No more bazooka strategy. The treatments are now differentiated and adapted to each one.

In the old days, all affected women received the same protocol of care, with more or less convincing results.

"We now know that there are several typologies of breast cancer, with distinct molecular characteristics," says Dr. Séverine Alran, surgeon-oncologist responsible for the outpatient surgery unit at the Institut Curie.

Through genetic analysis, targeted therapies

After a biopsy to establish the specificities of their tumor, the patients now benefit from a personalized "tailor-made" treatment.

Chemotherapy , for example, is no longer systematic. Genomic tests make it possible to determine if it is necessary. Less than 10% of breast cancers detected at an early stage derive a real benefit from this heavy artillery. No need to prescribe it to other women, given its undesirable effects: hair loss, nausea and vomiting, oral lesions ... These very expensive profiling tests (about 3000 €) are finally available and reimbursed since May 2016 in France.

New therapeutic molecules have also emerged, such as Palbociclib against aggressive hormone-dependent breast cancer.

Unlike conventional chemotherapy that attacks healthy cells and malignant cells without distinction, this molecule only blocks the multiplication of cancer cells.

"A true revolution, says Professor Roman Rouzier, medical director of the senology pole of the Institut Curie, not only it is a simple tablet that the patient can take at home, but its side effects are less than under chemotherapy.

Similarly, herceptin specifically targets tumor cells carrying the HER2 receptor (15 to 20% of mammary cancers with metastases). By neutralizing it, it reduces by 50% the risk of relapse. And immense progress is also expected on the side of immunotherapy.

Its principle? Stimulate the immune system so that the body itself eliminates cancer cells. Clinical trials are in progress for the treatment of triple negative breast cancer in particular.

Less aggressive radiotherapy

Often prescribed after surgery to destroy residual tumor cells, radiation therapy has increased significantly in recent years.

The new devices allow focused irradiation that halves the local 10-year recurrence rate (15 to 6%). Their ultra-precise rays treat the affected area and better save the neighboring healthy organs, which reduces the side effects (burns, pain when swallowing ...). The most recent devices even adapt the intensity of the energy delivered according to the volume of the tumor and the breast.

As a result, sessions are better supported and the number can be reduced to one or two a week in some cases, against five usually. A new protocol has also emerged: intraoperative radiotherapy . Designed for patients over 60 years of age with a tumor of less than two centimeters, it is performed in the operating room: the rays are administered inside the breast, just after the removal of cancerous tissue.

This unique treatment of 20 minutes replaces the 25 to 30 usual sessions. Amazing!