Management of patients with breast cancer at Gustave Roussy

Gustave Roussy provides care for patients with breast cancer or benign breast conditions, both before and after diagnosis.

The breast pathology team at Gustave Roussy is involved in:

• Diagnosing suspicious breast anomalies;
• Providing comprehensive breast cancer treatment: surgery, reconstructive surgery, chemotherapy, radiotherapy, targeted therapies, post-therapeutic follow-up, and supportive care;
• Managing women at high risk of breast cancer (particularly in cases of BRCA1 or BRCA2 gene alterations): screening and prevention;
• Treating certain specific benign conditions.

Each year, more than 10,000 patients of all ages are treated by the breast pathology committee, including 2,000 new patients.

Despite the high prevalence of the disease (58,500 new cases in France in 2018), patients with breast cancer diagnosed at an early stage achieve remissions in 87% with the ongoing advancements in clinical research (Source : INCa). 

One-day diagnostic consultation

Pioneering the "one-day diagnosis" approach, Gustave Roussy has been offering a dedicated consultation since 2004, allowing for a same-day diagnosis of a breast anomaly. This multidisciplinary consultation includes healthcare professionals from various fields, all specialists in breast pathologies (radiologists, surgeons, pathologists, oncologists, nurses, technicians, etc.). Patients are evaluated by a specialist and various exams are performed such as a mammography, ultrasound, tomosynthesis, angiomammography, MRI, image-guided anatomical pathology sampling (microbiopsy, macrobiopsy, fine needle aspiration). In 90% of cases, if the anomaly is a breast "mass" (lump, nodule), we can obtain an exact diagnosis within the day. In the case of microcalcifications (tiny deposits of calcium salts in the mammary gland), a few days are needed to detect the presence of cancer cells.

One-day therapeutic consultation

Patients who already have an established diagnosis of breast cancer and consulting for therapeutic management also have access to one-day therapeutic consultation. Therapeutic decisions are made during multidisciplinary consultation meetings (RCP), attended by physicians from various disciplines: radiologists, pathologists, surgeons, medical oncologists, radiation oncologists, nurses, and psychologists. They evaluate the best treatments for each patient based on exam results and cancer type and stage. These therapeutic recommendations are then communicated to the patient and their family by the referring physician (medical oncologist, surgeon, radiation oncologist). There are several multidisciplinary meetings within the breast pathology committee, including one dedicated to early-stage breast cancer and precancerous lesions and another for metastatic breast cancer. The breast pathology committee regularly participates in the multidisciplinary molecular meeting, where personalized treatment strategies are discussed based on molecular profiling results.

Dedicated clinical trial consultations

Gustave Roussy is a center for care and research. In many cases, alternative techniques or treatments are developed, studied, and may be offered to our patients with the aim of improving current standards. These alternatives are always optional, proposed, discussed, and carried out only in cases where the patient might potentially benefit and wishes to participate in ongoing research. The breast pathology committee offers a dedicated consultation to evaluate patient eligibility for current clinical trials. During this consultation, the treatments and procedures of the clinical trial are explained in detail. All ongoing clinical trials at the breast pathology committee, along with eligibility criteria, are listed on the Klineo application.

► Learn more about the ongoing clinical trials at Gustave Roussy

End of treatment consultation – transition day

Transition Day, organized in collaboration with the DIOPP, is dedicated to patients who have just completed their initial breast cancer treatment. This day aims to facilitate the transition between the end of active treatment and the return to everyday life. During this session, several crucial topics are addressed to help patients better manage certain side effects of the treatments received and improve their daily quality of life. The main topics covered include follow-up care, endocrine therapy, nutrition, physical activity, psychological aspects, and sexuality after cancer.

► Learn more details about transition day

Telesurveillance at the breast pathology committee

The breast pathology committee is actively committed to integrate innovative digital tools into patient follow-up protocols. This approach ensures personalized care at every stage of the therapeutic journey. We are pioneers in adopting telemonitoring by collaborating with the DIOPP and the Résilience team. Our goal is to continue optimizing the quality of care offered to our patients while ensuring more effective and early management of treatment side effects.

Research training

The breast cancer committee offers medical oncology training for medical students, interns, residents, and fellows, as well as preceptorships for certified oncologists. It also hosts students as part of the European University Diploma in Translational and Clinical Research in Oncology (DUERTECC), who conduct research projects in the various areas of expertise of the committee.

