The most common malignant disease among women in Israel and worldwide (Photo: ShutterStock)
Breast cancer is the most common malignant disease among women in Israel and worldwide.
Every year about 5,000 women are diagnosed with the disease - the absolute majority in its early stage.
According to data, the cumulative risk for women in Israel to get breast cancer during their lifetime is about 12.8 percent among Jewish women and about 7 percent among Arab women, although in recent years there has been an increase in the incidence of the disease among Arab society.
Most of the morbidity is in women over 50, and the risk increases with age.
Still, it is important to remember that most patients diagnosed at an early stage recover from the disease.
"Most of the patients I see today recover from the disease, mainly thanks to the early detection through a screening test," explains Dr. Ofer Globus, a specialist in the breast oncology unit at Sheba Tel Hashomer Hospital. And there are risk factors such as family history."
The screening tests usually include a mammogram, an ultrasound conducted in some cases, and an examination by a breast surgeon.
"A mammogram is considered an effective test, but in younger women, when the breast is denser, we add a screening test using ultrasound, and sometimes also an MRI. In women who are not at increased risk, the mammogram is an excellent test that will help in most cases to detect cases of breast cancer early" , explains Dr. Globus.
One name, three types
Breast cancer has different biological characteristics that are expressed in the tumor cells themselves and it is accepted to divide the disease into three main groups: "
The first group
- which makes up about 70 percent of breast cancers - is a hormonal tumor with receptors for the sex hormones progesterone and especially estrogen. Estrogen is secreted mainly from the ovaries at a younger age , and after menopause from other tissues, and they contribute to the division and spread of the cancer cells," explains Dr. Globus.
The second group,
which includes about 20 percent of the patients, is a HER2-positive tumor.
In this tumor there is an increased expression of a protein called HER2, which causes the cells to divide and spread and also to become more malignant.
These tumors can be positive for estrogen and progesterone or negative for those sex hormones," adds Dr. Globus.
The third group
It is called - triple negative and it makes up about 10 percent of the cases.
This is a condition in which the cancer cells of the tumor do not express receptors for estrogen and progesterone, nor do they express an increased amount of the HER2 protein," explains Dr. Globus, "This type is more common in young women and carriers of the BRCA1 gene."
Besides this basic division, there are also different subtypes of the disease, with different additional characteristics.
In recent years there has been great success in a treatment mechanism based on a combination of biological drugs attached to chemotherapy (Photo: ShutterStock)
A real revolution
"In the past, before the era of personalized treatments, the prognosis of patients with HER2-positive tumors was very poor. However, since the appearance of treatments against the HER2 protein about two decades ago, the prognosis has improved," explains Dr. Globus. According to him, the biological treatment against The cancer cells that express more HER2 results in delaying the disease and improves survival.In the last 20 years, several treatment groups have been developed that work against HER2-type tumors and the arsenal of drugs has been expanding.
In recent years there has been great success in a treatment mechanism based on a combination of biological drugs attached to chemotherapy.
A family of drugs that actually include an antibody that binds to the HER2 protein.
The antibody carries the active chemical substance and the release of the chemotherapy from the antibody takes place inside the tumor cells.
These drugs were able to lead to a real revolution in the treatment of this group of patients.
"In addition, this group of treatments has also been proven to be effective in a variety of breast cancers," explains Dr. Globus, "Today we also know that the expression level of HER2 is important, even if there is low expression in the tumor."
How does the treatment work?
"Most patients come with localized disease," explains Dr. Globus. "A woman who comes with a very small tumor that is positive for HER2, and has no lymph node involvement, will usually come to surgery, after which she will receive chemotherapy treatment for about three months together with an antibody to HER2 for sleep.
If the tumor is also positive for sex hormones, she will also receive anti-hormonal treatment.
" "A woman who comes with a larger tumor or lymph node involvement without metastases, will go for surgery but will first start with biological treatment together with a combination of chemotherapy drugs," explains Dr. Globus.
The treatment lasts between 4-5 months and may include side effects such as nausea, weakness, diarrhea and hair loss.
Most of these symptoms pass after a certain period of time.
"About a month after the treatment, an operation is performed, and the findings show that in 50 to 80 percent of the cases, there is no residual disease after the treatments. After the operation, during about a year, the treatment will be determined according to the response of the tumor to the treatment it received before the operation.
In the case of metastatic disease, treatment is started with a combination of chemotherapy and biological drugs and at some stage, depending on the response, only the biological drugs are continued.
"In such a case, it is usually not possible to operate, at the same time we can also achieve good results in metastatic disease," says Dr. Globus, "in the past, the life expectancy of women with such metastatic breast cancer was one to two years, and today they can live even a decade.
The drug treatments not only increased life expectancy, but also improved the quality of life, even though some of them still have difficult side effects," adds Dr. Globus.
What does the future hold?
"The near future, which is actually already in research, is the new biological drugs that may bring them to be used more and more in the local disease, before or after surgery," says Dr. Globus.
He further adds: "The future is to continue to improve the ability to cure a local disease and also try to even cure a metastatic disease. We all have patients who manage to survive beyond the statistics and perhaps in the near future we will also be able to completely cure a small percentage of these women. In general, we want to prolong life and improve the quality of life for everyone the patients. And I think that by and large we are in the right direction."
Health, in collaboration with AstraZeneca