Appropriate and personalized care for breast cancer – Public Health

Vilmar Marques de Oliveira

Prejudice and misinformation are still obstacles for women – and for society as a whole – in relation to breast cancer. The stigma surrounding a disease that can be serious and directly affects one of the greatest symbols of femininity gets in the way in several ways: from leaving for later the exams that should be periodic to emotional barriers that, once the diagnosis is made, prevent that this woman is the protagonist in your treatment.

What’s worse is that breast cancer is a complex disease. There are different tumor profiles and specific moments, which involve different decisions. Another issue is access to treatment options and adherence to the chosen approach, considering that it is a time-dependent disease that does not wait for anything or anyone to progress. It is faster or slower depending on the characteristics that are presented in each case.

That’s why they talk about patient journey with breast cancer. A woman who is unique and has a history of her own, but who should and can seek the most appropriate and personalized care for her profile. It is true that, on this path, misinformation and prejudgment weaken. But dialogue, knowledge, self-care and an effective support network, whether from family members, friends, co-workers and even the health team, contribute to life before, during and after cancer. A life that can be full.

This collective look at breast cancer as a topic of interest to all of society is essential for the implementation and improvement of public policies related to the pathology’s line of care (tracking, diagnosis and treatment), as well as to the navigation of patients in the health system. While we have important laws passed and a public and universal system, much remains to be done to save more women.

Breast cancer is the most frequent among Brazilian women, according to the National Cancer Institute (INCA), and still causes the death of 20 thousand women every year. The estimate of new cases for 2021 is approximately 66,000. Although it is traceable from the start from screening mammography, early diagnosis remains much less often than in the advanced stages of the disease.

Science has been doing its part. Appropriate planning right after diagnosis, associated with the best treatment for the patient’s profile, allows managing breast cancer with greater probability of cure or control. Whether or not it is invasive, the chances of cure are high (approximately 95%) when detection occurs at an early stage. Medicine increasingly understands the genetic alterations in cells that originate and characterize the types of tumors, knowledge that enables more adequate and efficient treatments, which often combine therapies before and/or after surgery, depending on each case.

To illustrate the relevance of this knowledge, we can cite patients with a specific biomarker, called HER2+. Women whose tumors have this mutation may benefit from therapies aimed at this change at different stages of the disease. When diagnosed at an early stage, the correct treatment, at the most appropriate time, can even protect patients at high risk of disease recurrence from progressing to a metastatic stage, bringing them closer to cure.

For example, women who need to start treatment before surgery, because they have larger tumors and/or compromised lymph nodes, in order to increase their chances of cure and enable conservative surgery, may still have tumor cells at the time of surgery, which indicates an increased risk of recurrence. Therefore, these patients need salvage treatment after surgery, in order to reduce the chances of progressing to metastatic scenarios. All this personalized therapeutic planning, carried out by the team that accompanies the patient, is essential to ensure that each person receives the most appropriate treatment according to the characteristics of their tumor.

I could not finish this text without clarifying, too, that any woman can have breast cancer. Most tumors – 90% – are not hereditary in origin. Risk factors are poor quality food, lack of regular physical activity, overweight, exposure to hormones (estrogens), smoking and excessive use of alcoholic beverages, among others.

However, it is not possible to specify the cause of the disease and, therefore, we need a new mentality. While it is necessary to adopt preventive measures to combat these risk factors – and the sooner the better – we must prevent this woman who has breast cancer from feeling guilty.

Therefore, movements such as “Come Talking about Life” are essential, which disseminate quality information on the subject, reverberate the actions of multiple signatories united for this purpose and strengthen the message that breast cancer need not be synonymous with failure, death or mutilation. There are ways for more and more women’s stories to be transformed. Discussing access to them is the responsibility of all of us.

Dr. Vilmar Marques de Oliveira he is Adjunct Clinical Head of Hospital da Santa Casa, Adjunct Professor at the Faculty of Medical Sciences of Santa Casa de São Paulo and current president of the Brazilian Society of Mastology.




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