Breast cancer

Dr Barbara Pistilli

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Breast cancer

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).

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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.

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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.

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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.

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  • 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 (link to the recommendations).

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