Breast cancer rates have increased by 22% in a decade in Malaga, but survival rates are now 90%

Breast cancer rates continue to grow in Malaga, increasing by 2% year-on-year between 2023 and 2024, reaching 1,283 cases, and, over the last decade, reaching nearly 22% in the period from 2015 to last year (the cumulative number is 11,548 cases). Moreover, it will continue to grow, according to data verified by SUR with the AECC Spanish cancer association, given that a sustained increase is forecast until 2040. In any case, there is good news for those affected, as the five-year survival rate in the Costa del Sol province now stands at 90%, compared to 85% a decade ago.

Emilio Alba, head of the medical oncology service at the Hospital Clínico Universitario Virgen de la Victoria in Malaga city and scientific director of the CITAC Foundation, asserts that the improvement in survival over the last decade is mainly due to "screening and the fact that people are being more vigilant: it's true that tumours are being diagnosed when at an increasingly smaller size, that's a fact, and it's also true that quality of life is improving with less aggressive approaches to cancer."

This year's International Breast Cancer Day, marked yesterday on 19 October, coincided with the crisis generated by the failures related to inconclusive tests carried out on 2,000 women across Andalucía, including dozens from Malaga province. This has also led to the implementation of several emergency plans not only for these breast screenings, but also for colon and cervical screening. The controversy surrounding this discovery also led to the resignation of the regional minister for health, Rocío Hernández, and her replacement by a man who is a close confidant of Junta president Juanma Moreno: Antonio Sanz, minister to the regional presidency.

Cancer specialist Alba points out that the least aggressive approach to cancer can be carried out in the early stages of tumour growth. "This is conservative surgery, which is pèrformed on the gland, making a mastectomy unnecessary. One thing that is done on some patients with certain small tumours and negative lymph nodes in the armpit is that the armpit, not even the sentinel node, is practically untouched" he says, which has many advantages in terms of the patients' quality of life, "because what really bothers women when they are operated on is the additional touching," he explains.

Likewise, "radiotherapy techniques have also become much less invasive, so that today five sessions are enough to complete radiotherapy, something that previouslt took six weeks", although the fundamental cornerstone is medical treatment.

The key to this success in the five-year survival rate is as follows: "We have increasingly effective treatments, primarily the judicious use of chemotherapy, hormone treatment and multi-target therapy such as anti-HER2 treatment and immunotherapy." Added to this is the arrival of so-called genomic platforms (a technological system that allows the genetic material of a person, cell or tissue to be analysed, generally for diagnostic, research or personalised treatment purposes). "They have allowed us to identify a large number of women who do not need chemotherapy treatment and still have a very good prognosis. This has allowed us to focus our efforts, concentrating on patients with a poor prognosis and giving them more aggressive and modern treatments while not giving others any aggressive treatment at all after surgery," says Alba.

Now, the challenges are to "refine the treatments a little: we know that there are still some subgroups of women in whom, with simpler treatments, we could achieve the same result and we are working hard on that". Alba also points out that 5% of women "debut with metastatic breast cancer", and another 5% or 10% of women, after a localised tumour is found, also end up suffering from metastasis. "But there are some very powerful research programmes to see exactly how to improve the prognosis with the new anti-HER2 drugs, what are called conjugated antibodies, and also with the new hormone treatments."

The disease cannot be cured in the case of metastatic cancers, but "survival rates of more than five years are not uncommon now", he says. He adds that relative increases in survival are now going to be somewhat slower, asserting that, in addition to factors such as smoking, being overweight, alcohol consumption and genetics, cancer has also increased in recent years for the following reason. "The reason why the risk increases very significantly is that the first pregnancy is very late. This is the main cause of increased incidence, because cancer occurs biologically at some point between a woman's first period and her first pregnancy: when that period is very long, the probability is very high."

The most disruptive therapy to come is conjugated antibodies: "That works like a drone, a magic bullet: it's an antibody that goes against a specific tumour surface antigen and is loaded with a toxic, almost poisonous substance, and it releases it there, specifically, sparing normal cells."

Fran Fernández, head of general surgery and also head of the breast unit at Vithas Xanit International Hospital, explains that breast cancer increases significantly with age due to cellular ageing. "The highest peak incidence appears from the age of 50, with menopause, until the age of 69", he states, adding that "an increase has been seen in the 42 to 49 years age group, accounting for, according to the sources consulted, a third of all diagnosed patients. Some of them are left out of the screening programmes."

The major advances, says Fernández, have been in "chemotherapy treatments, which have led to further improvements in other areas. In some subtypes, such as triple negative and also HER2, complete response rates are achieved solely with this treatment. This will open a window to the future where these patients will not need to undergo surgery if other non-surgical diagnostic methods confirm the disappearance for certain of the initial disease."

Fernández continues, "we are in the process of de-escalation thanks to research. We are on the verge of not having to perform surgery on a subgroup of patients who responded to chemotherapy treatment, minimally invasive and reconstructive surgical techniques have been implemented over time with pre-pectoral implants. In certain situations, the application of genetic studies performed by pathologists on tumours allows oncologists to avoid chemotherapy that is known not to be necessary."