Breast cancer Diagnostics and Surgery

The main reasons why women choose breast cancer (BC) treatment abroad:

• Technologies that maximise breast preservation. During surgery, foreign doctors use special machines that examine the excised tissue. If cancer cells are found at the edges, they increase the amount of intervention. Surgeons dissect the tissue until the edges are clean. Thanks to technology, foreign doctors do not need to remove the entire gland for reinsurance, as they do in CIS countries.
• High-precision radiotherapy with minimal risk of side effects. For radiotherapy, hospitals abroad have the latest generation of machines (2013-2019). These units are equipped with a system that allows the radiation beam to be adjusted to the shape and size of the tumour with an accuracy of 0.5 mm. This minimises the impact on surrounding healthy tissue. For comparison, in the CIS countries they use units from 2003-2008, the accuracy of which is several cm. At the same time, radiotherapy with a new device in a foreign clinic may cost you the same price as with an old one in a domestic hospital.
• Effective chemotherapy with hair preservation. Abroad, the chemopreparation and its dose doctors select individually for each woman according to the results of the study of the tumour. She is also prescribed effective supportive therapy to alleviate symptoms. In CIS countries, oncologists use standard chemotherapy protocols. In some foreign hospitals, special caps are available that cool the scalp during therapy. Thanks to this, blood flow in the area of hair growth slows down, the drugs reach the bulbs in smaller quantities and they do not fall out.
• Innovative treatment methods. In malignant breast tumours with a genetic mutation, targeting and immunotherapy are indicated. Doctors abroad have extensive experience in the successful application of these techniques and more such drugs are available abroad than in the CIS. For comparison, about 70 immunopreparations are used in the world practice, in Russia - 18, in Ukraine - 12.

Breast cancer is well treatable - this is the first thing that is important to know for women with such a diagnosis. According to the American Society of Clinical Oncology, the milestone of 5 years survive:

• 99% of patients whose disease has not advanced beyond the gland (stages 0-1);
• 85% of women with secondary tumours (metastases) in the lymph nodes (stage 2-3);
• 27% of patients with metastases in distant organs (stage 4).

If we talk about the average 5-year survival rate for all stages, it is 90%.

Choosing where to treat breast cancer, Bookimed patients in most cases give preference to the following countries:

• Germany. German clinics have the strictest control over the quality of medicine and the level of qualification of doctors. Departments of German hospitals, which specialise in the treatment of breast cancer, are equipped with the latest equipment, and their doctors use effective methods. This is evidenced by accreditations from the German Cancer Society.
• Israel. In Israeli hospitals, women with breast cancer are treated by doctors who undergo training and internships in Europe and the USA. The organisation of treatment here is faster than in Germany. The difference is due to the fact that the system of work of the international department of Israeli clinics allows you to more quickly get a doctor's opinion on medical records.
• Turkey. Hospitals of the country offer the best value for money. They work according to American and international protocols, some of them are included in the Top Master's in Healthcare Administration organisation's Top Hi-Tech Hospitals of the World. At the same time, the cost of treatment in Turkey is lower than in Israel and Germany.

When choosing a clinic for breast cancer treatment, it is necessary to consider such factors:

• The techniques available at the medical centre. It is important, to undergo a treatment that is maximised in a particular case and not the only one possible within a particular hospital. Therefore, pay attention that the clinic uses surgery, radiation, chemotherapy, chemo, hormonal, targeted and immunotherapy.
• Level of equipment. To ensure that treatment is carried out with minimal risk of side effects, the clinic should have the latest medical equipment. For example, radiation therapy machines (linear accelerators), should be no older than 2013.
• Breast Cancer Treatment Reviews. Read the stories of patients who have undergone therapy and surgery at a particular medical centre. Ask about the staff and quality of care.

More than 50 reviews of breast cancer treatment in different countries are collected here.

Here is one of them. It's a story about a woman who was told by doctors in the CIS that she had metastatic breast cancer. German doctors made a diagnosis and disproved this diagnosis.

When choosing a doctor for breast cancer treatment abroad, it is important to focus on:

• Number of years of experience. Leading doctors abroad have at least 10 years of practical experience in treating this disease.
• Accreditations from international or European oncology organisations that confirm he or she has the skills needed to treat cancer effectively (e.g. ESMO).
• Testimonials from female patients who have been treated by this doctor.

We have selected leading doctors who specialise in the treatment of breast tumours. When compiling the list, we were guided by the above criteria, so any of them we would recommend to our family and friends.

Dr Manuela Seifert (Solingen Clinic in Germany) is an oncologist with over 20 years of experience. She specialises in breast-conserving surgeries and the treatment of breast cancer that is genetically determined. Dr Seifert even sees patients with advanced stages.

Professor Yeşim Yıldırım (Anadolu Clinic in Turkey) is a top oncologist in Turkey with over 18 years of experience. She has received accreditation from the European Society for Medical Oncology (ESMO).

Professor Ilan Gil Ron (Suraski Medical Centre in Israel) - in oncology for about 30 years. He has trained in the USA and the UK. The doctor heads a research centre for the development of anti-cancer drugs.

The price for breast cancer treatment depends on such factors:

• The treatment programme. It may include one technique or a set of several procedures, which doctors select depending on the stage of the disease and the type of tumour. Therefore, the cost of breast cancer treatment is individualised in each case.
• Selected country and clinic. Prices for breast cancer treatment in different countries can differ several times. This is due to the level of economic development of the states. For example, the price of surgery for breast cancer in India - from $2 850, in Israel - from $ 9 500. The cost of procedures within one country may differ depending on the type of medical centre (private/public) and class.