Pathways of care in breast pathology

Patients referred to Gustave Roussy present a spectrum of breast anomalies, ranging from benign conditions to pre-cancerous lesions and invasive tumors. Some patients do not have an established diagnosis of breast cancer or any other breast pathology, requiring both diagnosis and treatment. Others have already been diagnosed with breast cancer and are seeking treatment options or enrollment in clinical trials.

If a suspicious breast lesion is detected

Since 2004, Gustave Roussy has pioneered dedicated breast pathology consults for a “one-day diagnosis”. These multidisciplinary consults are scheduled promptly and convene a team of surgeons, oncologists, radiologists, and pathologists, to ensure the timely diagnosis and treatment plans typically within the same day or within a few days.

The diagnostic process begins with a clinical examination of the breasts and axilla, followed by radiological examinations (mammography, ultrasound, and possibly breast angiomammography and MRI) and sometimes pathological examinations (breast and lymph node biopsy or fine needle aspiration).

► Learn more

If the diagnosis of breast cancer has already been established

Patients with an established diagnosis are referred to a specialist such as a surgeon, medical oncologist, or radiation oncologist, according to the recommended treatment pathway. They are received on a one-day therapeutic consult, during which the radiologist reviews the breast imaging already done and performs new assessments as needed. Additionally, the patients meet with the surgeon, medical oncologist, anesthesiologist, and nurses for a comprehensive assessment. Genetic testing can also be performed if indicated to inform treatment decisions.

► Learn more

Tailored diagnosis and treatment

Treatment decisions and recommendations are formulated by specialized multidisciplinary teams and then communicated, discussed and explained to the patients by their attending physician at Gustave Roussy. Primary care physicians are regularly informed about the patient’s case and are actively involved in many decision-making processes.

► Learn more about treatment options

The entire diagnostic and treatment pathway is generally conducted at Gustave Roussy. However, certain parts of this pathway may be outsourced:

• Certain tests can be performed at facilities near the patient’s residence.
• Chemotherapy and radiotherapy can be administered at centers close to the patient's residence for reasons of geographic proximity. In certain cases, specific treatments may be administered at home in collaboration with local healthcare services.
• Medium to long-term follow-up is entrusted to local physicians (gynecologists, primary care physicians, radiologists) according to standard of care, either partially, alternately, or entirely.

Follow up after breast cancer

Post-treatment monitoring is generally provided by specialist physicians during the initial years, up to 5-10 years, possibly alternating with the local physician (gynecologist or general practitioner + radiologist), and then will be entirely managed by the latter.

The core of the follow-up includes:

• Annual mammography for life
• Clinical examination every 6 months up to 5 years post-diagnosis, then annually for life
• Other necessary examinations (breast and pelvic ultrasounds, breast MRI or angiomammography, blood tests, etc.) will depend on the individual's situation and the treatments proposed.

In the case of high-risk individuals, and without a cancer diagnosis

Some individuals may be at increased risk of breast cancer and require specialized monitoring. A dedicated oncogenetic consultation is available at Gustave Roussy for hereditary risk evaluation or within Gustave Roussy's Interception program, a personalized prevention and screening program for individuals at increased risk of cancer.

► Learn more about Interception program

• Hereditary risk: Approximately 5% of breast cancers have a hereditary component and result from a genetic anomaly, particularly a mutation in the BRCA1 or BRCA2 genes. These anomalies can be detected through genetic analysis that are conducted in specific cases (multiple cases of breast or ovarian cancers in the family, breast cancer occurring at an early age, etc.). Tailored monitoring and preventive measures are then recommended.
• Histologic risk: The presence of certain "precancerous" lesions discovered following a breast biopsy can increase the risk of breast cancer, up to 20-35% over an individual’s lifetime. Regular monitoring with annual mammograms and clinical examination, to detect any palpable masses in the breast, is necessary.
• Other risks: Other situations can increase the risk, such as a history of radiotherapy to the chest, and require specific surveillance.

A dedicated oncogenetic consultation is available at Gustave Roussy for hereditary risk evaluation or within Gustave Roussy's Interception program, a personalized prevention and screening program for individuals at increased risk of cancer, according to the latest recommendations , (HAS 2014).

