Breast Cancer
"The survival from breast cancer has increased due to the improvement in early diagnosis and therapies applied in order to combat this pathology".
DR. ISABEL RUBIO RODRÍGUEZ
COORDINATOR. BREAST CANCER AREA
What is breast cancer?
Breast cancer is a disease of the mammary gland that occurs when cells grow and multiply abnormally. As a result, they grow uncontrollably and form a tumour. It is the most common cancer in women, although it can also affect men.
At the Clínica Universidad de Navarra, patients who come to us with any symptoms are diagnosed by one of our experts and receive a personalised treatment plan that can begin as soon as one week after the visit. We also have a high-risk consultation to assess the extent of the disease.
Likewise, the Breast Cancer Department of the Clínica Universidad de Navarra has the most advanced technology for the diagnosis and treatment of breast cancer. Approximately 90-95% of breast cancer occurs sporadically. That is, it is caused by alterations in the genes, in addition to other risk factors, but is not inherited.
Around 5-10% of breast cancer is caused by inheriting a genetic mutation from the mother or father. Our Genomic Medicine Unit can determine whether breast cancer is hereditary or not.
Contact us if you need more information or advice on the checkup you need.
What are the symptoms of breast cancer?
20% of anal cancer patients are asymptomatic. However, here are some of
the main symptoms that may be associated with anal cancer.
It is essential to see a specialist in breast pathology if you notice any of the following symptoms:
- A lump or thickened area in the breast or in the armpit (under the arm).
- Changes in the size, shape or appearance of the breast: Any asymmetry or alteration that is unusual deserves attention.
- Nipple retraction, eczema or sagging: These changes may be related to serious underlying conditions.
- Discharge of blood or other fluid from the nipple: Although not always indicative of cancer, this is a symptom that should be evaluated.
- Skin changes, such as redness, scaling or a texture reminiscent of orange peel.
- Persistent breast pain: Although breast pain is often associated with benign conditions, it can also be a sign of breast cancer.
- Partial or complete swelling of the breast, even if not accompanied by a visible lump.
Remember that early detection is key to the successful treatment of breast cancer. Seek medical attention promptly for any suspicious changes.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes?
The exact cause of breast cancer remains unknown. However, specialists have identified a number of risk factors, including:
- Age. The risk increases with age. The highest incidence of breast cancer is between the ages of 50 and 60.
- Family history of breast cancer. Depending on the number of affected family members and their relationship, whether they are first or second degree, and the age of onset, there are different risks of developing it.
- Hereditary factors. Approximately 5-10% of cases are hereditary. Half of these cases are attributed to the mutation of two genes: BRCA1 and BRCA2. In these cases, genetic testing is recommended.
- Having your first pregnancy after the age of 30 or not having children.
- Early menstruation (before the age of 12) or late menopause (after the age of 55).
- Certain breast lesions, especially proliferative lesions with atypia.
- High fat intake, alcohol consumption, obesity, smoking and physical inactivity.
More than half of all women with breast cancer have none of these risk factors, nor do all women with one or more risk factors go on to develop breast cancer. For this reason, early detection systems are particularly important.
What is my risk of having breast cancer?
At the Clínica Universidad de Navarra, we have a Risk Assessment Consultation where, after analysing the patient's family and personal history, as well as her breast characteristics, a computer programme is used to determine the approximate risk of breast cancer and recommend the most appropriate radiological tests for early diagnosis.
If you have a breast lesion that increases the risk of breast cancer, our specialists will explain the best way to follow up.
What types of breast cancer are there?
There are several types of breast cancer. Most form in the milk ducts and are called ductal.
Others are of the lobular type that form more in the area of the lobular ducts. Sometimes they can appear in the tissue surrounding the ducts and are called sarcomas, sometimes they affect the skin of the nipple and areola and are called Paget's disease.