Breast cancer diagnosis abroad includes:

• Doctor's consultation and chiropractic examination.
• A comprehensive blood test - determines abnormalities in blood composition, which may indicate abnormalities in the functioning of an organ.
• Test for oncomarkers - with its help doctors detect in the blood proteins characteristic of breast cancer.
• Mammography - this is an X-ray of the breast, which allows you to detect a tumour even before it is palpable when palpating the breast.
• Ultrasound - helps detect tumours in the tissue and lymph nodes. With the help of ultrasound, doctors can understand what the mass is filled with and distinguish a tumour from a cyst.
• MRI of the breast - the technique is used to establish the size of the tumour, its spread into neighbouring tissues.
• Biopsy - this is a procedure to take tumour tissue for laboratory examination.
• Histology and immunohistochemistry of the neoplasm - analysis of the material obtained by biopsy. With their help, doctors determine the presence of cancer cells, tumour type, receptor status of the neoplasm (presence of a genetic mutation in it, in which targeting and immunotherapy is indicated), the stage of the disease and select a treatment tactic.
• CT scan of the thoracic and abdominal cavity - allows doctors to determine whether the tumour has metastasised to organs located in these areas.
• Scintigraphy - is performed if bone metastases are suspected.
• Positron emission computed tomography (PET-CT) - a whole-body scan that helps detect even the smallest metastases - up to 3 mm.

Some overseas hospitals have these latest breast cancer diagnostic methods available:

• Tomosynthesis - three-dimensional mammography, which does not require compression of the breast.
• Molecular tomography - allows tumour detection in patients with dense breasts.
• Positron emission mammography (PEM) - is a type of positron emission tomography that helps to detect even tumours as small as 1.6 mm in the breast.
• Electrical impedance tomography (EIT) - it can distinguish a benign tumour from a malignant tumour without biopsy by using a current.
• Oncotype DX - is a genetic tumour test that determines the risk of breast cancer recurrence in patients who have been treated early in the disease.
• Mammaprint test - predicts the likelihood of recurrence and metastases within 10 years after removal of the primary tumour.Doctors use it to determine the need for post-operative chemotherapy.
• BluePrint test - doctors use it to determine the subtype of breast cancer and predict the effectiveness and need for preoperative therapy.

Treatment of breast cancer abroad is carried out with the help of such techniques:

Surgery

The amount of intervention depends on the size of the tumour. The following types of surgery for breast cancer are distinguished:

• Organ-preserving - indicated at the initial stages of the disease. Subspecies of the procedure:
  • Sectoral resection (tumorectomy, lumpectomy) - indicated for tumours less than 2 cm. During the operation, surgeons excise the tumour and about 1 cm of surrounding healthy tissue to prevent recurrence - the return of the disease.
  • Quadrantectomy - much like a lumpectomy, it also allows for breast preservation. During the intervention, surgeons remove the tumour and about 2 cm of nearby tissue.
• Total mastectomy is the complete removal of the breast. If there is a risk of the disease spreading to a healthy gland, doctors excise it as well.

Radiotherapy (radiation therapy)

This is a course of treatments during which the tumour is irradiated and gradually destroyed. Doctors perform radiotherapy in such cases:

• Before surgery (neoadjuvant radiotherapy) - to shrink the tumour and preserve breast tissue as much as possible;
• after surgery (adjuvant radiotherapy) - to destroy remaining cancer cells and prevent the disease from returning;
• instead of surgery - in advanced stages to slow tumour growth and reduce symptoms.

Radiosurgery

This is the one-stage destruction of the tumour with high doses of radiation. This treatment is performed in the early stages of the disease if the patient has contraindications to surgery.

Chemotherapy for breast cancer

This is the reception of special antitumour drugs, which with the bloodstream are spread throughout the body and destroy cancer cells. Types of chemotherapy:

• Neoadjuvant (pre-operative) - allows the tumour to shrink so that doctors can preserve as much gland tissue as possible during surgery.
• Adjuvant (postoperative) - destroys metastases throughout the body.
• Palliative - improves quality of life in the later stages of the disease.

Hormonal therapy

Treatment with hormonal drugs is prescribed to patients with hormone-dependent tumours in these situations:

• after surgery to prevent the disease from returning;
• if the disease has metastasised;
• in case of recurrence.

The following innovative treatments for breast cancer are available abroad:

Cryotherapy (cryosurgery/cryoablation)

This is the freezing of the tumour using an injection of liquid nitrogen. Due to the effect of low temperatures, cancer cells stop multiplying and the neoplasm dies.

The technique is indicated at 0-1 stages of breast cancer.

Intraoperative radiation therapy

The aim of the procedure is to destroy all cancer cells that may have remained in the area of the removed tumour. The procedure is a one-time procedure using a high dose of radiation. This prevents the patient from having to undergo post-operative radiotherapy to prevent a recurrence.

Immunotherapy

Immunopreparations activate the patient's immune system, so that the body begins to recognise cancer cells and destroy them on its own.

Targeted therapy

Targeted drugs target cancer cells without harming healthy tissues. This treatment causes fewer side effects than chemotherapy.

Patients who have had their breasts partially or completely removed, plastic reconstructive surgeons carry out the restoration of the gland. To do this, they use implants or the woman's own tissue, which is obtained from the lower abdomen. If the nipple was removed during the operation, surgeons create a special elevation, on which you can later make tattooing, giving it the desired colour.

To organise breast cancer treatment abroad, leave a request on the website. At a convenient time for you, you will be contacted by a Bookimed coordinating doctor who will advise you on all your questions. He will tell you about the leading doctors, medical centres and help you to choose the best breast cancer clinic based on your wishes in terms of price and quality. The coordinating doctor, will explain what documents are required to travel for treatment and will book you into the hospital of your choice.