Dr. Antonio Brugarolas is one of the most well-known oncology specialists at a national level, trained in the United States, he has been leading the Oncology Platform of the Quirónsalud Torrevieja hospital for more than twenty years. On the occasion of World Breast Cancer Day, Dr. Brugarolas looks at factors that cause the appearance of tumours and explains when to go to the doctor.

In what situations should a doctor be consulted?

It is essential that women carry out a breast self-examination and go to a specialist doctor when they notice any anomaly, a hardening, a visible change, alterations of the areola-nipple, or axillary thickening.

Tumours are usually painless while benign cysts and fibroadenomas can be painful.

The first mammogram: when is it recommended?

There are two keys to controlling the disease: improving your lifestyle in a healthy way and detecting the tumour when it is still less than 1-2 cm in size.

In tumours smaller than 2 cm, the cure of the disease is almost universally achieved, for this reason, check-ups (health and self-examination) have proven to be effective in controlling mortality.

The established clinical recommendation was to perform the first mammogram/ultrasound at age 40 and then every two years until age 50. From this moment on, annual controls are recommended until the age of 75.

When there is a family history, it can be carried out even before the age of 30.

When is it necessary to perform a mastectomy?

The presence of axillary metastases indicates that chemotherapy/specific combination therapy should be indicated first before surgery. For example, a tumour of less than 1 cm is cured with a surgical intervention that allows the breast to be preserved. In these cases, it is almost never necessary to give complementary chemotherapy to prevent metastases.

During the operation, a sentinel lymph node biopsy is performed and if it does not show metastasis, the cure rate is very high. When axillary metastases are present, radiation therapy to the axilla and remaining breast is always given. If mastectomy is performed, it is not necessary to irradiate the breast, but when the breast is conserved, postoperative radiotherapy must be given.

At Quirónsalud Torrevieja, there is a portable accelerator located in the operating room that allows a single dose of radiotherapy to be administered during the operation and to avoid subsequent radiotherapy treatment, which lasts about three weeks. On the other hand, in cases where mastectomy is performed, early breast reconstruction and symmetry is considered.

Can you live with metastatic breast cancer?

Fortunately, there are effective treatments that can provide years of quality life. Advances in molecular biology have produced excellent treatments.

In 2021 and 2022, exceptional results have been obtained with targeted drugs targeting new tumour genes. These drugs, defined by tumour genetics, constitute the so-called precision medicine or personalized cancer treatment.

Immunotherapy and breast cancer: what does it consist of?

Immunotherapy includes drugs aimed at boosting antitumor immunity, vaccines to generate a specific antitumor response, and genetic engineering approaches that modify a patient’s cells to provide a specific response. However, no vaccines or genetically engineered cells have yet been developed for breast cancer, which are emerging techniques that have already begun to be used in other tumours.

Immunotherapy with drugs that release checkpoints (PD1, PDL1 and CTLA) serve to enhance antitumor immunity and has been developed especially in adult solid tumours. It consists of the intravenous administration of drugs every 2-4 weeks, for 2 or more years, and which can already be administered as preventive in some triple negative breast tumours.

Immunotherapy in breast cancer is very effective in some triple negative tumours and in another group of tumours of the Luminal B lineage with a favourable immunological genetic profile for antitumor immunotherapy. In these cases, it is administered in preoperative guidelines in early cases because it enhances healing.

The combination of immunotherapy with conventional chemotherapy, with radiotherapy and with precision drugs enhances its efficacy and improves the response rate, as well as survival. There is still no conclusive data and more time is needed to be able to accurately specify the results obtained.

What is intraoperative radiation therapy (IORT)?

It is a high-precision irradiation technique in which a single, high dose of radiotherapy is administered to the surgical tumour bed, during a surgical intervention.

The purpose of IORT treatments is to reduce the risk of tumour recurrence, increase local tumour control and therefore patient survival. “This technique, when performed during the surgical intervention, allows direct visualization of the area to be treated, avoiding unnecessary irradiation of the surrounding healthy tissues, and therefore reducing possible side effects”, explains Dr. Rosa María Cañón, Radiation Oncologist Chironsalud Torrevieja.

IORT has been used in the treatment of different malignant tumours.

In the last two decades, there has been an important development in the application of IORT for the treatment of patients with breast cancer, in which in certain cases of early breast tumours, IORT can be administered during breast tumour surgery as the total radiotherapy dose, thereby eliminating all external radiotherapy sessions.

The ‘one step’ therapy, for patients with early breast cancer, who meet the appropriate criteria, allows all the local treatment to be performed in the same breast tumour surgery: removal of the tumour and the sentinel node, full-dose irradiation, and, if necessary oncoplastic reconstruction. IORT treatment only prolongs surgery by about 30 minutes and eliminates all external radiotherapy sessions.

Mobetrón, a great revolution

The Oncology Platform of the Quirónsalud Torrevieja hospital has a MOBETRON® mobile accelerator (Unique in Spain), developed in the United States (Intraop Medical, California), installed in one of the operating rooms, with which to perform IORT treatments.

At Quirónsalud Torrevieja, IORT treatments have been administered since 2004, within multidisciplinary programs that include, in addition to surgery, chemotherapy, immunotherapy, hormonal therapy, external radiotherapy. “From then until now we have treated tumours of different origin and location with IORT, with a large percentage and dedication to breast tumours,” confirms Dr. Rosa Cañón.

The Radiotherapy Oncology department of the Oncology Platform, as well as the rest of the specialists mentioned and involved, have extensive experience in the indication and administration of IORT treatments in the tumours where it is applied.