In 10% of breast cancer cases, the cause of the disease is hereditary/ShutterStock
Breast cancer is the most common type of tumor among women in the western world.
In Israel, about 5,000 new breast cancer patients are diagnosed every year.
According to estimates, one in eight Israeli women may get this cancer during her lifetime.
Thanks to high public awareness of early diagnosis and the importance of performing screening tests (such as mammography), most cases are discovered in the early stages - stages in which the chances of cure are about 90%.
Breast cancer forms in the breast tissues, usually in the ducts that carry the milk to the nipple and in the glands that produce the milk.
The disease mainly characterizes women but in fact also exists among men, but in very low rates.
The causes of the disease are diverse - some are congenital or age-related, and some are related to lifestyle.
In 10% of cases of breast cancer morbidity, the cause of the disease is hereditary (ie the disease is caused by changes in inherited genes).
It is important to emphasize that not every lump in the breast is a malignant tumor.
About 80% of the lumps that are discovered are benign, and do not pose a risk.
"In general, about 70% of the diagnoses are of the hormonal tumor type"/ShutterStock
In cases where the tumor is malignant, it can be classified into three main groups: a hormonal tumor activated by receptors for hormones such as progesterone or estrogen;
A tumor with overexpression of a protein called HER2 that causes cancer cells to divide and spread;
and a triple negative tumor - a tumor without progesterone or estrogen receptors and without expression of the HER2 protein.
In recent years, another classification was added - a tumor with low expression of the HER2 protein.
In the past it was customary to classify the patients as positive or negative for HER2, but today it is also possible to refer to those who have a low level of HER2 expression.
"In general, about 70% of the diagnoses have the type of hormonal tumor, 20-30% are positive for HER2 and the rest are defined as triple negative since they do not have any of the above-mentioned receptors," notes Dr. Shlomit Strolov Shahar, a senior physician in the breast cancer unit , in the oncology department at the Tel Aviv-Ichilov Medical Center.
It is important to emphasize that for some patients with breast cancer, individual treatment is adapted according to certain mutations/ShutterStock
An antibody that acts like a target-guided missile
According to her, the decisions regarding how to treat breast cancer patients are made based on medical considerations, depending on the patient's condition, the type of tumor and the stage of diagnosis.
"In cases where the breast cancer is of the hormonal type, they are treated with hormonal treatments that attack the receptor and prevent cell proliferation, sometimes in combination with biological therapy. In cases where the breast cancer is of the 'triple negative' type, the treatment is mainly through chemotherapy, while today some patients are added immunotherapy (activator treatment the immune system against the tumor," explains Dr. Strolov Shahar.
"In cases where HER2-positive tumors are involved, antibodies are used, which bind to this protein and inhibit its activity.
As of today, we have a new generation of drugs available, which are actually antibodies to which small chemotherapies are conjugated," explains Dr. Strolov Shahar.
"The treatment works like a 'target-guided missile', which is aimed directly at the malignant cells. In fact, the antibody directs the chemotherapy to the target itself, and the very binding of the antibody inhibits the signal transmission pathway, and the chemotherapy attached to it mainly attacks the nearby cells. This innovative treatment is suitable for types of HER2 type breast cancer - even for those with low expression.
It is important to emphasize that for some patients with breast cancer, individual treatment is adjusted according to certain mutations - hereditary mutations or somatic mutations (in the tumor). For example, in cases where a mutation is found in the BRCA gene, treatment with PARP inhibitors can be adjusted for certain patients Today, a test to detect mutations in the BRCA gene is included in the medicine basket free of charge and without the need for a referral to any woman of Ashkenazi descent.
To what extent is the treatment of the antibody linked to the chemotherapy a good news for the patients?
"Breast cancer is still a challenging disease and unfortunately for patients with metastatic disease, dealing with it is not easy.
At the same time, the new treatment groups have opened up a more promising therapeutic era for us because the effect of their action is dramatic - the tumors shrink and the reactions are also very prolonged, sometimes with a benefit of several years (even for patients in the second and third line of the disease), including reactions to brain metastases which are one of the symptoms of Cancer is positive for HER2, and these are things we have not seen before," concludes Dr. Strolov Shahar.
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