Breast Cancer Unit
The Breast Cancer Unit of the Oncological Institute (IOB) treats patients with symptoms of a possible breast cancer who need a diagnosis to confirm or rule out the presence of a tumour, in addition to patients who have already been previously diagnosed in other centres and come to IOB to receive treatment. Furthermore, it offers a second opinion service to guide individualised decision making for each patient according to the genetic and molecular characteristics of the tumour cells.
Patients treated at the Breast Cancer Unit are treated by a multidisciplinary team consisting of oncologists, specialised breast surgeons, anatomic pathologists, radiotherapists, radiology and nuclear medicine specialists and nursing staff. The different specialists conduct a coordinated decision making for each patient, so that the sequence of treatments is planned individually looking for the maximum benefit in each case.
Additionally, this multidisciplinary team makes it easier for patients to undergo all the tests and receive all the treatments they need in a coordinated way in the same place and in as little time as possible, without the need to travel and visit different specialists separately.
The Breast Cancer Unit is headed by Javier Cortés, oncologist, and Isabel Rubio, surgeon. The breast cancer oncologists José Pérez, Jesús Soberino, Cristina Saura, Vanesa Ortega, Silvia Patricia Cortez, Celia Miralles, Luciano Cerrato and Javier Román are also part of the unit.
Any “lump” in a breast, change of colour, nipple retraction or abnormal discharge deserve a consultation with a specialist to make sure they are not caused by a tumour. Although most of the time these symptoms are not related to cancer, any of them must be considered a warning sign and may allow an early diagnosis. If a breast cancer is diagnosed in its initial stage, the recovery probability is very high.
It is advisable to perform regular mammograms to enable detecting breast cancer before the symptoms appear. Mammograms are recommended for all women over 40. Below the age of 40, the realisation or not of mammograms must be considered by each woman with her gynaecologist.
Likewise, it is convenient to perform a breast self-examination once a month to know in detail one’s own breasts and detect any changes that may occur in them. This method allows for the early detection of around 50% of breast tumours, so it is advisable to do it regularly. However, since it is not an infallible method, it must be complemented with a mammogram.
In the event of having any suspicion of breast cancer, the diagnosis begins with imaging tests that usually include a mammogram (x-ray examination) and an ultrasound (ultrasound scan). If these tests confirm the suspicion of cancer, it is necessary to perform a biopsy to establish the diagnosis conclusively.
In some cases, the oncologist may consider it appropriate to order additional imaging tests to check if the cancer has spread to other organs, in addition to a comprehensive blood test. The biopsy involves the removal of a sample of cells to be analysed in the laboratory. It is usually performed with ultrasound control to ensure that the cells are removed from the appropriate area.
The analysis, which is performed by a specialist in pathology, reveals whether the cells are cancerous or not. If they are, the analysis allows to determine which specific type of cancer is involved.
The rapid diagnosis circuit implemented at IOB allows the time between the first consultation of a patient for a suspicion of breast cancer and the performance of a biopsy to be reduced to 24 hours. The result of the biopsy that determines if the cells are cancerous or not requires between 48 and 72 hours. The identification of the specific type of tumour requires between 4 and 7 days from the time that the biopsy is performed.
Given that there are more than 50 different types of breast tumours, it is essential to clarify this diagnosis in order to decide the best treatment for each patient individually. IOB is a pioneer in introducing genetic analyses that allow to characterise in detail each tumour and find out which is the most suitable treatment in each case.
The treatment is decided individually depending on the results of these analyses that indicate the specific type of tumour a patient has and how advanced the disease is at the time of making the diagnosis.
In cases where cancer is diagnosed before it has spread to other organs, which are the majority, treatment should include surgery to remove the tumour. In two-thirds of patients, surgery allows the tumour to be removed and the breast preserved. In the remaining third, in which the breast must be removed, a specialist in plastic surgery participates in the intervention so that the breast can be reconstructed in the same operating room. In the reconstruction, whenever possible, the skin of the original breast is always preserved and so is the nipple-areola complex, with generally excellent aesthetic results and minimal psychological impact on the patients.
Depending on the type of tumour, the surgery is complemented with chemotherapy, hormone therapy and / or pharmacological treatments aimed against specific molecular targets of the tumour cells. For each patient, it is necessary to assess if it is convenient to start these treatments before surgery or if it is better to postpone them until after the operation. Likewise, it is necessary to assess for each patient whether radiotherapy should be administered after surgery or not.
Generally, chemotherapy treatments for breast cancer (which attack rapidly reproducing cells, such as cancer cells, but also some healthy cells) usually last between three and six months. Treatments against molecular targets (which specifically attack the cells of specific tumours) usually last one year. Hormone therapy (which blocks the action of female hormones on tumour cells) must be maintained for five to ten years. In cases where radiotherapy is required, the treatment usually lasts between four and eight weeks, although the duration can vary greatly since it is individualised according to each patient.
Once the chemotherapy treatment is finished, the patient’s evolution is monitored with a visit every three month during the first two years and a visit every six month in the following years. Follow-up visits include a physical examination of the patient, a blood test, an annual mammogram and individualised image tests according to each case.