Can PIP breast implants cause cancer?
According to a risk evaluation requested by the Spanish Agency of Medicines and Medical Devices (AEMPS), there is no evidence of an association between PIP implants and the development of cancer or connective tissue disorders. Due to the limited information available there is no evidence suggesting that women carrying these implants are exposed to higher health risks than women carrying other breast implants. However, the scarcity of clinical data, as well as the results obtained from physical, chemical and skin irritation tests, do not allow for the exclusion of potential side effects. Statement of the Spanish Agency of Medicines and Medical Devices
What can I do to prevent breast cancer?
In other types of cancer there is a clear triggering factor, such as smoking in squamous cell carcinoma of the lung. Nevertheless, breast cancer is not the consequence of a single cause that may be avoided. Thus, it is not possible to implement primary preventative measures. It is possible to modify certain circumstances related to a higher probability of developing breast cancer.
In developed countries, the increase of breast cancer has been associated to the social and work-related changes underwent by women. These changes are causing a delay in their first pregnancy. Having the first pregnancy before the age of 25 reduces the risk of developing breast cancer, as well as having several children and choosing an extended breastfeeding. The use of hormone replacement therapies in order to soothe the symptoms of menopause has been found to increase the risk of developing breast cancer, especially if the use of this therapy exceeds 5 years. A healthy diet, rich in vegetables and fruits and low in animal fat, seems to reduce the risk of breast cancer; obesity and a moderate to high alcohol consumption are also risk factors. Recent studies have found that aerobic physical exercise (for 30 minutes per day, 3 times per week) reduces the risk of developing breast cancer by 15-20%.
Being aware of all these risk factors may help women change behaviors and life-styles, thus decreasing the breast cancer incidence in our environment. However, the most important thing is to reduce the mortality of this disease, and in order to achieve this goal it is imperative to have an early diagnosis. This will be possible thanks to the prevention campaigns using mammographies as the main diagnostic tool.
In the treatment of breast cancer, is it safe to remove only part of the breast?
Several decades ago, it was thought that the only way of treating breast cancer was by removing the whole breast. Afterwards, many controlled clinical trials carried out with thousands of patients with small breast cancers (less than 3-4 cm) showed that breast-conserving surgery achieved the same survival as mastectomy. In the clinical practice, around 70% of the women with breast cancer are treated without mastectomy, mainly thanks to an early diagnosis of the disease.
The conservative treatment is based on the removal of the tumor with a margin of healthy breast tissue around it, followed by the study of the potential spread towards the lymph nodes. In most cases, this is performed using a biopsy of the sentinnel lymph node in combination with radiation therapy in order to reduce the risk of tumor re-growth.
The localization, shape and size of the scars are associated with the actual localization of the tumor in the breast, as well as with a good cosmetic result. A conservative treatment is not considered appropriate in the presence of tumors in different areas of the breast (multicentric cancer), mammographic malignant-appearing extensive microcalcifications and in case of insufficient resection margin. The tumor size is a relative counter-indication because it depends on the size of the breast, and it may be reduced in many cases after a chemotherapy treatment before surgery (neoadjuvant chemotherapy).
The main risk of the conservative treatment is the re-growth of the tumor. Currently this represents approximately 1% every year, but the studies have shown that it does not influence the survival rates. When this happens, mastectomy is the treatment of choice.
What is a sentinel lymph node biopsy?
Malignant breast cancer cells can migrate towards the lymph nodes, in most cases towards the armpit of the same side. The probability of this migration depends essentially on the size of the tumor; the bigger the tumor, the higher the risk. However, as breast cancers are being diagnosed at an early stage, around 60% of the cases do not present involvement of the lymph nodes.
The removal of the axillary lymph nodes with metastasis reduces the risk of relapse and obtains a better disease classification. However, the removal of unaffected lymph nodes does not result in any benefit but in a higher risk of difficult-to-treat complications: chronic swelling of the arm (lymphedema) and chronic shoulder pain. In order to avoid unnecessary excisions of axillary lymph nodes, the sentinel lymph node technique was developed.
The lymphatic drainage of the breast occurs in an orderly manner, reaching first a small number of lymph nodes, frequently only one lymph node, and then spreading to other lymph nodes. The sentinel lymph node technique identifies these first lymph nodes using a protein marked with a radioactive isotope, a coloring agent or a combination of both. Then, the lymph node(s) are removed and analyzed under the microscope. If no malignant cells are found in the sentinel lymph node, we know that it is very unlikely that other lymph nodes are affected, rendering it unnecessary to remove the lymph nodes. If the sentinel lymph node has metastasis, then we proceed to remove the remaining axillary lymph nodes (lymphadenectomy). Currently it is being studied whether it is possible to preserve in certain types of cancer the remaining lymph nodes even though the sentinel lymph node has metastasis.