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.
The Genetic Consultation
The evaluation of the usefulness of a genetic counselling test is primarily based on an analysis of the patient's family history. As mentioned, the criteria listed in Table 1 are used for orientation purposes. On the basis of the family history, not only an indication for starting a molecular examination is made, but also an estimation of the risk of breast cancer for other women in the family is made. The latter is particularly important if the hereditary examination does not show any mutation.
If heredity is suspected in a family, heredity testing or also mutation analysis can be initiated. Mutation analysis is initially offered to a person who has already developed breast or ovarian cancer. Molecular genetic testing is offered to as many affected women in a family as possible. The reason for this is as follows: in families in which a BRCA1 or BRCA2 mutation is present, it is still possible for a woman who is not a carrier to develop breast or ovarian cancer. This person has therefore developed cancer without being genetically affected; the scientific name for this phenomenon is phenocopy.
If the test were to be carried out on this woman alone, the family would obviously make the wrong decision. In order to minimise this risk, all affected relatives should be fully examined. The initiation of a hereditary examination in a person who has already developed cancer is called a diagnostic genetic examination. In this genetic testing, we look for the genetic abnormality in the BRCA1 or BRCA2 gene. This search takes about six months, despite recent technological developments. The examination is reimbursed in Belgium.
If a diagnostic test can reveal a mutation, we can check all unaffected relatives who wish to do so to see whether they have inherited the mutation. We call this test a predictive or presymptomatic test. On the basis of this presymptomatic testing, we can be certain about the risk of developing breast or ovarian cancer: women who have not inherited the mutation have a population risk of breast and ovarian cancer, while in women who are carriers, this risk is significantly increased. Of course, it is also useful to offer male relatives this test, since their risk of colon and prostate cancer may be increased and because they can also pass on the mutation to their children. This is obviously very important if they have daughters themselves.
If the diagnostic test in an affected woman cannot detect a mutation, it is not possible to say whether or not breast cancer runs in her family. A false normal test result is one possible explanation. There is also a chance that a mutation in another unknown (and therefore unexamined) gene is present in her family. For genetic advice to her unaffected relatives, we must then fall back on the family history; offering a presymptomatic examination to other relatives is not possible in this case.
If all the women in a family who developed breast or ovarian cancer have died, presymptomatic testing of an unaffected first-degree relative may be considered. However, in these women, the a priori probability of being a carrier is 50%, so a negative test result should be considered uninformative. There is a chance that a BRCA1 or BRCA2 mutation was present in affected relatives, but that person did not inherit the mutation. Moreover, the possibility of a false negative result still exists. If a mutation is found, carrier status is confirmed with certainty.
An important step in the initiation of a hereditary test is obtaining the informed consent of the patient. Given the specific nature of a hereditary test, a number of topics are discussed with the patient before the test is started, so that she is fully informed about the course, implications and possible test results of the hereditary test. Specific points of attention are listed in the table.
Table. Points of attention when obtaining informed consent from the patient when initiating a hereditary test.
the right not to be examined
the purpose, reliability and course of genetic testing
the cost of genetic testing
the implications of normal genetic testing or detection of a genetic abnormality
the possibility that no useful information is obtained after the test is completed
the disadvantages of genetic testing
the confidentiality of test results
the possibility of discrimination
the risk of carrier status in children
In addition to providing information about genetic testing, increasing attention is being paid to the psychological counselling of patients and families in whom testing is initiated, both in diagnostic and in presymptomatic settings. The main objective of this counselling is to offer support tailored to the needs of the patient and her surroundings in
dealing with and processing the test result
exchanging information within a family
choosing a particular preventive strategy
concerns about carrier status in children or other relatives
the impact of hereditary testing on the relationship
the desire to have children