Breast cancer survivors. Early diagnosis – successful treatment – quality of life: multidisciplinary approach




breast cancer, radiation therapy, hormone therapy, chemotherapy


Breast cancer is the leading cause of cancer-related deaths in European women. Breast cancer diagnosis is widely represented in women with such risk factors as exposure of endogenous end exogenous estrogens, some genetic predispositions, low parity and others. Consumption of fat, alcohol leads to the rising breast cancer incidence of last decades. Breast cancer occurs mostly after 50 years. Genetic BRCA1 and BRCA2 polymorphism, family history allows supposing breast cancer in 10% of women in risk group. In Ukraine radiation played a great role due to Chernobyl atomic station catastrophe in 1986.

In a treatment of breast cancer different methods are used in a combination. Primary surgery and systemic approaches include radiation therapy, hormone therapy and chemotherapy. Important role belongs to a chemotherapy and post-treatment after surgical intervention.

Chemotherapy is recommended in the vast majority of triple-negative, HER2-positive breast cancer and in high-risk luminal HER2-negative tumors (evidence level I, A). The absolute benefit from chemotherapy is more pronounced in estrogen receptors negative tumors. The most frequently used regimens contain anthracyclines and/or taxanes, although in selected patients the CMF therapy (cyclophosphamide, methotrexate, and fluorouracil) may still be used. Endocrine therapy is indicated in all patients with detectable estrogen receptors expression irrespective of the use of chemotherapy and/or targeted therapy (evidence level I, A).

Routine physical examinations with a careful taking history are the most valuable measures of detecting breast cancer recurrence. The European Society for Medical Oncology recommends regular visits every 3 to 4 month in the first 2 years, every 6 month from years 3 to 5 and annually thereafter.

Author Biographies

T. F. Tatarchuk, Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine

MD, professor, corresponding member. NAMS of Ukraine, Deputy Director for Research, Head of Endocrine Gynecology

I. I. Smolanka, National Cancer Institute of the NAMS of Ukraine

MD, professor, Chief oncosurgeon of the Ministry of Health of Ukraine, head of the Scientific and Research Department of Breast Tumors and its Reconstructive Surgery

