Breast cancer forms in the ducts and in the lobules for the breast.1,2,3 Many breast cancers can be estrogen-, progesterone-, or HER-2/neu-positive, which causes the cancer to grow. HER-2/neu positivity is associated with more-aggressive disease, decreased overall survival, and a higher probability of recurrence.3,4
Breast cancer is the second most frequent cancer in Belgium and is the most commonly diagnosed cancer in women5. Although breast cancer is rare in men, it nevertheless affects 1 man for every 100 women6. If detected early, when the cancer is localized in the breast, five-year survival statistics are approximately 90,5% in Belgium.7 In 2021, 2081 people died of this cancer in Belgium.8
Breast cancer that’s found early, when it’s small and has not spread, is easier to treat successfully. Getting regular screening tests is the most reliable way to find breast cancer early. Screening refers to tests and exams used to find a disease in people who don’t have any symptoms. Early detection means finding and diagnosing a disease earlier than if people had waited for symptoms to start. The goal of screening tests for breast cancer is to find it before it causes symptoms (like a lump that can be felt). Breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis of a woman with this disease.
While clinical breast exams and regular self-breast exams still belong to the standard routine of early detection programs in several parts of the globe, medical imaging technology, standardized and quality approved examination procedures and appropriate reading protocols are beginning to dominate successful and cost-effective screening programs.
Women can contribute actively to early detection with self-examinations by examining their breasts one week after their menstrual cycle has begun. They need to check their breasts carefully and pay attention to changes. In case of any finding, they need to contact the doctor. If the physical examination performed by a physician detects anything suspicious, the doctor will refer the patient for a mammography, an ultrasound scan, and/or magnetic resonance imaging.
Mammography is the most common method for detecting breast cancer and initial tumor stages. A mammogram is a low-dose X-ray image of the breast. During a mammography screening, the breast is positioned between the X-ray tube and a detector and carefully pushed down with a compression plate. The optimal amount of compression is applied to maintain the highest image quality, allowing the radiologist to detect any abnormal findings or lesions between tissue.
Superior mammography uses wide-angle tomosynthesis to see more of your breast, helping to detect suspicious findings easier. Siemens Healthineers is the only vendor with 50° wide-angle tomosynthesis, which creates 3D images of the breast reconstructed from several so-called image slices. With our 50° wide-angle tomo-synthesis, we provide a superior method for detecting cancers.9 Get it right first time: eliminate unnecessary biopsies and get the final results fast. We believe, this will result in a significant improvement for breast care professionals, radiologists, and – most importantly – for the many women who participate in screening programs.
Thanks to the 50° wide-angle tomosynthesis of the Siemens Healthineers' mammo device small distortions in the breast are easily detected. Also, benign or malignant characteristics of lesions are better depicted. This technique helps us in daily practice to perform mammograms with more confidence and detect breast cancer in an earlier stage.
Magnetic Resonance Imaging (MRI) is an examination for women who may need additional screening after a mammogram, with significant breast cancer risk, and/or particularly dense breast tissue.
MRI exams present as the most sensitive technique for dense breast tissue. However, MRI examinations tend to take time and are costly. An abbreviated MRI protocol is a shortened version of a standard MRI protocol, consisting of a single early phase dynamic contrast enhanced (DCE) series. Several clinical studies have shown that this MRI protocol does not negatively affect sensitivity or specificity for breast MRI screening purposes. This makes abbreviated MRI protocols an appropriate screening method for high-risk patients and/or women with dense breasts, potentially with less than 15 minutes table time. However, this has yet to turn into a routine methodology and the topic of reducing a comparatively high false positive rate has yet to be addressed.
Ultrasound examinations present an adjunct to mammography in patients specifically with dense breasts. This radiation-free method is often ideal to clarify breast pain or other suspicious symptoms. Ultrasound is highly viable in further specifying palpable abnormalities. It is the method of choice for a “second look” at suspicious findings.
Recent studies show, that up to 30% of cancers are missed during screening, despite high non-cancer recall rates.10 During diagnosis and therapy decision, a key challenge remains to increase diagnostic accuracy. Once potential patients have progressed along the pathway from screening and early detection to actual diagnosis, stress levels obviously increase. Upon initial findings or suspicious lesions coming from a screening examination, additional tests to specify and diagnose breast cancer are often used. Ranging from low to high in terms of specificity physicians usually rely on an order and sometimes even a combination of different methods: Breast ultrasound and resulting sonograms
Should breast cancer be diagnosed in a patient, other tests are done to find out if cancer cells have spread within the breast, the lymph system or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under a patient’s arm, or has spread outside the breast determines the patient’s stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment a patient optimally requires.11
Breast cancer is treated in several ways. Finding the right treatment depends on several factors, some of which have been touched upon within this cheat sheet. Patient history, time of initial finding, diagnostic methodology employed to come to diagnosis – just to name a few. A study conducted almost a decade ago concludes that 26% of oncology treatment plans are inappropriate.12 Having stated this, the importance of having the right information at hand to firstly plan an appropriate treatment based on a patient’s entire history and presentation and, secondly, iteratively monitoring the efficacy of treatment and adapting it to her reaction becomes eminent. Breast cancer treatment depends on the kind of breast cancer that was diagnosed and how far it has spread. Quite often more than one kind of treatment presents as an option:
In advanced health systems, physicians, and specialists from several clinical fields of expertise are working closer together and less in silos. Radiologists, surgeons, medical oncologists, radiation oncologists quite frequently get together in treatment or tumor boards to align on a most effective treatment plan. Even more so, having the complete set of information on a specific patient’s case is a huge lever for making more accurate treatment decisions.
The serum HER-2/neu test is a simple biomarker for metastatic breast cancer. The test measures the portion of the HER-2/neu protein present on the outside surface of cells and shed into the blood of metastatic breast cancer patients. It provides information to help monitor a patient’s therapy over the course of disease in conjunction with information available from clinical and other diagnostic procedures in the management of breast cancer.
Patients who have elevated HER-2/neu levels tend to have tumors that grow more aggressively and resist hormonal therapy and some chemotherapies, and patients generally have a poorer prognosis. Serum levels of HER-2/neu parallel the clinical course of disease regardless of the treatment regimen. Increases ≥15% indicate progression; an increase of <15% indicates a lack of progression. This allows HER-2/neu measurement to help manage therapy.
Studies have reported that monitoring serum HER-2/neu in combination with other tumor markers such as CEA and/ or CA 15-3 may improve sensitivity for early detection of breast cancer recurrence.
Care for patients diagnosed with breast cancer does not end when active treatment has finished. It is extremely important for patients to be in close contact with physician teams and regularly check for signs of the cancer recurring, managing any side effects, and monitoring the patient’s overall health. Follow-up care may include regular physical examinations, further and recurring medical tests, or both. Physicians usually collect large amounts of data tracking a patient’s post-treatment health status and progress. This data should be made available both to the patient and potentially alternating health care teams. A key criterion for successful follow-up is patients and care teams working together to develop personalized follow-up care plans.13
Main pillars of breast cancer follow-up care:
The COVID-19 pandemic has reinforced the need for digital technologies that enable and support close patient-physician interaction. The demand for and use of tele-consulting and telemonitoring services and applications have surged during the year 2020.