En todos los cánceres de mama se analizan una serie de propiedades como son los receptores de estrógeno, de progesterona y el Her2 que permiten a los especialistas dar el tratamiento adecuado a cada tipo de cáncer.
Can breast cancer be inherited?
In 20% of cancer patients there is a previous family history of cancer.
Cancer is a disease that occurs due to abnormal gene function. Thus, in most hereditary cancer syndromes, there is a 50% chance that a child will inherit the family mutation. Although carrying a mutation is not synonymous with cancer, it does imply an increased risk of developing it in the future.
Check-Up Unit
Within 24 hours we carry out a comprehensive examination to assess your state of health.
Genomic Medicine Unit
Find out if you are at risk of developing breast cancer if there are cases in your family.
Prevention program
This programme is aimed at women aged 40 and over.
How is breast cancer diagnosed?
One of the keys to success when treating breast cancer is a comprehensive assessment.
For this reason, the Clínica Universidad de Navarra has a specific medical area for the diagnosis and treatment of breast cancer, made up of a multidisciplinary team.
They will take a clinical history, perform a physical examination and add imaging methods such as:
- Mammography
- Breast ultrasound
- Magnetic resonance imaging
- Breast biopsy
How is breast cancer treated?
Breast lumpectomy
Breast lumpectomy is a surgical treatment that is indicated in 70-80% of breast cancer cases, as it is less aggressive and does not require complete removal of the breast.
Its aim is to remove the tumour while preserving the breast. This procedure usually requires hospitalisation for one or two days. If possible, hidden scars (periareolar, submammary fold, axillary line) or oncoplastic surgery (combining the principles of oncological surgery with those of reconstructive plastic surgery) are performed.
Oncoplastic techniques aim to completely remove the breast tumour with sufficient margins and to reshape the breast so that the aesthetic result is as good as possible.
Sometimes this includes minor surgery on the healthy contralateral breast to achieve better symmetry. Survival rates with conservative surgery and radiotherapy are equal to those with mastectomy.
Mastectomy
In 20-30% of breast cancer patients the entire breast needs to be removed. There are two types of mastectomy for breast cancer:
- Simple mastectomy. The surgeon removes all the breast tissue and the nipple. Hospitalisation is required for 2-3 days. Can be combined with other treatments.
- Modified radical mastectomy. This consists of the removal of all the breast tissue, the nipple and the axillary nodes. It requires hospitalisation for 2-4 days, depending on whether immediate reconstruction is performed or not. Can be combined with other treatments.
Sentinel node breast biopsy
This diagnostic technique is performed at the same time as surgery. In most cases, it avoids the removal of the nodes in the armpit.
It involves removing the first lymph drainage node of the cancer, known as the sentinel node, for laboratory analysis and, if it is free of malignant cells, the remaining axillary nodes are not removed.
It provides doctors with valuable information and carries fewer risks for patients than other procedures.
Breast reconstruction techniques can be performed during the surgical procedure in which the tumour or breast is removed. These techniques aim to offer the best solution with the least possible after-effects for patients.
Postoperative radiation is essential, as it reduces the risk of local recurrence to one third. Our specialists have extensive experience in both conventional radiotherapy (irradiation of the entire breast for 6 weeks) and partial radiotherapy, with irradiation only in the tumour bed, for only 5 days.
It has been proven that in early stage breast tumours, partial radiotherapy, restricted to the area at risk (tumour bed) achieves very satisfactory results with a minimal risk of relapse.
The Clínica Universidad de Navarra has implemented different partial breast irradiation techniques:
- High-rate perioperative breast brachytherapy: this is a minimally invasive radiotherapy procedure which offers significant advantages for the patient as instead of 6 weeks of treatment it can be carried out in just 5 days and at the same time as the surgery to remove the tumour. Once the treatment is completed, the catheters are easily removed in the consultation room without the need for anaesthesia. We are an international reference centre for this technique and we are the centre with the most accredited experience in performing this minimally invasive intraoperative implant.
