Metastatic breast cancer, how many cases are there in Italy
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Just six years ago, talking about October 13 in Italy was only a small group of patients gathered in a blog in this newspaper. In recent days, however, the Day for the awareness of metastatic breast cancer has been talked about everywhere. Places, monuments and even cancer centers have been illuminated: it is a symbolic gesture that does not help much, one could say. But, it must be remembered, it is still an SOS signal. How many women are throwing it? In this week’s newsletter Breast Healthlet’s give the numbers.
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More than 50,000 women get breast cancer every year. How many of them are diagnosed with stage IV (that is, metastatic) cancer right from the start? How long does the initial tumor progress? And how old are these patients? To answer this, a study conducted by the Local Health Unit – IRCCS of Reggio Emilia and published on Breast Cancer.
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According to the new estimates, the cancer is discovered in the first stage in half of the cases (50.4%), in stage II (which is always early) in about a third (32.4%), in stage III, i.e. locally advanced , in 10.8% and in stage IV, that is metastatic, in 6.4%. This latter percentage translates into about 3,500 new cases per year already metastatic at the first diagnosis, overall in Italy.
Screening makes a difference
However, this is an average figure, because there are differences between the percentages found in the North, lower (5.1%), those in the Center (7.4%) and Southern Italy (7.8%). “We believe that the difference is due to mammography screening and, in general, to the greater diffusion of the culture of early diagnosis in the North”, he tells Breast Health Lucia Mangoneepidemiologist of the USL-IRCCS of Reggio Emilia, Head of the Cancer Registry of the same municipality and first author of the study: “This is reflected in the presence of a high number of early forms in the northern regions, while the advanced forms are more frequent in the southern regions “.
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The age of metastatic patients
As was already known, the organs most affected by metastases are the bones, followed by the liver, lungs and brain. As regards age, the tumor is metastatic to the same extent both before the age of 50 and in the age group from mammography screening (50-69 years): in fact, 5.6% of all cancers diagnosed in these groups, while the percentage is 8% in women over 70. “We must eliminate the prejudice that metastatic women are elderly”, underlines Mangone: “Instead, it is very often young patients, who they work and have children or parents to take care of “.
Over 50,000 women in Italy are living with the disease
The research, in which Europa Donna Italia also participated, evaluated a sample of over 5 thousand cases collected from eight cancer registries of Northern, Central and Southern Italy, diagnosed between 2013 and 2019. Unfortunately – underline the authors – in the registers tumors there is no information on the onset of metastases in the years following diagnosis. According to previous studies, the percentage of tumors that progress from the initial stage to metastatic varies from 20 to 30%.
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“According to our estimates, today in Italy there are over 50,000 women living with metastatic breast cancer, that is all those who fell ill in 2022 and in the past years”, continues the epidemiologist: “We believe that this number does not detachments from the real one, considering the greater survival of patients thanks to the important progress made in the last 10 years. Currently, surgery can also be contemplated in some cases: when there are few metastases, for example, surgery and hypofractionated radiotherapy can be Those who make decisions in the health sector should keep in mind these numbers, which are not low and, on the contrary, are destined to increase. Cancer centers, hospitals and territorial, must know that they will have to take care not only of those who fall ill in 2022, and to ensure that these women have a quality of life that can continue to occupy their roles in society “.
But where is the multidisciplinarity?
It is no coincidence that on this day various associations have turned the spotlight on the need for a multidisciplinary approach also for the metastatic phase, and not only for the initial stages of cancer. “Today we have chosen to bring attention precisely to the word ‘multidisciplinary’, because unfortunately we do not always see this approach applied in the reality of those who live with stage IV cancer”, he says. Marina La NorciaPresident of the Noi Ci Siamo – MBC Italia association: “For this reason, on 13 October we asked some cancer centers to light up the Breast Units, the places dedicated to the treatment of breast cancer, in purple. We need a model of multidisciplinary care and a network of assistance between the Breast Unit and the territory “.
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We need a “dynamic multidisciplinarity”
If it is true that when breast cancer becomes metastatic the patient is entrusted to the oncologist, it is also true that other figures come into play to ensure the most suitable treatment, case by case. And there are a number of issues also linked to the quality of life, ranging from nutrition to the management of adverse events, palliative care, psychological support.
“In some cases, the figures of the gastroenterologist, the rheumatologist, the radiotherapist, the interventional radiologist, the neurosurgeon, and so on are needed,” he explains. Ugo De GiorgiDirector of the Complex Structure of Clinical and Experimental Oncology in Innovative and High Dose Therapies of the IRST “Dino Amadori” IRCCS (one of the centers that have joined the Noi Ci Siamo initiative): “The multidisciplinary management of metastatic patients is however very more complex than that of patients with early-stage cancer, because the disease pictures are different from person to person. Specialists, therefore, must be activated ‘on demand’. The model to be implemented is that of a dynamic multidisciplinarity “.
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The model for bone metastases
Multidisciplinary approaches have already been activated in some situations for metastases affecting the bones, the most frequent in both breast and prostate cancer. Such models foresee, for example, the figures of the orthopedic surgeon, the radiotherapist, the palliativist, the physiatrist, the physiotherapist for the rehabilitation phase following a possible surgical intervention. “Multidisciplinary groups like these cannot, of course, be present in every cancer center or in every city – underlines De Giorgi – What matters, in fact, is their specialization. The important thing, however, is to have a network that connects oncologies with specialized centers of reference, and that access paths are created. Having a group of dedicated professionals, even if not exclusively, but with high competence, is certainly an advantage “.
A cultural change
In this scenario, the lack of resources – economic and human – of hospitals and territorial assistance is certainly a problem, which however must be addressed in a structural way, according to the association: “We do not want metastatic breast cancer to be remembered. only in one day – concludes La Norcia – but we ask for a cultural change and a humanization of the treatment that starts from listening to those who live with metastatic disease, to create concrete solutions “.
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