Breast Cancer Course 13/09/2021


Educational opportunities for young surgeons – courses and fellowships – Mariela Vasileva-Slaveva, MD. PhD, secretary of Women for Oncology – Bulgaria

There is a huge inequality in the education of breast specialist around Europe. This is particularly seen in surgery, where breast cancer patients can be operated on by gynecologists, general surgeons or thoracic surgeons, which are dedicated or not to breast cancer treatment. There are many societies around Europe providing education opportunities as short courses or long term fellowships. They aim to improve the quality of breast cancer care and produce a certified breast specialists.

The missing link – screening programs for gynecological cancers – Assoc. prof. Angel Yordanov, MD. PhD, Department of gynecological oncology, Medical University Pleven, Pleven, Bulgaria

Over 40% of cancer cases are preventable. The primary prevention remains the most cost-effective intervention in cancer control and most of the European countries have established screening programs. The effect of the mass screening is seen in the last years in Europe, where cancer mortality has been constantly reduces. This is not the case in Bulgaria, where the mortality of breast cancer is keeping the same levels and the mortality of cervical cancer is invreasing.

Procedures for cancer prevention in BRCA positive women – Claudia Iannetti, MD.  Medical University Innsbruck, Innsbruck, Austria

Hereditary breast cancer represents 5-10% of the newly diagnosed breast cancer. Most often it is associated with mutations in BRCA1/2 genes. Germline mutations in those genes result in a significantly increased lifetime risk of developing breast and ovarian cancer, estimated at up to 7 and 25 times (respectively) higher of the average risk population. The purposeful searching and identification of women at high risk of breast cancer provides the opportunities to reduce their individual risk.

Vacuum assisted biopsy of breast lesions – indications and contraindications – Prof. Dobri Dimitrov, MD. PhD, Department of surgical oncology, Medical University Pleven, Pleven, Bulgaria

Triple assesment of breast cancer lessons, combined with additional methods can discriminate between benign and malignant breast lesions with 95% accuracy. Still, none of these methods is perfect. Uncertainty in diagnosis may lead to multiple and sometimes unnecessary hospital admissions. Patients may neglect follow-up visits only to return later with advanced breast cancer. Therefore, a selective histological diagnosis is necessary to assure patients and to avoid a misdiagnosis for lesions higher than BI-RADS category 3. Vacuum assisted biopsy of breast lesions offers the best possible histological sampling and aids avoidance of unnecessary operations.

This work was supported by the European Regional Development Fund through the Operational Programme „Science and Education for Smart Growth“ under contract №BG05M2OP001-1.002-0010-C01(2018-2023)

The sentinel node – the axilla and the probe – Assoc. prof. Svilen Maslyankov, MD. PhD, Department of surgery, Medical University Sofia, Bulgaria

The technique of intraoperative lymphatic mapping was developed in the 1990s. It has been used to identify the first site (lymph node) of the metastatic spread. It was first described during surgeries on the parotid gland and later on in the lymphatic drainage of the penis, testis and later on – breast. Currently sentinel node dissection is a gold standard procedure for evaluating the status of the axillary node in patients with early clinically node negative breast cancer.

Marking primary tumor and metastatic lymph nodes with titanium clips and wire –  Birgit Amrot, MD., Medical University Innsbruck, Innsbruck, Austria

We all should always leave a mark! The radiologist should mark the site of biopsy in order to prevent multiple interventions in the breast. He should live a mark in the tumor to help surgeons to identify the lesion and to guide him during the operation. The classic approach in this is to use a titanium clip and a hook wire. The procedure of marking of the non palpable breast lesions or tumors prior neoadjuvant chemotherapy is allowing for much more breast conserving surgeries and has direct impact on quality of life and cosmetic outcomes.

Surgery in advanced and metastatic breast cancer – Konstantinos Zarampukas, MD., Interbalkan Medical Center of Thessaloniki, Greece

Surgery in advanced and metastatic breast cancer patients is topic rising many discussions. Systematic spread of the disease is usually contraindication for radical local treatment, because in its essence it can’t be radical. Some retrospective studies are suggesting that surgery may improve survival in metastatic patients, but the quality of the evidence is very low. The current recommendation of treatment for both locally advance and metastatic breast cancer patients include systemic therapy as initial treatment and surgery only in selected cases and if performed with the same attention to detail (e.g. complete removal of the disease) as in patients with early-stage disease.

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