Fewer and fewer women are dying of breast cancer. That’s because researchers know more about the disease. Recently, researchers are not only looking at cancer cells and ways to fight them, but also at what the body itself can do to get rid of them. This prevents women from receiving unnecessary chemotherapy or drugs.
You can treat a patient too little, but also too much. Doctors call this overtreating. Oncologists are becoming increasingly aware of the best treatment method for each patient and cancer. Because every body reacts differently to the disease.
“That’s how we end up with personal treatment,” Sabine Linn, internist-oncologist at the Antoni van Leeuwenhoek Hospital, told NU.nl. “We have made good strides in that direction in the last twenty years.”
For example, a test has recently become available for many women with so-called HER-2 negative breast cancer (75 percent of patients have this form). “We use that test to determine who needs hormone treatment and who needs chemotherapy. As a result, there is now more tailor-made treatment.”
Feiten en cijfers
- Ruim 15.700 mensen kregen in 2021 de diagnose borstkanker.
- Gemiddeld is bijna 9 op de 10 patiënten na 5 jaar nog in leven, en 8 op de 10 patiënten na 10 jaar.
- Meer dan 80 procent van de mensen die borstkanker krijgen, is 50 jaar of ouder.
- Heel soms krijgen mannen ook borstkanker. Vorig jaar ging het om 133 gevallen.
Medicines and chemo not necessary for everyone
There is also good news for patients with triple-negative breast cancer. About 10 to 15 percent of women with breast cancer have this form and it is considered one of the most dangerous forms of breast cancer. According to Linn, there are now a number of promising developments for combating this variant.
“In triple-negative breast cancer, we know that the immune system is crucial. We have discovered that about 20 percent of that group has many immune cells in the breast that clear up the cancer cells. Studies show that these women do not need drugs or chemotherapy. and irradiation is sufficient, provided that the axillary glands are ‘clean’.”
However, this treatment is not yet applied in practice. According to Linn, a study will soon start in the Netherlands, in which women will be given the opportunity to be treated in the new way. In any case, the prospects are promising. “Researchers in Europe have discovered that the risk of metastasis in the group with many immune cells is only 2 percent after 15 years. That risk is very low.”
Immunotherapy turns good cells into action
Some women don’t have those immune cells, or have some. Immunotherapy can help with this group. According to Linn, this therapy ensures that the own immune system comes into action to destroy cancer cells. The treatment method is already being used successfully against other forms of cancer, such as lung, colon and skin cancer.
Immunotherapy for breast cancer is not yet a standard treatment in the Netherlands. “At the moment it only happens in combination with chemotherapy. In the future we want to see whether immunotherapy alone is sufficient and patients therefore do not have to undergo chemotherapy.”
A pathologist can see under the microscope who has many, a few or no immune cells. In order to select even earlier and better who benefits from immunotherapy, a test should be developed for this, says Linn. That should ensure that even less is overtreated.
Researchers do not know why the number of immune cells in the breast differs per woman. “That’s the million dollar question“, says Linn. “It would be great if we knew that. Then you can really start doing prevention.”
Breast can often be preserved
Ultimately, surgery is still the most important treatment for breast cancer. A surgeon then removes the tumor. Irradiation is also still necessary, because some tumor cells move in the breast and they can only be removed in this way.
However, the breast can be preserved more often. “We now mainly operate in a breast-saving manner,” says surgeon-oncologist Bea Lemaire of the Elkerliek Hospital. “Amputations still occur, but less than in the past. The ratio is now about seventy-thirty.”
In the last five to ten years, surgeons have also paid more attention to reconstructing the breast. “That is happening more and more beautifully. We operate differently than before. For example, we remove the tumor from the bottom. The breast becomes smaller, but the shape is retained. Without a huge dent,” says the doctor.
Surgery-free treatment and vaccine still far away
An operation, amputation or breast-saving tumor removal has only a small influence on the survival rate of breast cancer patients. It mainly depends on whether there are metastases. These are less common these days. According to Lemaire, this is because the treatments have improved. The result is that surgeons now perform fewer armpit surgeries to prevent (possible) metastases in the lymph nodes. “To less than 5 percent,” Lemaire says.
Population screening, for which women are invited from the age of fifty, has already caused a decrease in the number of amputations. As a result, breast cancer is detected earlier than in the past.
In the future, it may no longer be necessary to use a knife at all to treat breast cancer. But those studies are still in their infancy. The UMC Utrecht, among others, is now conducting a study. A breast cancer vaccine, which may also be a future option, is still a long way off.
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