Beautiful After Breast Cancer Foundation

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.

Risk-reducing strategies for carriers of BRCA1/2 mutations

Women who have inherited mutations in the BRCA1 or BRCA2 genes have substantially increased risks of breast and ovarian cancer. Mutation carriers have various options, including extensive and regular surveillance, risk-reducing surgery and chemoprevention.

The first option is surveillance (breast self-examination, clinical breast examination, screening using mammography and breast magnetic resonance imaging (MRI), trans-vaginal ultrasound scanning and blood levels of CA125). This concept is based on early detection of cancer rather than cancer prevention. Undoubtedly, surveillance is the least invasive option; however, it is associated with various negative consequences, such as increased anxiety, false reassurance and unnecessary biopsies.


Risk-reducing surgery in BRCA1/2 gene mutation carriers includes prophylactic bilateral salpingo-oophorectomy (BSO, removal of the ovaries and fallopian tubes) and/or prophylactic bilateral mastectomy. The aim of surgery is to reduce the risk of cancer development and to reduce mortality. In a large, retrospective analysis of BRCA carriers, BSO was found to have reduced the risk of ovarian cancer by 96% and breast cancer by 53% at a mean follow-up of 9 years. The potential benefit of surgical prophylaxis however has to be weighed against the risk of surgical complications and the impact of mastectomy or oophorectomy on a woman’s self-image and their sexual and reproductive function.

The final option is chemoprevention. It is well recognised that oestrogen plays an essential role in breast cancer development by exerting a carcinogenic effect. Therefore, targeting oestrogen synthesis with anti-oestrogen medication aims to reduce this risk. Currently there are few studies investigating the use of chemoprevention in BRCA1 or BRCA2 mutation carriers and this option remains relatively controversial. Only in women who have already developed breast cancer has Tamoxifen been shown to reduce the risk of developing a new tumour by approximately 50%. Chemoprevention may however have a role for asymptomatic mutation carriers in the future.


Choosing between these different risk-reducing strategies is a complex process involving both personal choice and medical opinion. Important personal factors include the anxiety associated with developing a cancer, the desire to have a family, one’s sexuality and its effect on relationships and any previous experience with cancer in the family. There is also no medical consensus on the benefits of risk-reducing strategies.


The optimal frequency of screening for both breast and for ovarian cancer remains uncertain. Although we know that Magnetic Resonance (MRI) can detect breast cancer at early stage, the role of MRI screening in BRCA1 and BRCA2 gene carriers is controversial. There is currently insufficient data on the improvement in life expectancy offered by the different risk-reducing strategies. For example, although surgery can reduce the chance of developing breast cancer, it is unknown whether this, in comparison to intensive screening, actually results in a better overall survival. Also, the effect of temporary hormonal substitution after prophylactic removal of the ovaries is unclear, because there are fears that the risk of developing breast cancer would rise again.


Therefore when considering the different options, there is no single “best” choice. It is vital that each patient finds a solution that she is most comfortable with. For some, this is risk-reducing surgery, whilst for others regular clinical examination offers the most reassurance. In addition, meeting other affected patients can be helpful.
A support group for people with hereditary breast or ovarian cancer has recently been established in Belgium, Natarelle (http://www.natarelle.be).

For male carriers of the BRCA1 or BRCA2 mutation, screening is recommended for the early detection of colon and prostate cancer and skin tumor (table).

Table: possible preventive strategies in carriers of a BRCA1 or BRCA2 mutation

Female carriers

Breast cancer

Screening

monthly self-examination from an early age

clinical examination by a doctor every 3-6 months from 20 years of age

annul ultrasound and mammography, +/- MRI from 25 years of age

Risk-reducing surgery

prophylactic mastectomy

prophylactic bilateral salpingo-oophorectomy

Chemoprevention

amoxifen (currently used in women who have already developped breast cancer)

Ovarian cancer

Screening

gynaecological exmaination every 6 months from 35 years of age

transvaginal ultrasound every 6 months from 35 years of age

blood level of CA-125 every 6 months from 35 years of age

Risk-reducing surgery

prophylactic bilateral salpingo-oophorectomy

Chemoprofylaxie

(possible effect of hormonal contraceptives)

Male carriers

Breast cancer

Screening

no uniform guidelines

Bowel cancer

Screening

colonoscopy at 50 years of age

Prostate cancer

Screening

prostate examination and ultrasound

blood level of PSA from 40 years of age

Melanoma

Screening

annual skin examination (usually only for BRCA2 gene carriers)