Breast cancer treatment. Interview with the famous professor. Part 2
The interview with Professor Fatih Agalar, the famous Turkish oncologist, on the diagnostics and treatment of breast cancer. Read the part 1 of the interview on our website.
Preventive mastectomy is very popular now thanks to Angelina Jolie. What is your point of view on this? Can you give any recommendations? Does preventive mastectomy make sense?
As we’ve already known, breast cancer can be hereditary. Due to this statement, we divide patients into those who have this risk, and those who do not have a predisposition. If the medical records include cases of breast cancer (in the grandmother, mother, sister or aunt), a woman has to make tests for the disease prevention. In our clinic, we conduct BRCA1 and BRCA2, CHEK2 tests, which are necessary for people at risk. Women may also undergo check-up diagnostics, a unique program of cancer screening for women.
What is BRCA?
BRCA is a test for the detection of specific mutations that are characteristic for breast cancer. If the test results are positive, we can perform a mastectomy (removal of the breast). In some cases, a patient can require an additional operation (for example, removal of the uterus). But a doctor does not make this decision independently, but only after discussion with a patient. Especially in cases when a woman plans a pregnancy in the future. Before making a final decision, a surgeon consults with other specialists.
The only desire of a patient to undergo the preventive mastectomy is not enough for carrying out this surgical intervention. This operation can only be performed in the case of positive test results.
Is operation in the early stages of breast cancer necessary? What kind of treatment do you provide for patients in the initial stages of the disease? Will recovery surgery be required?
We never perform a mastectomy in the early stages of breast cancer. In this case, only organ-preserving techniques are used, such as mammoplasty.
The kind of operation depends on the type of disease. The oncologists provide an individual approach to each patient. In the case of the organ-preserving intervention, radiotherapy is additionally prescribed. It is necessary.
During the operation, we carry out the removal of the tumor and reconstructive surgery to correct changes in the shape of the breast. Usually, a mammal surgeon and oncoplastic surgeon provide these types of operation. As for me, I perform both kinds of surgery. I’m someone like the mammal and oncoplastic surgeon at the same time. But for this you need very long training and experience, you need to know the surgical method well.
Doctor's advice: Patients should choose an operation with reconstruction. Such a procedure is cheaper and carries less risk, side effects, and complications that may occur with implants. In our clinic, we try to preserve the breast completely and even make it more beautiful. Now such a technique is considered as more efficient. Although it is more complicated. Such a complex surgical intervention is not carried out in all clinics, so I recommend to choose the hospital where such an operation can be performed.
Tell us about the breast reconstruction. Why do patients not always want to implant?
Some patients need the complete breast reconstruction because we practice oncoplastic surgeries, so-called organ-preserving operations. But if a patient requires such a procedure, we take the material from the patient's body (autologous material). But before this, it is necessary to take into account the size, the shape of the breast, the location of the nipple and so on.
Each patient’s body is unique and needs an individual treatment approach. The specialists do not prefer implants due to a small risk of lymphoma development.
What are the problems and consequences of total mastectomy? Can this method cause the lymph flow impairments?
Total mastectomy is very difficult to bear psychologically for a lot of patients. Many people ask “how can a woman live without the breast?”. Even in 20 years after recovery, a patient has psychological trauma.
As for lymphatic disorders, lymphostasis is often observed after the total mastectomy. The primary symptom of this disease is the hands swelling. We try to avoid this. The less invasive the surgical intervention and the more necessary specialists involved in the treatment process (the multidisciplinary approach), the fewer side effects a patient has.
Does the breast removal affect the sexual activity?
Total mastectomy affects the sex life. The relationship between husband and wife may suffer, especially if both breasts have been removed. Before the operation, husband and wife need the support and help of a psychologist. That is why it is essential to detect breast cancer at the early stage when breast removal can be avoided.
Are the problems after mastectomy psychological or physiological too?
Loss of the nipple sensitivity is the only physiological problem after mastectomy. This problem occurs after the complete removal of breast tissue. In general, the essential thing in breast surgery is minimal impact and aesthetics. And the less intervention, the more aesthetically the breast looks.
Do women and girls have sexual desire and pleasure after the operation?
These things do not change.
What about the prognosis on the early stages of breast cancer?
On the first stage, 90% out of 100 patients recover completely if the lesion is found only in 1 breast. And in some cases, the recovery rate is up to 100%. If the disease has spread to the lymph nodes, the statistics worsen significantly.
Therefore, it is essential to establish the stage of the disease, to provide accurate diagnostics and effective treatment. In some cases, a patient does not even chemotherapy need on the initial stage.
What is the recovery rate on 2-3 stages of breast cancer?
If to speak about 2 and 3 stages, 40-50% of patients out of 100% have all chances to recover. The recovery rate depends on the age of a patient, the features, and type of the disease.
There are no cases of recovery on stage 4 of breast cancer, are they?
Unfortunately, there aren’t such cases. But there is an opportunity to prolong life. Various techniques and drugs improve the quality and life expectancy of a patient.
And what is the maximum lifespan fixed on the last stage of breast cancer for today?
The 15-20 years lifespan is described in the literature. But such a case is infrequent. In our practice, the maximum life longevity is 10 years. But every day there are more and more new and effective medicines, methods of targeted therapy, allowing to improve the quality of life of patients significantly.
What is the treatment plan for pregnant women with breast cancer? What are the risks for the fetus?
Today there are protocols for the treatment of cancer with chemotherapy during pregnancy. It has been proved that pregnant patients can successfully undergo chemotherapy and even surgical intervention (after 6 months). Oncologists can prescribe radiation therapy after the baby birth.
A significant risk is bringing forward the treatment of cancer on the delivery time. Most women do not want to interrupt the pregnancy. In this case, we carry out surgical intervention and chemotherapy (if necessary).
Does pregnancy reduce the effectiveness of cancer treatment?
The treatment protocol for pregnant women differs from the standard one. We apply small doses of medicines to avoid the spread of cancer. Treatment of breast cancer during pregnancy at least allows us to suspend the development of the disease. And after the birth, we carry out a complete and effective therapy.
Surgery is the primary method for breast cancer treatment. So we need to perform this technique. If we have an opportunity to provide operation for a pregnant woman with cancer, we have all chances to help a patient.
Can the pregnancy interruption increase the effectiveness of breast cancer treatment?
One of the Bookimed founders Evgeny Kozlov and Professor Fatih Agalar
It is a very controversial issue. Some patients are so afraid of this disease that they interrupt the pregnancy. Oncologists discuss all the treatment options with a patient for a long time. But the most effective treatment option for pregnant women is the strategy mentioned above.
Does this option affect the fetus?
Chemotherapy is carried out in such a way that it does not affect the fetus. However, this treatment can be provided only after the 3rd month of pregnancy. It’s a significant risk to perform chemotherapy before this period.
Can the fetus catch cancer?
No, oncology is not catching.
What is the difference in the treatment of patients of different age groups?
It is possible to carry out the treatment for patients under 65 years old and over 65. The type and duration of therapy are prescribed individually, depending on the characteristics of the disease.
How much does triple negative breast cancer worsen the prognosis?
The prognosis, in this case, is not very good. Oncologists recommend the more intensive course of chemotherapy.
And what prognosis is for patients with triple negative breast cancer on the early stage?
On the initial stage, the chances for recovery are high. But if the triple negative occurs in young women, they need to undergo additional genetic tests. The daughter of a patient can inherit this type of cancer.