sensitive to immunotherapy. If the tumour is greater than two centimetres, a chemo and immunotherapy combination is recommended. “This is to downstage the tumour in the breast to make surgery feasible, and to get rid of any cancer cells being circulated.”
Surgery
“There is certainly a movement within oncology to only do a mastectomy, which is the removal of all the breast tissue, when it is absolutely necessary,” says Prof. Walshe. “If we have a localised tumour where we feel we can do a surgery and make sure the margins, that being the area around the tumour, shows no abnormality and is clear, then a person will have a lumpectomy as opposed to a mastectomy.”
The lymph nodes under the arm will then be tested to see if the cancer has spread.
Genetics
People who have a family history of cancer will be sent for genetic testing, Prof. Walshe adds.
The main centre for genetic testing works out of St James’s Hospital in Dublin, but the HSE has plans to employ a geneticist in every cancer centre in the future.
Genetic testing is important for those with a family history of cancer as it can inform the type of treatment they should get, from getting a mastectomy or a lumpectomy, avoiding radiation therapy, and what drugs to use.
New treatments
A new drug called Abemaciclib is showing promising results in patients with high-risk, hormone sensitive HER2 negative breast cancer, who use it alongside anti-hormonal therapy. “That is only a small proportion of patients, but they really need this as they have a high risk of disease recurrence,” Prof. Walshe says.
“That drug makes anti-hormonal therapy work better and reduces resistance to those drugs. It reduces the risk of that cancer occurring elsewhere, like in the liver, bone or lung. This will have a big impact in reducing deaths from breast cancer.”
- The Irish Cancer Society’s Daffodil Day takes place on Friday 28 March. The public are being urged to help raise vital funds for cancer patients and their families. There are lots of ways to get involved and Go All in Against Cancer. Visit cancer.ie to learn more
- Anyone with questions or concerns about cancer, can contact the Irish Cancer Society Support Line on Freephone 1800 200 700 or supportline@irishcancer.ie
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