One in every eight women will have breast cancer during their lifetime, but most will overcome it.

José Antonio Sau

"One in every eight women will develop breast cancer in her lifetime." Oncologist Bella Pajares from the Clinical University Hospital Virgen de la Victoria is emphatic in her statements to SUR. "It is the most common tumor in women, far ahead of the next, which is colon cancer; it's almost double in Spain," she explains. Despite this, it is one of the tumors "that has most improved, both in terms of cure and quality of life. Thus, even though the incidence and prevalence numbers are large, so too are the life expectancy and the quality and cure rates of the patients," she adds.

The five-year survival rate for breast cancer exceeds 85%, according to the latest available data, "which is very encouraging thanks to early diagnosis campaigns and advances in treatments: it's a very common tumor, but the survival rate is very high, so the message must be very positive," emphasizes Dr. Bella Pajares.

When a woman receives news of this nature, she should pay attention to "what surrounds the purely medical aspect, such as lifestyle, social relationships, family relationships, physical issues: the first thing is to have time to come to terms with the moment, the diagnosis, and that her life will change in the coming months," a period she should use to "find the necessary tools to get through it."

Dr. Pajares insists on a holistic approach: "She needs to attend to all spheres of her person, the physical, the most important, proper nutrition, physical exercise, rest, restorative sleep, and pay attention to her periods of activity and rest. Also, to be aware of her mental state, whether she needs to be working or on leave, the time she needs, what her emotional moment is. As I often tell my patients: 'You've never been in a situation like this, have you? So, if you don't seek psychological help now, from a group of people like you who are going through the same thing, when will you do it?'"

In her opinion, it is essential "to try to surround yourself with all those things that nourish you so that the health process, treatment, and disease are experienced in the healthiest way possible and as an opportunity for personal growth."

There are signs that may indicate the presence of a tumor in the breast. In some cases, one may not notice any painful or non-painful lump, but in other cases, one might "notice something visual, striking: a lump or a mass, some hardness in the breast area. It can be painful or not. Often there is an asymmetry in the breast, that is, the two breasts that have always been the same way, one larger than the other or whatever, then you see something that visually makes you think that the breast is different and, sometimes, secretion from the nipple." However, she notes, there are tumors that give signals and others that do not.

The first test performed is imaging, "a mammography sometimes accompanied by an ultrasound." "These may have been requested because the patients noticed a lump, requested by a healthcare professional or the family doctor." Or, alternatively, they may have undergone the screening programs of the Junta de Andalucía. If the result is suspicious, the patient is called in for a biopsy, which rules out or confirms the presence of the malignant tumor. If the result is negative, the patient sometimes requires a second check-up at six or twelve months. If positive, she enters "a multidisciplinary protocol, which is an integrated care process for breast cancer where we discuss the cases of the patients individually every Friday, with their mammography, biopsy, age, menopausal status, if there are diseases and their comorbidities to personalize the treatment as much as possible," she explains.

In this committee, it is decided whether the patient is operated on right away or receives systemic treatment before the intervention or if she needs an additional test such as a breast MRI, she explains.

Prevention is key. "There are factors like family history and age that we cannot control, but we can avoid drinking alcohol, one of the factors with the highest risk of breast cancer, we can try to avoid obesity, overweight, which after menopause is a risk factor for the development of breast cancer," she says. But there's more: doing sports, avoiding sedentarism, "and also avoiding hormone replacement therapy after menopause if it is very prolonged." Secondary prevention would be to participate in all screening programs, "having mammograms in the available age range," between 49 and 71 years. The idea is to continue expanding them. There has also been an improvement in metastatic breast cancer. "Breast cancer is not a single entity; we have hormone-dependent tumors, triple-negative and tumors whose proliferation mainly depends on HER2 proteins, which are the HER2-positive tumors. In all three subtypes, there have been advances," she adds.

Lymphedema is a chronic and irreversible sequel that can occur after breast cancer treatment, especially when lymph nodes are removed from the armpit. It consists of an accumulation of lymphatic fluid that causes significant swelling in the arm and back of the hand. Oncologist Bella Pajares notes that the arm "sometimes hurts, is very tense, and limits its mobility and function," affecting the quality of life of women and hindering their work. Previously, axillary clearance was performed, removing all lymph nodes, and then came the sentinel node technique, which allows for the removal of only one or two, not the entire armpit.

"We can now, in some tumors with a good prognosis and in selected patients, with the armpit showing no evidence on ultrasound or clinical examination of affected lymph node, not surgically touch that armpit, thus the risk of lymphedema no longer exists. This surgical advancement is as important as any of the drugs," assures Dr. Bella Pajares.

• More topics
• Menopause
• Junta de Andalucía
• Women
• Hospital Clínico de Málaga
• Breast Cancer
• Colon Cancer
• Tumor
• Cancer