Dr Marta Ribeiro González is a surgeon in the breast unit of the El Clínico hospital in Malaga. She is a leading figure in breast ... and thyroid cancer surgery, as well as in breast reconstruction.
She is chair of the 44th Congreso de la Sociedad Española de Senología on 23 and 24 October at the Fycma trade and fair centre in Malaga, with around 1,000 specialists taking part.
—As chair of this conference and a surgeon at Hospital Virgen de la Victoria, what does leading this event mean for healthcare in Malaga and what impact will it have on patients?
—On the one hand, it means visibility: it gives all of us specialists working in breast cancer the opportunity to showcase our quality levels and standards, which are very high. On the other hand, it always provides a boost to specialists in the province, who will come away inspired to try new things. Many doctors from the mainland will be attending, not just from across Spain, but also Portuguese surgeons and radiologists.
—There is a perception that women with breast cancer are undergoing fewer surgeries or that these are less aggressive. What exactly is behind this shift in approach and how has it been achieved without compromising the chances of a cure?
—Surgical procedures have become less invasive, while achieving the same or better outcomes in terms of recovery. Even as the number of surgeries decreases and even without advances in other treatments, the outcomes remain the same. We can now take that leap forward with the support of adjuvant treatments, that is, targeted oncology. This enables us to determine what a patient needs in terms of surgery.
—Advances such as intraoperative radiotherapy and axillary-sparing surgery aim to prevent serious complications such as lymphoedema. What type of patient is already benefiting from these techniques in Malaga and what scope for improvement is there within the public health system?
—They are usually postmenopausal patients, as they are at lower risk and have less aggressive tumours at an early stage. Ultimately, it all comes down to the same thing: with early detection, we will be able to use less aggressive treatments. We can even avoid axillary surgery. Not only do we not need to perform a lymphadenectomy or axillary dissection, but there are patients in whom we do not even need to perform sentinel lymph node biopsy.
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With partial breast radiotherapy, by selecting the right patients, this can be possible in many cases. Within the public healthcare network in Malaga, we are one of the provinces that have always been pioneers in advancing any treatment. Right now, all Malaga hospitals are omitting sentinel lymph node biopsy when it is not necessary. I am aware that many provinces in Spain have not yet taken this step. When sentinel lymph node biopsy was first introduced and lymphadenectomy was phased out, back in 2011, we were also among the first to adopt it.
—A specific area has been dedicated to fertility preservation. Has the patient profile changed in recent years? Are more cases of breast cancer being detected in young women?
—Yes, we are diagnosing more and more young patients. In fact, the Spanish society of medical oncology has a specific research group for women under the age of 40, as this demographic requires a tailored approach when it comes to fertility, returning to work and preventing overtreatment. We are currently at a crossroads: on the one hand, cases are being detected at an earlier age and, on the other, women are delaying motherhood for longer and longer. This makes it necessary to establish very specific protocols for fertility preservation in women facing a breast cancer diagnosis before they have had children.
—With the development of liquid biopsy and molecular profiling, how close are we to having a bespoke treatment for every tumour?
—We have already made considerable progress with immunohistochemistry and molecular biology. There are subtypes that now proceed directly to chemotherapy regardless of tumour size, because we know that patients benefit simply from having their response assessed. Both liquid biopsy and molecular testing will indeed become increasingly precise. There are already studies identifying which patients will not benefit from chemotherapy, allowing us to omit it. This is now also possible thanks to genomic platforms. It will be rare for two patients to receive the same treatment.