► Learn more about Interception program

Treatment of localized breast cancer

The treatment of patients with localized breast cancer typically involves surgery and is often complemented by additional systemic therapies such as chemotherapy, endocrine therapy, immunotherapy, targeted therapies, in addition to radiotherapy.

Breast cancer surgery and reconstruction

Surgery is the cornerstone in the treatment of localized breast cancer, and it is rare for it not to be recommended. It is tailored to the patient's preferences and performed by breast surgeons who are often specialized in oncological plastic surgery. The surgery department at Gustave Roussy specializes in outpatient surgery for breast cancer, oncoplastic techniques involving breast reshaping during lumpectomies, and immediate breast reconstruction performed during the same procedure as the mastectomy (offered whenever possible unless contraindicated). Gustave Roussy provides all innovative breast reconstruction techniques: using the patient's own tissues, such as fat injections (lipofilling), breast reconstruction through microsurgery (free flaps of DIEP, PAP, gracilis, lumbar, fascia lata, etc.), or pedicled flaps (latissimus dorsi with a short scar and without implants, etc.). Our team also addresses the aftereffects of cancer treatments such as breast deformation after lumpectomy.

► Learn more about breast cancer surgery and reconstruction

Chemotherapy

The efficacy of adjuvant chemotherapy in reducing the risk of breast cancer recurrence has been well established, with studies showing reductions ranging from 5% to over 50%. Its primary objective is to eradicate any residual tumor cells that may not be detectable. In certain cases, chemotherapy may be administered before surgery to quickly control the disease, increase the chances of breast preservation, or facilitate breast cancer surgeries that were initially deemed complex. It is important to note that if chemotherapy is administered intravenously, the placement of a portacath – a small device implanted under the skin and connected to a catheter – is necessary throughout the treatment period.

► Learn more about chemotherapy in breast cancer

Endocrine therapy

Endocrine therapy works by blocking hormone secretions or inhibiting their action to impede the proliferation of cancer cells. It is recommended for patients with breast cancer that expresses hormone receptors (estrogen and/or progesterone), with an expected benefit in reducing the risk of recurrence. This is often the case as these treatments decrease the risk of recurrence, including metastases, local recurrence, or relapse, by 30 to 60%.

Several treatments are available:

• The anti-estrogen treatment Tamoxifen blocks the functioning of the estrogen receptor on tumor cells that may remain in the body or have the potential to develop. Thus, it can prevent both a recurrence of the treated cancer (local or metastatic) and the onset of new breast cancer.
• The aromatase inhibitors (Letrozole, Anastrazole, Exemestane) are traditionally prescribed for postmenopausal women. They block the activity of an enzyme capable of producing estrogen hormones after menopause when the ovaries no longer function. Their efficacy is well established in reducing the risk of recurrence and preventing new breast cancer.
• Ovarian suppression can be used in premenopausal women to induce artificial menopause, in addition to Tamoxifen or Aromatase Inhibitors. These treatments are administered in the form of a subcutaneous or intramuscular injection once a month or every three months (Enantone®, Decapeptyl®, Zoladex®). Their side effects include menopausal symptoms such as hot flashes, vaginal dryness, and weight gain.

► Learn more about the adverse events of endocrine therapy

Targeted therapies

Targeted therapies are medications designed to selectively target specific pathways or receptors within cancer cells.

Several targeted therapies are available for HER2-positive breast cancers. Trastuzumab, an antibody targeting HER2, is associated with a 50% reduction in the risk of recurrence, in addition to that conferred by chemotherapy and other treatments. Trastuzumab will be prescribed for patients with invasive breast cancer strongly expressing the HER2 protein on the surface of tumor cells when chemotherapy is indicated. Pertuzumab another therapy targeting HER2, will be prescribed in combination with Trastuzumab and chemotherapy, before surgery in patients with breast cancer and lymph node involvement. Trastuzumab emtansine or T-DM1, an antibody-drug conjugate targeting HER2, will be prescribed after initial chemotherapy followed by surgery in the absence of complete sterilization of the tumor bed.

