Dr. Aguinaldo Andrade

Gynaecologist/Obstetrician
Sub-Specialty in Gynaecology Oncology & Senology

Breast cancer

The future revisiting the past

HPA Magazine 19

The history of breast cancer treatment follows the evolution of surgical science, which follows the progress of human knowledge.
There is a centuries long empirical phase, and a scientific phase that is just over one hundred years old. 
The last and most important stage is that of the last forty years.

The discovery of the microscope revolutionized the understanding of diseases.
In 1757, Henri François Le Dran, publishes the following: breast cancer is a disease that starts locally, in the mammary gland, and from there, through the lymphatic channels, it reaches the axillary nodes, only then spreading throughout the body… The foundations of the mastectomy with axillary dissection were created.
The concept that it is necessary to stage breast cancer to rationalize its treatment is generally know. 
Halsted decided to resect en bloc: the entire mammary gland, plus the pectoralis major muscle and the entire content of the axillary.
This operation by Halsted, was first performed in 1882 at Roosevelt Hospital (New York) and was called a radical mastectomy and lasted until the 1970s.
In 1971 there was a paradigm shift based on the Fischer study, where it was concluded that breast cancer is a systemic disease.
In 1906, the first work on a new therapeutic procedure in the fight against breast cancer as a first line treatment, was published in Boston: Radiotherapy.
Alongside some spectacular cures, there were complications resulting from indiscriminate doses of X-rays, which, at that time, were applied in a single session. This even led to the death of patients. It was not until 1911 that Claude Regaud (1870-1941), from Paris, conceived radiotherapy in fractioned doses. Currently, intraoperative radiotherapy is performed in a single dose. The Senology Group of Hospital Particular do Algarve was pioneer in the southern region of the country, in the treatment of breast cancer by intraoperative radiotherapy.
It is necessary to emphasize that a mammography does not prevent breast cancer, therefore it is necessary to repeat the exam at regular intervals. Breast cancer screening with a mammography permits the detection of 2 to 3 mm size lesions. To study these tiny lesions, a special methodology is required. Hospital Particular do Algarve is the only private healthcare unit in the entire southern region of the country to carry out stereotactic marking of infra-clinical breast lesions.
Progress in the understanding of tumour biology has enabled Specialists to make decisions on personalized treatment to be carried out.  The radical nature of breast surgery gave way to oncoplastic surgery with better aesthetic results and a better prognosis.

BREAST CANCER – THE FUTURE
Personalized Medicine “There are no diseases, only patients”.
It is not possible to take care of people's bodies without taking care of their minds. It is the duty of all doctors to listen to our patients and be part of the emotions of those we treat every day (Umberto Veronessi).
Hence the importance of having an Interdisciplinary Group to address breast diseases, such as the Breast Unit of our Hospital.