In Italy, in 10 years, cases of breast cancer have increased by 16%: they were 48 thousand in 2013 and 55,900 in 2023. It is the most frequent neoplasm not only among women, but in the entire population. On the other hand, the tools available to clinicians to deal with the disease are increasingly effective and, today, over 834 thousand patients live after diagnosis. The treatment path, which is different for every woman, must always take place within breast care centres, the Breast Units, which guarantee multidisciplinary management and greater chances of survival. To make everyone – patients, caregivers and citizens – understand how every breast cancer must follow a specific treatment path, defined by multidisciplinary teams, the national awareness campaign ‘They are not all the same’ is underway. Breast cancer and life paths’, structured in a multi-channel strategy, which includes an in-depth landing page (www.nonsonotuttiuguali.it) and a social media plan.
The project, promoted by MSD and presented today at a press conference in Rome, has the scientific consultancy of the Aiom Foundation (Italian Association of Medical Oncology) and the patronage of Anisc (Italian National Association of Breast Surgeons), Aps Senonetwork Italia (the network of centers of breast cancer), Sipo (Italian Society of Psycho-Oncology), Aps Susan G. Komen Italia and the patient associations Europa Donna Italia, Fondazione IncontraDonna and Salute Donna OdV, with the recognition of Sirm (Italian Society of Medical and Interventional Radiology).
The campaign also aims to analyze the emotional aspects, through a monologue that tells the story of a woman who receives a diagnosis of breast cancer, played by an exceptional artist, Lucia Ocone. The monologue is presented at the opening of the Rome and Milan stages (10 and 17 May 2024) of the tour in the arenas of a very successful Italian group, the Pinguini Tattici Nucleari.
“In our country, 88% of patients are alive 5 years after diagnosis – states Saverio Cinieri, president of the Aiom Foundation – The disease can present itself in various forms and each patient is different from the others. The choice of therapy depends on several factors , including the histological and biological characteristics of the tumor and those of the patient, for example age and presence of other diseases, which influence the clinical history and response to treatment. The strategies consist of loco-regional treatments, such as surgery and radiotherapy, and pharmacological therapies, to be implemented before or after surgery. Thanks to the optimal integration of these therapeutic modalities, in the last thirty years there has been a significant increase in survival. The formal institution of Breast Units in our country, a starting from 2014, has contributed significantly to the result. It is essential that all women are aware of the importance of being treated, from the moment of diagnosis, within breast centers and that they turn to these structures”.
Histological grade, which is based on the extent to which tumor cells differ in their appearance from normal breast cells and how quickly they multiply, can help determine the cancer’s aggressiveness, prognosis and approach. of care. It is also important to identify at diagnosis, based on the biopsy results, the so-called tumor subtype, determined by the different molecular characteristics. In this sense, the three main subtypes are hormone-sensitive tumors (70% of cases), which respond to hormonal therapies, the so-called Her2-positive (20%), which can be treated with targeted anti-Her2 therapies, and triple- negative (10-15%), which are negative for both estrogen and progesterone receptors and for the Her2 protein.
“Morphology, immunohistochemistry and molecular diagnostics are three very important aspects that the anatomic pathologist deals with, capable of determining subsequent therapeutic choices – underlines Filippo Fraggetta, president of Siapec-Iap (Italian Society of Pathological Anatomy and Diagnostic Cytology) – The analysis of the biological characteristics defines the subtype of breast cancer and any hereditary molecular alterations, for example those of the Brca genes, which allow a prevention path to be started in the patient’s family members. The prospects of recovery and long-term survival become increasingly important, thanks to the ‘third revolution’ that is affecting pathological anatomy. The digital transition, combined with artificial intelligence, constitutes an opportunity to manage the large amount of data generated by pathological anatomy departments, starting from specific algorithms. The digitized slide, i.e. converted into a computer file, can be shared with experts around the world for more precise diagnoses.” In stage I the 5-year survival rate can reach 100%, in stage II 90%, while it drops to 71% in stage III, up to 29% in stage IV. Treatment by a breast center is associated with an improvement in survival and quality of life.
“A study on over 13,700 patients, published in the ‘British Medical Journal’, demonstrated an 18% increase in survival for women treated in Breast Units, where assistance is guaranteed by teams of professionals who study the individual case , identify the most suitable therapy, the optimal surgical approach and subsequent care – highlights Mario Taffurelli, president of Aps Senonetwork Italia – Each center must treat a minimum of 150 new cases per year and have a ‘core team’ of 6 professionals dedicated: surgeon, radiologist, anatomical pathologist, oncologist, radiotherapist and nurse, to which other figures can be added. It is estimated that approximately 90% of breast cancer cases belong to the 156 Breast Units included in the Senonetwork network patients, however, still remain outside the network. It is therefore necessary to raise awareness among the entire population, including caregivers, and the ‘They are not all the same’ project has precisely this objective”.
“The team collectively establishes how to proceed based on the results of the biopsy and the biological characterization of the tumor, i.e. directly with the operation or with neoadjuvant systemic therapy, which is administered before surgery – explains Daniela Terribile, vice president of Anisc – This last approach allows to reduce the volume of the tumor and facilitate its removal, in favor of more conservative surgical interventions. And even if the operation remains ablative, techniques that provide reconstructions with better aesthetic results can then be used neoadjuvant therapy is used in approximately 30-35% of breast centers, an objective that our country must also aim for, where this percentage stands at around 20%”.
“MSD’s commitment to correct information is one of the three fundamental pillars of our commitment in oncology, together with prevention and, above all, research – declares Nicoletta Luppi, president and managing director of MSD Italia – Alongside our primary objective of innovate with concrete solutions in the fields of medicine where until yesterday there was no solution, where neither a therapy nor an opportunity for prevention was possible, we are firmly convinced that we have the responsibility to do our part also in contributing to spread knowledge on particularly relevant health issues. The awareness campaign ‘They are not all the same’ was born with this objective, also leveraging new languages and new artistic forms useful for amplifying the messages to make them even more inclusive and allowing them to be reached. to ever larger audiences”.
“In 2022 in Italy, the coverage of mammographic screening at a national level was 43%, down 3% compared to 2021 – remarks Massimo Calabrese, president of the Senology study section of Sirm – It is important to raise awareness among all women about importance of this test, which can save lives because it allows the diagnosis of the disease in the initial phase. Too many regions, especially in the South, record low adherence rates. Mammography is able to highlight thickenings, microcalcifications and nodules even of a few millimetres The X-ray dose used is very low and the hypothetical risks are less than the benefits.”
The diagnosis of breast cancer constitutes “a fracture in the existential path – observes Anna Costantini, past president of Sipo – A traumatic event that gives rise to a reactive process with adaptation capacities different from person to person. Approximately 40% of patients present in any phase of the disease, significant psychological suffering defined as distress, which would require specialist help since 2011. The national oncology plan has recognized that the neoplastic disease can have profound repercussions on the psychological, emotional, family, social and sexual spheres of both patients and patients. of family members, and in 2020 the European Society of Breast Ca
ncer Specialists (Eusoma) updated the European requirements of the Breast Units, reiterating that the specialist support of the psycho-oncologist is fully part of the extended multidisciplinary team of the Breast Unit throughout the entire course of the disease for patients and family members, in order to identify early and respond to the need for help in delicate areas such as the relationship with children, partners, sexuality and to support doctors in the psychological aspects of communication”.
“This project – concludes Lucia Ocone – combines art and science to raise awareness among all citizens, starting from the youngest. We want to go beyond traditional means of communication, to make people understand clearly and directly the importance of research, prevention and of innovation in care”.
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