-
High-rate perioperative breast brachytherapy + external radiotherapy with "forward" technique: in patients whose cancer is more widespread, a combination of radiotherapy treatment is applied. Brachytherapy is first administered directly to the area of greatest risk and then complemented by external radiotherapy to the remaining breast tissue.
- External radiotherapy with "forward" technique: this radiotherapy technique offers more advantages than the conventional radiotherapy technique. It is administered in a more homogeneous manner, reducing acute adverse effects. In this way, the treatment can be administered in 15 sessions instead of the 25 sessions required in conventional treatment.
The selection of the most appropriate chemotherapy regimen in breast cancer will depend on tumour size, lymph node involvement, presence of distant metastases, previous treatments, tumour subtype of breast cancer (based on expression of oestrogen receptors, progesterone, HER2, etc.), age, comorbidity, functional status of the patient and potential toxicity.
In general, chemotherapy in breast cancer can be administered adjuvantly (after breast cancer surgery), neoadjuvantly (before tumour surgery) and in disseminated disease to control distant metastases.
-
Adjuvant is used in localised tumours to support local treatments to control the disease. The intention is to eradicate circulating tumour cells and micrometastases.
-
In neoadjuvant treatment, the aim is to start systemic treatment as soon as possible, to evaluate the tumour's response to treatment in vivo (to check that the tumour is sensitive and decreases with chemotherapy) and to try to reduce the size of the tumour in order to increase conservative surgery and to remove the smallest possible area of breast or so that the tumour can be operable.
The Clinic has specific protocols and extensive experience in the administration of chemotherapy during breast cancer in pregnancy. We currently have a wide range of anti-tumour chemotherapy drugs for breast cancer.
It is the first specific therapy used for breast cancer, and is prescribed for tumours that express oestrogen receptors, i.e. hormonal breast cancer. These are the most common tumours, accounting for 70%-80% of breast cancers.
Hormone therapy has shown benefit by decreasing the risk of relapse and increasing survival in patients with this hormone-sensitive disease.
There are different drugs such as selective oestrogen receptor modulators (tamoxifen), aromatase inhibitors (anastrozole, letrozole, exemestane), LHRH analogues (goserelin, triptorelin), oestrogen receptor antagonists (fulvestrant) and progestogens (megestrol acetate and medroxyprogesterone).
Removal of the ovaries (oophorectomy) may also be performed to decrease the body's production of oestrogen.
The main determinant for selecting the most appropriate hormonal treatment in these patients is the functional status of the ovary. For this purpose, patients are divided according to their menopausal status by means of clinical history and determination of hormone levels produced by the ovary in the blood.
During anti-tumour hormone treatment it is important to monitor patients by gynaecological examination (cytology and ultrasound), bone mineralisation levels (densitometry) and blood cholesterol levels.
The use of this hormone therapy is currently being considered for preventive purposes in patients who have not developed breast cancer but who have been diagnosed with premalignant breast lesions (atypical hyperplasia).
The immune system is central to the development and control of tumours. Immunotherapy aims to stimulate or repair the patient's immune system so that the body itself fights the tumour disease.
The breast cancer vaccines administered in immunotherapy treatment are made from the patient's own cells, thereby triggering her immune system to respond to her tumour.
The limited disease volume and the combination of immunotherapy and chemotherapy make this a good additional treatment option for breast cancer patients with localised disease who need chemotherapy.
Tolerance is good because the vaccines are made with cells from your own body and therefore there is no rejection and it is an individualised treatment, which can be administered together with chemotherapy and for a prolonged period of time in the first 5 years, when the disease is most likely to recur.
No es una terapia aislada, sino que se trata de complementar el tratamiento oncológico estándar de la paciente con un calendario vacunal de dos años de duración.
Las vacunas se elaboran en el laboratorio GMP de Terapia Celular de la Clínica Universidad de Navarra con las células extraídas de la propia paciente. Una vez que están procesadas las células, se obtienen de ellas los antígenos propios del tumor de la paciente.