In patients with hormone receptor-positive breast cancer at increased risk of relapse, abemaciclib a cell cycle inhibitor, is associated with a reduction in the risk of recurrence by approximately 6.4% at 4 years. Abemaciclib will be prescribed for patients with invasive breast cancer presenting with 4 or more lymph node involvement or 1 to 3 lymph nodes with a grade III or a tumor size of 5 cm or more. Olaparib, an inhibitor of a DNA repair enzyme, is associated with a reduction in the risk of recurrence by approximately 7.3% at 4 years. It will be prescribed for patients with a mutation in the BRCA1/2 gene and an involvement of at least 4 lymph nodes or a non-complete response to neoadjuvant chemotherapy according to the CPS EG criterion. Olaparib is also prescribed for patients with triple-negative breast cancer in case of a non-complete response to neoadjuvant chemotherapy or if the tumor is larger than 2 cm or there is lymph node involvement without prior neoadjuvant chemotherapy.

Radiotherapy

Radiotherapy is a key step in the management of the majority of patients with breast cancer. It uses ionizing radiation (photons and/or electrons) which primarily acts by breaking the DNA strands within the nucleus, thus preventing cell multiplication. Radiotherapy is indicated after surgery to reduce the risk of local and/or regional recurrence of breast cancer.

Adjuvant radiotherapy is generally prescribed at a frequency of 5 sessions per week for a duration of 3 to 5 weeks depending on the required dose for each patient. The breast pathology committee has been a pioneer in the development of hypofractionated radiotherapy. This treatment approach is shorter in duration and more intense, reducing the total number of sessions, easing the burden of treatment, and preserving healthy tissues while maintaining the same effectiveness. Thus, we have implemented a 5-day radiotherapy program specifically for women aged 50 and older who have undergone breast-conserving surgery for localized breast cancer without lymph node involvement. This program allows for the radiotherapy sessions to be completed over five consecutive days, from Monday to Friday, with each session lasting approximately 15 minutes. Treatment is administered after ensuring precise positioning by radiation therapists and using onboard imaging, without requiring hospitalization.

Such organization is possible through advanced radiotherapy techniques, including:

• A positioning scanner that delineates the irradiation area and protects organs.
• Synchronization with breathing to better shield the heart and lungs.
• Automated contouring using artificial intelligence techniques.
• Intensity-modulated script-based dosimetry developed by our medical physicists.
• Highly precise and personalized radiotherapy guided by imaging.

► Learn more about radiotherapy in breast cancer

Treatment of metastatic breast cancer

Distant metastases refer to the spread of tumor cells originating from breast cancer to organs other than the breast and its adjacent lymph nodes. Patients with metastases are typically treated with systemic therapies; however, outside of exceptional cases, a definitive cure cannot be achieved. A metastatic cancer is considered a chronic condition requiring long-term treatment. Regular follow-up consultations and imaging are performed to assess the efficacy and tolerance of the prescribed treatments.

The treatment options for patients with breast cancer are numerous and tailored to each individual. They include chemotherapy, endocrine therapy in patients with breast cancer expressing hormone-receptors, targeted therapy (monoclonal antibodies and conjugates, cell cycle inhibitors, DNA repair enzyme inhibitors), radiotherapy targeted to a specific lesion, surgery in certain cases, and denosumab in patients with bone metastases. Our doctors may also offer a clinical trial as a treatment option.

Ongoing research and clinical trials

Gustave Roussy is a cancer center for patient care and research. In many instances, alternative techniques or treatments are developed, studied, and may be offered to our patients with the aim of enhancing current standards. These studies cover screening, diagnosis, prevention, surgery, radiotherapy, medical treatments, as well as supportive care. They are always optional, proposed, discussed, and carried out only where patients could potentially benefit and wish to participate in ongoing research.

► Learn more about the ongoing clinical trials

Localised breast cancer

Research programs focusing on early preoperative breast cancer aim to enhance available therapeutic strategies and improve breast cancer cure rates. These programs are designed to deepen our understanding of the mechanisms of action of different treatment classes (e.g., immunotherapies, targeted therapies) and to identify effective treatment combinations. By focusing on the preoperative context, our goal is to optimize treatment protocols and outcomes for breast cancer patients through targeted research and innovative approaches. Below are some ongoing studies for early breast cancer:

POP-DURVA clinical trial (NCT05215106 ; https://classic.clinicaltrials.gov/ct2/show/NCT05215106)

BIS-PROGRAM clinical trial (NCT05180006 ; https://clinicaltrials.gov/study/NCT05180006)

Metastatic breast cancer

Our research programs on metastatic breast cancer aim to optimize treatment strategies through four fundamental axes:

