5-year survival time doubled in metastatic breast cancer

Breast cancer, which is the most common cancer in women in the world and in Turkey, ranks first among the cancer types that cause death in women. Expressing his opinion on the occasion of Breast Cancer Awareness Month, Internal Medicine and Medical Oncology Specialist Prof. Dr. Nilüfer Güler emphasized that the five-year survival time in metastatic breast cancer has increased from 10% to 22% thanks to innovative drugs and treatment options. At the time of diagnosis, while the rate of metastatic breast cancer is as low as 6% in developed countries, this rate can reach 50-80% in underdeveloped regions. Dr. Güler continued: “In our country, breast cancer incidence is 10%. In the follow-up of patients with early stage breast cancer at the beginning, metastatic disease may develop at a rate of 20% to 50%, depending on the initial stage of the disease and tumor characteristics.

Complaints in metastatic breast cancer vary according to the site of metastasis.

Stating that one out of every 8 women is expected to be diagnosed with breast cancer during her lifetime, Prof. Dr. Güler gave the following information: “Breast cancer is a cancer that can be diagnosed early. For this reason, it is very important for all women to participate in early diagnosis and screening programs, to recognize their own breasts, and to raise awareness on this issue. Breast cancer is evaluated in four different stages, from 0 to 4, according to the extent of the disease. Stage 0 is the stage we call cancer in situ. The risk of metastasis at this stage is less than 1%.


Stages 1 and 2 are called early-stage breast cancer, stage 3 is called locally advanced breast cancer, and stage 4 is called metastatic breast cancer. In the metastatic stage, cancer cells spread to organs other than the breast. Cancerous cells in the breast can metastasize to other organs, primarily bone, lung, liver, less likely the brain, via lymphatic vessels and blood vessels. Less common sites of metastasis are the pleura, peritoneum, pericardium, meninges; much more rarely, the digestive system, ovaries, urinary bladder may be present.

Patients have complaints according to the location of the disease: Bone pain in bone metastases; headache, dizziness in brain metastases, shortness of breath in lung metastases, cough; such as abdominal pain in liver metastases. Patients who are under regular follow-up may not have any complaints and may occur as a result of examinations and tests.

The aim of treatment is to increase life expectancy and quality of life.

Giving information about the treatment options in metastatic breast cancer, Prof. Dr. Güler gave the following information: “Options include surgery (especially single organ, limited metastases), radiotherapy (metastasis to organs such as the brain and bones) and systemic treatments. Systemic treatments include hormonal treatments, chemotherapy and biological treatments. Local treatment applications such as radiofrequency ablation, radioembolization and chemoembolization are among the treatment options we recommend according to the location of the tumor.

Treatments applied in metastatic breast cancer progress with decreases or increases in disease findings according to the response of the disease. The choice of treatment depends on the patient’s age, menopausal status, general condition, additional health problems, wishes, socio-economic status and most importantly, according to tumor characteristics and metastasis regions and tumor burden. determines. The aim of the treatment is to reduce the symptoms related to the disease, to prolong the life span and to keep the quality of life at the maximum while aiming these. Many of our patients are able to continue their normal daily activities and work with treatment. Whether there is a response to the treatments applied or not is determined by the history, physical examination, laboratory tests and radiological examinations that are deemed necessary at regular intervals.

1 in 4 women with breast cancer are at risk of lymphedema

Hormone receptors and HER2 test result determine systemic therapy choice

prof. Dr. Nilüfer Güler stated that the most important factors in the selection of systemic treatment are the tumor characteristics (estrogen and progesterone hormone receptors) and the result of the HER2 test and continued as follows: “These tests should be performed on the primary tumor tissue in the breast and/or the tissue taken from the metastasis area if biopsy can be performed. In a case of stage 4 breast cancer with positive hormone receptors, if the tumor burden is low, the preferred treatments are hormonal (antiestrogen) treatments.

In HER2 positive disease, anti-HER2 drugs are administered together with chemotherapy or hormonal therapy. The introduction of these drugs into clinical use has revolutionized this group of patients. It enabled us to get very good responses and very significant prolongation in the life span of the patients was achieved. Clinical studies of new anti-HER2 agents are also ongoing.

“The only weapon we use in patients with negative hormone receptors and HER2 tests, which we call triple negative, is chemotherapy. In this group, in case of mutation in one of the gene tests, which we call BRCA1-2 tests, the use of drugs called PARP inhibitors in the treatment may provide a better and longer-term response. Recently, new molecules have been developed that prevent the development of resistance to hormonal therapy in metastatic disease with positive hormone receptors and negative HER2 test.

One of them is the m-TOR inhibitor, the others are drugs called CDK4/6 inhibitors. Administration of these drugs together with drugs called aromatase inhibitors provided a very significant prolongation of the metastatic disease being under control and our patients’ transition to chemotherapy. Some drugs in this group can also be effective as a single agent. The use of drugs called bisphosphonates in patients with bone metastases helps to reduce bone pain and reduce the risk of fracture. Before using these drugs, if there is a condition that requires treatment in the teeth, it must be resolved. If dental treatment is performed after starting the drugs, there are non-healing wounds on the jawbone. Many studies are continuing on drugs to be used in both cancer treatment and supportive treatment.

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