Considerable progress has already revolutionized the prognosis of breast cancer, which remains the most common female cancer. In surgery, the operative procedure, removal of the tumor alone (lumpectomy) or of the entire breast (mastectomy), is now a collegial decision in which we try to anticipate the quality of the post-operative aesthetic result. The operation can be performed before or after chemotherapy.
“The future of cancer treatment depends on establishing the molecular signature of the tumor and the patient’s genetic identity card. This makes it possible to better define the therapeutic strategies by trying to adapt and target the treatments to obtain maximum effectiveness with minimum side effects ”, explains Pr Rémy Salmon, head of the surgery department at the Institut Curie, in Paris. . Today, 73.8% of sick women under the age of 50 do not have their breast removed.
More efficient techniques
Fewer mastectomies are performed due to early detection by mammography, which allows small tumors to be removed. In half of the cases, the removal of the breast can also be avoided thanks to chemotherapy before the operation, which can sometimes “melt” an invasive tumor.
A greater number of women are also now benefiting from new techniques, called oncoplastics, which allow the removal of larger tumors with good aesthetic results. Surgeons trained in this new discipline reshape the injured breast during the operation. But a total ablation is sometimes inevitable without for all that predicting a bad prognosis. If the breast is completely removed, immediate reconstruction is sometimes possible; it can also be done later.
Avoid removing lymph nodes under the arm
The sentinel node technique, validated for small tumors, constitutes real progress in the fight against breast cancer. In practice, one or two lymph nodes in the armpit, related to the tumor, are removed and analyzed. If they are unharmed, classic axillary dissection removing around ten lymph nodes will be avoided, thus sparing women from possible sequelae in the arm and shoulder.
Larger tumors ongoing clinical trial
“Since 2005, the French recommendation has been to limit the sentinel node technique to infiltrating tumors of less than 2 cm”, explains Dr Jean-Marc Classe, head of the surgery department of the Gauducheau Cancer Center in Nantes.
A clinical trial (GAS 2 +) initiated in Lyon is attempting to extend this technique to larger tumors. In practice, he plans to offer 200 women both the sentinel node technique and axillary dissection. If the comparative analysis of these techniques shows consistent results, an axillary dissection could in the future be safely spared these women and offer them more comfort.
Oncoplasty: reshaping the breast during or after the operation
A greater number of women are now benefiting from new techniques, called oncoplastics, making it possible to remove larger tumors with good aesthetic results.
Surgeons trained in this new discipline reshape the injured breast during the operation. If the breast is completely removed, immediate reconstruction is sometimes possible; it can also be done later.
Associations to help you
-: European coalition against breast cancer 01 44 30 07 66.
-: 0810 111 101 (price of a local call).
-: 01 44 30 03 03.
-: 01 53 55 25 26.
– 2009 report “Women’s health in France”, coordinated by DREES (Department of research, studies, evaluation and statistics).