• Academic Research Programs in the field of Antibody-Drug Conjugates (ADCs). This program allows patients to benefit from early access to innovative and promising treatments. Concurrently, we examine various biological characteristics such as gut microbiota, immune system specificities, genetic profiles, and tumor properties. We analyze how these elements evolve during treatment to better understand the mechanisms underlying the efficacy or resistance to therapies. This comprehensive approach helps decipher the complexities of carcinogenesis, paving the way for significant improvements in ADC treatment effectiveness.
• Academic Research Programs in close collaboration with cooperative research groups (e.g., UNICANCER, SOLTI) as part of various national and European studies.
• Participation in Industry-Sponsored Clinical Trials. We actively engage in industry-sponsored clinical trials, providing early access to innovative therapies.
• Médecine de Précision. Within various research projects at Gustave Roussy, we systematically sequence blood and, in some cases, tumors to identify molecular alterations that could enable patient inclusion in clinical trials dedicated to targeted treatments. Our goal is to tailor therapies to the individual genetic characteristics of tumors to optimize treatment effectiveness.

► Learn more about the ongoing clinical trials at Gustave Roussy and eligibility criteria

Treatment guidelines for professionals

Please refer to Référentiel francilien de pathologie mammaire (Sénorif) / Attitudes diagnostiques et thérapeutiques, protocoles de traitement 2021-2022

Breast Diseases Committee

Head of unit - Dr Barbara Pistilli

Oncologist

Barbara Pistilli
Suzette Delaloge
Joana M Ribeiro
Alessandro Viansone
Elie El Rassy
Bruno Achutti-Duso
Fabrice André
Leony Antoun
Tarek Ben Ahmed
Chayma Bousrih
Bianca Cheaib
Antonio Di Meglio
Julia Dixon-Douglas
Thomas Grinda
Meriem Mokdad-Adi
Sophie Marchi
Caroline Poisson
Cyril Roussel-Simonin
Adina Sabau
Ines Vaz Luis
Benjamin Verret
Jean Zeghondy
Layal Rached
Maria Alice Franzoi
Sara Akla
Fedérica Giugliano
Leila Bedrane

 Gynecologists

Marion Aupomerol   
Lucie Veron

Surgeons

Nicolas Leymarie
Françoise Rimareix
Jean-François Honart
Angelica Conversano
Anna Ilenko
Kevin Daroles
Léo Ouhayoun
Nicolas Walhin
Chloé Uzan
Jérémie Zeitoun
Adeline Turpin
Camille Vaillant
Héloïse Boullenois
Marion Goutard
Anne Puchar
Arthur Glorion
Andréa Cavalcanti

Radiotherapists

Patrick Ezra
Elisa Folino
Guillaume Louvel
Sofia Rivera
Elena Roberti
Tambo Bathily
Sacha Benichou
Federica Medici
Dr Sana Gamra
Francisco Velichi

Pathologists

Natacha Joyon
Magali Lacroix-Triki
Grégoire Gessain
Léa El Khoury
Zahira Merabet

Oncogenetics

Veronica Goldbarg

Radiologist

Corinne Balleyguier
Sana Harguem-Zayani
Barbe Remy
Salma Moalla
PIERRE Thibault
Selhane Fatine
Kasraoui Ines

Nuclear Medicine Physician

Theophraste Henry
 
Advanced Practice Nurse: Laila Yassine
Research Nurse: Jacqueline Deneuve, Barbara Loiseau
Senior Medical Assistant: Carole Legrain

Appointment at the Institute

If you have diagnosis

• +33 (0)1 42 11 64 33. Opening hours: from monday to friday, 8h45-12h45 and 13h45-16h00
• or by email. Please add your contact details in the email (first name, last name, address, phone number).
  Please do not forget to have your reports with you while contacting us (mammogram, ultrasound, …).

If you don't have any diagnosis and you are not treated 

• Oncology:
  +33 (0)1 42 11 64 33 / Fax : +33 (0)1 42 11 52 74
• Surgery:
  +33 (0)1 42 11 65 36 ou +33 (0)1 42 11 24 01  / Fax : +33 (0)1 42 11 52 73
• Opening hours: from monday to friday, 8h45-12h45 and 13h45-16h00
   

Request for a medical opinion

Please visit our dedicated page for more information on Second Opinion requests.