La Clínica Universidad de Navarra ha realizado un ensayo clínico para comprobar la eficacia de la aplicación de vacunas autólogas dirigidas a reducir la progresión del cáncer de mama en un subgrupo determinado de esta enfermedad, aquel en el que las células tumorales no expresan la proteína HER2. Actualmente, ofrecemos estas vacunas como tratamiento compasivo complementario al tratamiento habitual.
There are currently a number of drugs available that act on tumour cells, both extracellularly and intracellularly.
HER2 is a receptor protein that exists in some tumours and causes tumours to grow more actively. Some breast tumours overexpress this protein and can be treated with HER2 receptor inhibitors.
This treatment has been shown to be highly effective in combination with chemotherapy, improving tumour responses and patient survival. Trastuzumab and lapatinib are currently on the market, but new drugs such as pertuzumab or trastuzumab-DM1 are in development.
Finally, anti-angiogenic drugs prevent the formation of abnormal vessels that supply nutrients to the tumour and promote tumour growth and metastatisation.
The addition of bevacizumab to chemotherapy has been shown to delay disease progression in patients with distant metastases.
The Clínica Universidad de Navarra continues to investigate new therapies with the intention of increasing efficacy and reducing toxicity.
A PERSONALIZED MEDICINE
Second Opinion,
peace of mind
Request a second opinion from our professionals with great experience in the diagnosis and treatment of oncological diseases
In 3 days, without leaving home.
Or if you prefer you can come to the Clinica.
Why choose the Clínica Universidad de Navarra
THE MOST AVANT-GARDE TREATMENTS
Oncoplastic surgery and
Breast reconstruction
Our surgeons specialize in surgical planning to preserve as much healthy breast tissue as possible and, if necessary, to carry out immediate breast reconstruction.
- Conservative oncoplastic surgery.
- Nipple–areola-preserving mastectomy.
- Intraoperative ultrasound.
- Prevention of axillar lymph node involvement.
- Immediate breast reconstruction.
Targeted therapies and immunotherapy for breast cancer
We have extensive experience in administering the most innovative therapies, such as vaccines based on dendritic cells, which complement standard treatments.
- Immunotherapy-based treatments.
- Breast cancer vaccines.
Accelerated partial breast irradiation
We are pioneers in Spain in accelerated partial breast irradiation with brachytherapy, reducing radiotherapy courses to five days instead of the standard twenty-five days.
- Interstitial brachytherapy.
- Intraoperative brachytherapy.
- Intraoperative radiotherapy.
- Innovative radiotherapy techniques (proton therapy).
Proton therapy for cancer
Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.
The Proton Therapy Unit of the Cancer Center Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.
Where do we treat it?
IN NAVARRE AND MADRID
Nuestro equipo de profesionales
We help our patients to overcome their stories
Their testimonies encourage us to continue improving our services
Rosi
Hereditary breast cancer
"There were several cases of breast cancer in my family. I had a genetic test to see if I carried the BRCA gene.
When I tested positive, I decided to have a bilateral mastectomy and immediate reconstruction. For me it has been night and day, I am another.
Pilar
Breast Cancer
"They treated me for breast cancer so fast I didn't even know it.
After surgery to remove the tumor, they placed the catheters and within 5 days gave me all the radiation therapy sessions I needed.
Beatriz
Breast cancer during pregnancy
"It's hard but I think it's harder when you have no hope. It was very important that I was given a choice to fight for both my health and my son's life. He is my driving force.
La Clínica has given me the possibility of surviving and having my son. That is what la Clínica is for me, life.
Merche
Breast Cancer
"I didn't know if I could handle it all, you don't know what you're going for until it happens to you. Because of the breast cancer, I had to have a bilateral mastectomy.
I have a wonderful husband and a son who is my future. I love life, I still have a lot to do with them. And I will.
