Conservative surgery plus radiotherapy in breast cancer gives better results than mastectomy

MADRID, (EUROPA PRESS). – The surgeon at the La Paz University Hospital in Madrid, José Ignacio Sánchez Méndez, highlighted that there is more and more data in breast cancer surgery that demonstrates that conservative surgery plus radiotherapy provides better results for patients than a mastectomy (complete removal of the breast).

This was stated by the expert during the GEICAM Annual Review of Advances in Breast Cancer (RAGMA), organized by the GEICAM Breast Cancer Research Group, which was held this Thursday in Madrid. “In this type of surgery it can be said that less is more and better,” Sánchez highlighted.

“Many surgical gestures do not contribute anything, we can perform surgeries that do not benefit patients. We have to convey that mastectomy is not the truth for all patients, we cannot apply it to the general population. The latest advances have shown that it is always better conservative surgery plus radiotherapy than a mastectomy,” defended the expert, who added that this type of action “improves the quality of life of the patients.”

Furthermore, Sánchez explained that new research points to the no need to complete the axillary dissection when there are less than three sentinel lymph nodes affected, in scenarios that are little represented or not contemplated in it, such as mastectomy or periganglionic infiltration.

ARTIFICIAL INTELLIGENCE IN SCREENING

Artificial intelligence (AI) has identified 99.3 percent of breast cancers detected by screening as positive, according to a Norwegian study that was presented during RAGMA.

This is a study carried out in Norway with 661,695 digital mammographic examinations performed on 242,629 women, the data set included 3,807 breast cancers detected by screening and 1,110 interval breast cancers – those that are diagnosed between a screening mammogram. routine that seems normal and the next mammogram.

“When the tests performed were divided into two and the AI ​​used 50 percent as a threshold for low versus high scores, 99.3 percent of breast tumors detected by screening (3,781 of 3,807) were identified as positive. ) and 85.2 percent of interval breast cancers (946 out of 1,110). On the other hand, 17 percent of the false positive results (2,725 out of 16,040) were considered negative,” the study explained during the meeting. Dr. Solveig Hofvind, head of the Breast Cancer Screening Section and head of BreastScreen Norway at the Norwegian Cancer Registry.

Likewise, the use of AI in mammographic screening can lead to earlier detection of breast cancers. For Hofvind, thanks to these advances, it is expected that AI will soon allow screenings to be personalized, but more studies are needed to provide the necessary evidence to implement it safely.

“In addition, we need to maintain the interpretation skills of radiologists and establish benchmarks to monitor the effect of using AI as a decision support, as an independent reader or to classify women according to their risk score.” , the researcher has pointed out.

ADVANCES IN HEREDITARY BREAST CANCER

The professor of Epidemiology at the Institute of Cancer Research and Imperial College in London, Montserrat García-Closas, has discussed in RAGMA recent very large-scale studies that allow us to know the risk of developing breast cancer much more precisely than before in women with mutations in high-risk genes: such as BRCA1 and BRCA2.

These studies are identifying additional genes with high-risk mutations, so they represent a great improvement in risk counseling in women with hereditary cancer.

“Now we know with much better precision what the risks of these mutations are and we have also been able to confirm genes that are not safe,” García-Closas highlighted.

The has also discussed the polygenic risk score (PRS) which may improve the ability to predict breast cancer risk, especially when combined with traditional risk factors such as family history, hormonal and reproductive factors, and*density. breast on a mammogram.

Thus, PRS could lead to personalized risk-based screening programs rather than relying solely on age-based guidelines. “Currently, clinical trials such as WISDOM in the US and MY-PEBS in Europe are evaluating the practical benefits, costs and effectiveness of using polygenic risk indices to improve the quantification of individual risk and results are expected in the next five years,” he stated.

Early identification of people at high risk for hereditary breast cancer allows for targeted interventions, which may include more frequent and earlier screening, preventive surgeries, and risk-reducing medications. These measures can help significantly improve survival rates.

Furthermore, early identification and intervention would result in long-term economic savings by reducing the need for costly treatments associated with advanced cancer and its complications.

GEICAM AND RESEARCH

The different RAGMA sessions cover relevant aspects in the approach to breast cancer, as well as contributions from the Group itself. “For example, the GEICAM studies have allowed us to distinguish which subgroup of triple negative patients really benefit from treatment with capecitabine, which is another step towards the individualization of medicine,” explained coordinator José Enrique Alés Martínez.

Other advances in this regard have been the incorporation of agents that have a preferential action on patients with tumors with specific alterations, such as inavolisib for mutations in PIK3CA or elacestrant for mutations in ESR1. Some learnings are more subtle, for example, as data accumulates from less frequent subgroups of patients with breast cancer or with a predisposition to develop it, the real risks of populations can be better established and, in the future, at the individual level, explains the Dr. Alés. For example, the actual risk of developing breast cancer for carriers of pathogenic mutations in BRCA2 is now estimated to be 15-20 percent lower than thought.