Prevention
Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.
Diagnosis
I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.
The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.
Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.
Treatment
The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.
The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.
"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.
The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.
Revalidation
Those treated for cancer often need a long period to recover.
Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.
There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.
Quality of life
Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.
BRCA1, BRCA2, Breast and ovarian cancer
To understand the genetics of breast cancer, we first need to explain some basic principles. Our genetic information is contained in individual packages called chromosomes. We each have 46 chromosomes which are divided into 23 pairs: 22 pairs of autosomal chromosomes and one pair of sex chromosomes. We inherit one chromosome of each pair from our father (23) and one chromosome of each pair from our mother (23). A chromosome consists of a single long strand of DNA containing our genetic code. A gene is a fragment of DNA, somewhere on the chromosome, that contains the code for a protein with a specific role. The information on each chromosome of the pair is the same, so we have two copies of each gene. BRCA1 and BRCA2 are genes that code for a protein that normally protects the individual against developing cancer. Where there is an error or mutation in one or another of the genes, the risk of developing cancer is greatly increased. Abnormalities in BRCA1 and BRCA2 genes may also be inherited and the chance that an affected individual will pass on the abnormality to his / her child is 50%.
Female carriers of the BRCA1 or BRCA2 mutation have a significant risk of developing breast and ovarian cancer (Table). The risk of breast cancer is probably equal for the carriers of the BRCA1 or BRCA2 mutations, exceeding over 80%. The risk of developing ovarian cancer is significantly higher in female carriers of the BRCA1 mutation.
The cancer risk is likely elevated in male carriers of the mutations, although to a much lesser extent. Men seem to be at a particular risk of developing breast cancer if they are carrying the BRCA2 mutation. This knowledge and the mode of transmission enable us to identify families that may be potential carriers. It includes families with a breast cancer diagnosis at a young age, a history of breast and ovarian cancer, bilateral breast cancer in one or more relatives, or male breast cancer in the family. One can see that these are also the criteria used to identify families at risk of breast cancer.
Tabel: Risks associated with having a mutation in the BRCA1 or BRCA2 gene.* | ||
Female carrier | ||
BRCA 1 | BRCA 2 | |
Breast cancer | 85% | 86% |
Contralateral breast cancer** | 60% | 55% |
Ovarian cancer | 63% | 27% |
Male carrier | ||
BRCA 1 | BRCA 2 | |
Breast cancer | possibly increased | 7% |
Darmkanker | possibly increased | possibly increased |
Prostate cancer | 33% | 34% |
Melanoma | - | 5% |
* These risks are derived from studies of families with significant BRCA1 and BRCA2 mutations and can therefore be seen as a maximum.
** Breast cancer in the other breast of a woman with breast cancer
Patients often wonder if they may be the source of a particular mutation, but this is rarely the case. In almost all instances the mutation is derived from a parent. This explains why the mutation in a BRCA1 or BRCA2 gene can be detected in a large number of people from the same family suffering from breast or ovarian cancer. It also explains why a mutation is almost never detected in patients without a family history, even if they are diagnosed with cancer at a young age.
Mutations in the BRCA1 and BRCA2 genes can occur anywhere along the length of the gene and there are no ‘hot-spots’ or frequently recurring mutations. As a result of the large size of both genes, the molecular analysis is time consuming and intensive: it takes about 3 to 6 months per patient. The complexity of both genes also has a negative influence on the sensitivity of the analysis. The sensitivity depends on the types of mutations that occur in a given population and all forms of the mutation may not be detected using the same technique.
Although both genes can be completely analyzed, one needs to bear in mind that the result may be falsely negative: the particular abnormality of the BRCA1 or BRCA2 gene may not be identified by the technique used.