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Breast cancer – from hope to cure.Breast cancer – from hope to cure.

Breast cancer research has made great strides in recent decades. It has become possible to diagnose cancer more precisely and to treat it in a more targeted manner as it progresses. Thanks to groundbreaking scientific findings, there is now hope for recovery within the framework of primary care for more and more affected people.

Few available treatment options until the 1970s

Descriptions of breast cancer exist from as far back as ancient times, and it was considered incurable for hundreds of years. In the late 19th century it was finally discovered that the removal of the breast, known as a mastectomy, can improve the chances of survival. Removal, in a more or less radical form, was often the only hope for affected women up until the 1970s. Although the operation – now enabling breast conservation in about three quarters of cases – is still an important pillar today, the range of treatment options has been massively expanded in recent decades.

Breast cancer patients have been treated with chemotherapy since the 1980s. The cytostatic agents used have different modes of action and are intended to prevent further division of the cancer cells or even kill them. Radiation therapy also contributes to the combat against breast cancer.

Two breakthroughs lead to a sharp rise in the cure rate

The role of hormones in breast cancer has been a topic of discussion since the early 20th century. The focus has mainly been on estrogen, which was suspected relatively early on to promote the growth of certain types of tumors. A breakthrough, however, was the discovery in 1960 that certain breast cancer cells had hormone receptors. The first medication targeting a hormone finally came to the market in the 1980s. Various types of anti-hormonal treatments are now available. These are incredibly important since around two thirds of all breast cancers are hormone-receptor-positive. The wide availability of this treatment has increased the cure rate by approximately 30%.1

In the 1980s, researchers finally discovered that around a quarter of all breast cancer patients have a very high density of HER2 receptors in the breast cancer cells. It has been demonstrated that these receptors lead to particularly aggressive tumor growth. Based on this groundbreaking discovery, targeted cancer medications were developed for the first time. There are now various anti-HER2 therapeutic agents. Their use in HER2-positive patients has become part of the standard treatment, leading to a large improvement in quality of life. The progression of the disease can be significantly delayed and the survival time extended. 1, 2

Identification of tumor characteristics as a new standard

The described discoveries not only offered new treatment options for patients who previously had little hope of successful treatment, but also laid the foundation for a completely new approach. Identifying the tumor biology characteristics for all patients has now become standard. Not all breast cancer is created equal – treatments can only be effective if the tumor actually has the corresponding structures.3

In addition to improved early detection, such milestones in research and development have made it possible to reduce the mortality rate of breast cancer patients by 50 percent over the past three decades:4

Figures 1 and 2: Deaths related to breast cancer among 15–49 and 50–69-year-old women in Switzerland (source: Global Burden of Disease (GBD)), https://vizhub.healthdata.org/gbd-compare/#

Not only has the discovery interval of effective treatment methods for an increasing number of breast cancer types sharply decrease, at sharply decreasing intervals, but it is now also possible to make these new options available to all patients. It is expected that the next few years will bring forth further innovations that will quickly make the leap into primary care. Today, 87 percent of all affected women are still alive five years after diagnosis.5 This proportion will likely continue to increase in the future and additional lives will be saved.

1 Krebsliga (2020): Brustkrebs. https://www.krebsliga.ch/ueber-krebs/krebsarten/brustkrebs
2 Hamburger Ärzteblatt (2012): Das Mammakarzinom im Wandel. https://www.d-k-h.de/fileadmin/Agaplesion_dkh-hamburg/user_upload/121112_Artikel_Brustkrebs_Lindner_.pdf
3 Leitlinien-Programm Onkologie (2021): Interdisziplinäre S3-Leitlinie für die Früherkennung, Diagnostik, Therapie und Nachsorge des Mammakarzinoms. https://register.awmf.org/assets/guidelines/032-045OLk_S3_Mammakarzinom_2021-07_1.pdf
4 Bundesamt für Statistik (2021): Schweizerischer Krebsbericht 2021. Stand und Entwicklungen. https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffentlichungen.assetdetail.19305696.html
5 Deutsche Krebsgesellschaft (2022): Der Erkrankungsverlauf bei Brustkrebs. https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/krebsarten/brustkrebs/erkrankungsverlauf.html

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