O. V. Popkov

PhD, gynecologist


  1. National Cancer Registry. Ukraine. NCI (2011).
  2. GLOBOCAN 2008 Update. Avialable from: [ iarcnews/2011/globocan2008-prev.php], last accessed Feb 15, 2016.
  3. De Santis, C.E., Lin, C.C., Mariotto, A.B., et al. “Cancer treatment and survivorship statistics, 2014.” CA Cancer J Clin 64 (2014): 252.
  4. Jemal, A., Siegel, R., Xu, J., Ward, E. “Cancer statistics, 2010.” CA Cancer J Clin 60 (2010): 277.
  5. Cheung, W.Y., Neville, B.A., Cameron, D.B., et al. “Comparisons of patient and physician expectations for cancer survivorship care. “J Clin Oncol 27 (2009): 2489.
  6. Ottini, L., Palli, D., Rizzo, S., et al. “Male breast cancer.” Crit Rev Oncol Hematol 73 (2010): 141–55.
  7. Autier, P., Boniol, M., La Vecchia, C., et al. “Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database.” BMJ 341 (2010): 3620.
  8. Allemani, C., Weir, H.K., Carreira, H., et al. “Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 populationbased registries in 67 countries (CONCORD-2).” Lancet 385 (2015): 977–1010.
  9. Sant, M., Chirlaque Lopez, M., Agresti, R., et al.; EUROCARE-5 Working Group. “Survival of women with cancers of breast and genital organs in Europe 1999-2007: results of the EUROCARE-5 study.” Eur J Cancer (2015). Avialable from: [ pubmed/26421822], last accessed Feb 16, 2016.
  10. Minino, A.M., Murphy, S.L. “Death in the United States, 2010.” NCHS Data Brief 1–8 (2012).
  11. Tsu, V. “Evaluation of Key Components of PATH’s Ukraine Breast Cancer Assistance Project: Ten Years After.” Avialable from: [http://sites. Ukraine_2011.pdf], last accessed Feb 16, 2016.
  12. McDermott, A.M., Toelle, T.R., Rowbotham, D.J., et al. “The burden of neuropathic pain: results from a cross-sectional survey.” Eur J Pain 10 (2006):127–35.
  13. McDonald, M., Hertz, R.P., Unger, A.N., et al. “Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older.” J Gerontol A Biol Sci Med Sci 64 (2009): 256–63.
  14. Materials of European Cancer Congress – 2015. “Treatment patterns for older patients with non-metastatic breast cancer in four European countries – preliminary data from a EURECCA international comparison.” Avialable from: [ European-Cancer-Congress-2015/Treatment-patterns-forolder- patients-with-non-metastatic-breast-cancer-in-four- European-countries-preliminary-data-from-a-EURECCAinternational- comparison], last accessed Feb 16, 2016.
  15. Miguel, R., Kuhn, A.M., Shons, A.R., et al. “The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome.” Cancer Control 8 (2001): 427.
  16. Meijuan, Y., Zhiyou, P., Yuwen, T., et al. “A retrospective study of postmastectomy pain syndrome: incidence, characteristics, risk factors, and influence on quality of life.” Scientific World Journal (2013). DOI: 10.1155/2013/159732
  17. Wallace, M.S., Wallace, A.M., Lee, J., Dobke, M.K. “Pain after breast surgery: a survey of 282 women.” Pain 66 (1996): 195.
  18. Poleshuck, E.L., Katz, J., Andrus, C.H., et al. “Risk factors for chronic pain following breast cancer surgery: a prospective study.” J Pain 7 (2006): 626.
  19. Berry, D.A., Cirrincione, C., Henderson, I.C., et al. “Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer.” JAMA 295 (2006): 1658–67.
  20. Clarke, M., Coates, A.S., Darby, S.C., et al. “Adjuvant chemotherapy in oestrogen receptor-poor breast cancer: patient-level meta-analysis of randomised trials.” Lancet 371 (2008): 29–40.
  21. Colleoni, M., Gelber, S., et al. “Tamoxifen after adjuvant chemotherapy for premenopausal women with lymph node-positive breast cancer: International Breast Cancer Study Group trial 13–93.” J Clin Oncol 24 (2006): 1332–41.
  22. Swain, S.M., Jeong, J.H., Wolmark, N. “Amenorrhea from breast cancer therapy-not a matter of dose.” N Engl J Med 363 (2010): 2268–70.
  23. Floyd, J.D., Nguyen, D.T., Lobins, R.L., et al. “Cardiotoxicity of cancer therapy.” J Clin Oncol 23 (2005): 7685.
  24. Singal, P.K., Iliskovic, N. “Doxorubicin-induced cardiomyopathy.” N Engl J Med 339 (1998): 900.
  25. Carver, J.R., Shapiro, C.L., et al.; ASCO Cancer Survivorship Expert Panel. “American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects.” J Clin Oncol 25.25 (2007): 3991.
  26. Auner, H.W., Tinchon, C., Linkesch, W., Tiran A., et al. “Prolonged monitoring of troponin T for the detection of anthracycline cardiotoxicity in adults with hematological malignancies.” Ann Hematol 82.4 (2003): 218.
  27. Gnant, M., Mlineritsch, B., Schippinger, W., et al. “Endocrine therapy plus zoledronic acid in premenopausal breast cancer.” N Engl J Med 360 (2009): 679–91.
  28. Pagani, O., Regan, M.M., Walley, B.A., et al. “Adjuvant exemestane with ovarian suppression in premenopausal breast cancer.” N Engl J Med 371 (2014): 107–18.
  29. Cuzick, J., Ambroisine, L., et al. “Use of luteinizing-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormonereceptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials.” Lancet 369 (2007): 1711–23.
  30. Jonat, W., Kaufmann, M., Sauerbrei, W., et al. “Goserelin versus cyclophosphamide, methotrexate, andfluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: the Zoladex Early Breast Cancer Research Association study.” J Clin Oncol 20 (2002): 4628–35.
  31. Sismondi, P., Biglia, N., Volpi, E., Giai, M., de Grandis, T. “Tamoxifen and endometrial cancer.” Ann N Y Acad Sci 734 (1994): 310–21.
  32. Bissett, D., Davis, J.A., George, W.D. “Gynaecological monitoring during tamoxifen therapy.” Lancet 344 (1994): 1244.
  33. Fisher, B., Costantino, J.P., Redmond, C.K., et al. “Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14.” J Natl Cancer Inst 86 (1994): 527–37.
  34. Magriples, U., Naftolin, F., Schwartz, P.E., Carcangiu, M.L. “High-grade endometrial carcinoma in tamoxifen-treated breast cancer patients.” J Clin Oncol 11 (1993): 485–90.
