Prof. Tadeusz Pienkowski

Congress President

SIS Past President

 

Women Fear Breast Cancer

Women fear breast cancer. This disease has a very bad name. Cancer myth is crueler than the real truth about this disease. Meanwhile, the diagnosis is not judgment. We treat patients getting better. For many years, you can control this disease and live life to the fullest. My patient is generally a person that after going through despair, pervasive fear, sometimes anger, sometimes a sense of wrongs, they realize that you need to take treatment and treat it as a job. Sense of responsibility, duty and commitment to life is that good works with them. Breast cancer is a chronic disease and at every stage you need and you can treat it. As long as the disease is treated successfully or under control women can life a normal life. This is very important.

The biology of breast cancer. For a very long time breast cancer was diagnosed by malignant cell growth. The last decades have shed new insights about molecular factors operating at the level of cells and tissues, which is carcinogenesis. The rise of cancer is a long-term dynamic iterative process. In its course initially we are dealing only with genetic changes, phenotypic changes occur at a later stage. Cancer cells become insensitive to the influence of endogenous regulating factors. This does not mean that they become absolutely autonomous. In part of the cases, the cancer cells become hypersensitive to physiological factors that stimulate cell division. Breast cancer cells may also retain sensitivity to endogenous estrogens. It has become essential to understand that cancer is more than a single cell becoming malignant and showing monoclonal growth. A cancerous tumor is a complex structure, which includes various cancer cells with different biological characteristics and also reactions of non-cancer cells such as connective tissue and vessels. Breast cancer is a heterogeneous disease with many features correspondingly. Each of the various subtypes is characterized by different biological characteristics, prognosis and susceptibility to various treatments.  The WHO histological classification of tumors of the breast differentiates between the most frequent non-special type cancer and more than 15 special type cancers and variants.  Molecular tests distinguish between 5-7 subtypes of breast cancer. Immunohistochemistry has characterized three major subtypes of cancer. (a) Cancer with positive estrogen and progesterone receptors (Luminal A and B). This type of cancer is susceptible to hormonal treatment.  In patients diagnosed with estrogen receptor positive breast cancer endocrine treatment is indicated. It should be used for both, treatment and follow-up in the adjuvant and palliative therapy. Several generations of endocrine therapy include aromatase inhibitors (anastrozole, letrozole, exemestan), selective estrogen receptor modulators (tamoxifen), the pituitarys release hormone agonists and pure antiestrogen (fulvestrant) . These medicines are convenient and safe to use. (b) The next type is cancer, whose cells overexpress Human Epidermal Growth Factor receptors (HER2). This family of receptors is involved in cell-cell and cell-stromal communication primarily through a process known as signal transduction. The growth factor receptors activate intracellular signaling pathways in response to extracellular signals and promote the proliferation of tumor cells. Drugs that target against these signal pathways comprise monoclonal antibodies (trastuzumab, pertuzumab) or kinase inhibitors (lapatinib). They interrupt the signaling pathways, stop tumor growth and can improve the natural course of the disease by. They can be used in adjuvant and palliative treatment. (c) The third subtype is triple negative cancer that shows no hormone receptors for estrogen or progesterone and also no HER2 receptor. In this type of cancer no targeted therapy exists to date. Chemotherapeutic agents are used for systemic treatment.

The breast organizations. Since decades we are seeing a tendency to define senology or the science of breast diseases as a separate discipline. In the 70s scientific national breast societies developed whose purpose was to study the development, diagnosis and treatment of breast cancer. Charles Marie Gros founded in Strasbourg 1976 the Senologic International Society. The major scope of this first international society on breast health was forming an international federation and to exchange results of research every two years during a world congress. Today numerous congresses and conventions are focusing on the problem of breast cancer. Besides the SIS World Congress the most important breast meetings include St.Gallen Breast Cancer Conference, European Breast Cancer Conference and San Antonio Breast Cancer Symposium. The 19th World Congress of the Senologic International Society will be organized in Warsaw in cooperation with the annual meeting of the Polish Society for Research on Breast Cancer from 5-8 May 2016.

Breast Centers. Scientific studies have shown that it is of great importance for the prognosis of patients to diagnose breast cancer early in the preclinical phase. Therefore, an urgent need exists to carry out screening effectively and to ensure that patients will receive appropriate treatment according to the stage and biologic aggressiveness of the tumor. The three pillars of breast cancer therapy focus on appropriate surgical treatment, radiation therapy and systemic treatment. The complexity of decisions has generated the formation of breast clinics, bringing together professionals of different specialties, dealing with breast cancer only. The founder of SIS, Charles Marie Gros (1910-19849, was pioneering worldwide by providing this type of clinic. Similar hospitals called breast cancer centers or units have developed in many countries later. It has been proven that the results of treatment obtained in such breast centers are much better than the results obtained by a medical professionals working in separate places.  The idea of organ oriented breast cancer clinics in all countries worldwide was launched by the Senologic International Society first, but found sound resonance and enhancement by other important national and continental societies in Europe, America and Asia. It is an important task to bundle these efforts and forming a global alliance for accrediting breast centers. Also the European Parliament adopted a resolution on combating cancer in the enlarged Union on 10 April 2008. Member countries are obliged to follow this resolution by establishing a program of screening, ensuring that all patients have the same access to medical benefits at a high level and organizing a network of specialized centers for diagnosis and treatment of cancer. Only a few countries fully adopted this resolution. The proper organization and conduct of screening requires commitment throughout the Member States, a number of different government agencies, local governments and social organizations. The most important tasks are in summary organizing a national program of breast cancer screening and organizing accredited research and treatment centers that are subject to the certification audit. Accreditation is not ostentation. It is the guarantee to monitor the performance of a breast center independently and to apply quality assurance. The Polish Society for Research on Breast Cancer calls for a statutory solution to this issue since years.

 

SIS Journal is the Electronic Journal of the Senologic International Society, the World Society of Breast Diseases. ISSN: 1688-8170