  35. Davies, C., Pan, H., Godwin, J., Gray, R., et al. “Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial.” Lancet 381 (2013): 804–16.
  36. Moore, H.C., Unger, J.M., Phillips, K.A., et al. “Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy.” N Engl J Med 372 (2015): 923–32.
  37. Regan, M.M., Leyland-Jones, B., Bouzyk, M., et al. “CYP2D6 genotype and tamoxifen response in postmenopausal women with endocrine-responsive breast cancer: the breast international group 1–98 trial.” J Natl Cancer Inst 104 (2012): 441–51.
  38. Sideras, K., Ingle, J.N., Ames, M.M., et al. “Coprescription of tamoxifen and medications that inhibit CYP2D6.” J Clin Oncol 28 (2010): 2768–76.
  39. Coleman, M.P., Quaresma, M., Berrino, F., et al. “Cancer survival in five continents: a worldwide populationbased study (CONCORD).” Lancet Oncol 9 (2008).
  40. Khatcheressian, J.L., Hurley, P., Bantug, E., et al. “Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update.” J Clin Oncol 31 (2013): 961–65.
  41. Senkus, E., Kyriakides, S., Penault-Llorca F., et al. “Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.” Ann Oncol 24.6 (2013): 7-23.
  42. Achiron, R., Lipitz, S., Sivan, E., Goldenberg, M., et al. “Changes mimicking endometrial neoplasia in postmenopausal, tamoxifen-treated women with breast cancer: a transvaginal Doppler study.” Ultrasound Obstet Gynecol 6 (1995): 116–20.
  43. Bertelli, G., Venturini, M., Del Mastro, L., et al. “Tamoxifen and the endometrium: findings of pelvic ultrasound examination and endometrial biopsy in asymptomatic breast cancer patients. “Breast Cancer Res Treat 47 (1998): 41–6.
  44. Fung, M.F., Reid, A., Faught, W., Le, T., et al. “Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen.” Gynecol Oncol 91 (2003): 154–9.
  45. Love, C.D., Muir, B.B., Scrimgeour, J.B., et al. “Investigation of endometrial abnormalities in asymptomatic women treated with tamoxifen and an evaluation of the role of endometrial screening.” J Clin Oncol 17 (1999): 2050–4.
  46. Markovitch, O., Tepper, R., Aviram, R., et al. “The value of sonohysterography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients.” Gynecol Oncol 94 (2004): 754–9.
  47. Chalas, E., Costantino, J.P., Wickerham, D.L., et al. “Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial.” Am J Obstet Gynecol 192 (2005):1230–9.
  48. Syrjala, K.L., Yi, J.C., Ganz, P.A., Vora, S.R. Overview of psychosocial issues in the adult cancer survivor. Avialable from: [ overview-of-psychosocial-issues-in-the-adult-cancer-survivor], last assessed Feb 17, 2016.
  49. DeSantis, C.E., Lin, C.C., Mariotto, A.B., et al. “Cancer treatment and survivorship statistics, 2014.” CA Cancer J Clin 64 (2014): 252.
  50. Lerro, C.C., Stein, K.D., Smith, T., Virgo, K.S. “A systematic review of large-scale surveys of cancer survivors conducted in North America, 2000-2011.” J Cancer Surviv 6.2 (2012): 115-45.
  51. National Research Council. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs // Ed. by N.E. Adler, A.E.K. Page. The National Academies Press. Washington D.C. (2007).
  52. Institute of Medicine, National Research Council. From Cancer Patient to Cancer Survivor: Lost in Transition // Ed. by M. Hewitt, S. Greenfield, E. Stovall. The National Academies Press. Washington D.C. (2006).
  53. Beckjord, E.B., Reynolds, K.A., van Londen, G.J., et al. “Population-level trends in posttreatment cancer survivors’ concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys.” Psychosoc Oncol 32.2 (2014):125.
  54. Forsythe, L.P., Kent, E.E., Weaver, K.E., Buchanan, N., et al. “Receipt of psychosocial care among cancer survivors in the United States.” J Clin Oncol 31.16 (2013): 1961-9.
  55. Greer, J.A., Solis, J.M., Temel, J.S., et al. “Anxiety disorders in long-term survivors of adult cancers.” Psychosomatics 52 (2011): 417.
  56. Costanzo, E.S., Ryff, C.D., Singer, B.H. “Psychosocial adjustment among cancer survivors: findings from a national survey of health and well-being.” Health Psychol 28 (2009): 147.
  57. Mitchell, A.J., Ferguson, D.W., Gill, J., et al. “Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis.” Lancet Oncol 14 (2013): 721.
  58. Mols, F., Husson, O., Roukema, J.A., van de Poll-Franse, L.V. “Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry.” J Cancer Surviv 7 (2013): 484.
  59. Mosher, C.E., DuHamel, K.N., Rini, C.M., et al. “Barriers to mental health service use among hematopoietic SCT survivors.” Bone Marrow Transplant 45 (2010): 570.
  60. Sonmezer, M., Oktay, K. “Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection.” Avialable from: [http://www. gonadotoxic-treatment-or-gonadal-resection], last accessed Feb 17, 2016.
  61. Loren, A.W., Mangu, P.B., Beck, L.N., et al. “Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update.” J Clin Oncol 31 (2013): 2500.
  62. The Practice Committee of the American Society for Reproductive Medicine. “Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion.” Fertil Steril 100 (2013): 1214.
  63. The Ethics Committee of the American Society for Reproductive Medicine. “Fertility preservation and reproduction in patients facing gonadotoxic therapies: a committee opinion.” Fertil Steril 100 (2013): 1224.
  64. Das, M., Shehata, F., Moria, A., et al. “Ovarian reserve, response to gonadotropins, and oocyte maturity in women with malignancy.” Fertil Steril 96 (2011): 122.




How to Cite

Tatarchuk, T. F., Smolanka, I. I., & Popkov, O. V. (2016). Breast cancer survivors. Early diagnosis – successful treatment – quality of life: multidisciplinary approach. REPRODUCTIVE ENDOCRINOLOGY, (28), 34–41.



Tumors and pretumoral pathology

Most read articles by the same author(s)