According to the WHO, breast cancer is the most common cancer in the world. In France, it accounts for 33% of women’s cancers and remains the leading cause of cancer deaths (French National Cancer Institute, Panorama des cancers en France 2023).
Thanks to research, its causes are now clearer. In 17% of cases, it is linked to alcohol consumption, and in 5-10% of cases to hereditary factors. Other potential factors include ageing (80% of breast cancers develop after the age of 50), certain hormone treatments, body mass, and lack of physical activity. But science is still a long way from fully understanding the biological, genetic and epigenetic mechanisms that transform a healthy cell into a cancerous one.
National and international experts in cancer
The causes of breast cancer are the focus of research at the Institut Curie, a national and European leader for all gynecological cancers. Dr Céline Vallot, for example, is working on the role of epigenetics in the development of triple-negative breast cancer and the adaptation of tumor cells to anti-cancer treatments. This type of breast cancer is particularly aggressive and insensitive to certain treatments such as hormone therapy and anti-HER2 targeted therapy. “We are looking at tumor cells in the mammary gland through the prism of ‘single cell’ analysis. (…) Certain epigenetic modifications could enable us to develop new diagnostic tools or identify new therapeutic targets for treating triple-negative breast cancer.”
Another study, led by Dr Raphaël Ceccaldi, focuses on the failure of the biological systems that repair DNA breaks, present in almost half of breast and ovarian cancers. His teams have identified a previously unknown DNA repair mechanism involving a protein, PolꝊ, capable of acting during cell division. Their discovery paves the way for the development of new therapeutic targets
Comprehensive patient support
Every year, the Institut Curie cares for more than 7000 women with breast cancer, including more than 3000 new patients. 1400 professionals work with them at the two hospital sites.
The institute is a pioneer in oncogenetics, carrying out 4200 tests a year on susceptibility genes (in particular BRCA1 and BRCA2).
Since 2005, a support system has also been in place to strengthen the psychological support available to women from the moment of diagnosis. A team of specially trained nurses and psychologists provide counseling and respond to women’s concerns.
In May 2023, the Institut Curie also announced the creation of an institute dedicated to women’s cancers (“Institut des Cancers des Femmes”), due to open by 2025 and certified as part of the third wave of the Hospital-University Institute (IHU) under the France 2030 plan. This unique international facility, in the heart of Paris, will be dedicated to all women’s cancers. The idea is to bring together all medical, paramedical and scientific expertise, alongside companies and patient associations, in collaboration with PSL University and Inserm (National Institute of Health and Medical Research), to better understand, prevent and cure women’s cancers.
“The teams at the Institut Curie support women at every stage: diagnosis, treatment (surgery, radiotherapy, medical treatments, clinical trials, etc.), reconstruction, psychological support, management of side effects, pain, prevention, adapted physical activity, nutrition, aftercare, return to work, etc,” Pr Steven Le Gouill, director of the Institut Curie Hospital Group
Breast cancer can be cured in more than nine out of ten cases, if detected early (survival rate of 88% at 5 years according to the French National Cancer Institute). Significant progress has been made in treatment in recent years. For metastatic cancers, whatever the subtype, conjugated antibody-drugs extend patients’ lives. As for CDK 4/6 inhibitors, they offer hope to women with a higher risk of relapse (HER2).
Post-cancer, an essential stage
Surviving cancer is a tremendous victory, but so is surviving the long-term consequences of the disease and its treatment. This realization has given rise to Interval, a medical and scientific program dedicated to the aftermath of cancer at Gustave Roussy, the 4th best cancer hospital in the world. The aim of the program is to prevent the after-effects of treatment (changes in body image, pain, fatigue, chronic motor disorders, urinary and gastric problems, psychological and professional consequences, etc.) and improve the quality of life of patients in remission.
Gustave Roussy is also preparing to inaugurate My Care, a new facility dedicated entirely to post-cancer care in the Paris region. It will offer specific support programs (nutritional advice, functional physiotherapy, psychological support, acupuncture, adapted physical activity, etc.) and will include a day clinic to care for around 2000 people a year.
Gustave Roussy’s Breast Disease Committee treats more than 10 000 patients every year, including 2000 new cases.
Expertise throughout France
Innovation in breast cancer care and research is far from being limited to the French capital. The Institut Régional du Cancer in Montpellier, the Institut Paoli-Calmettes in Marseille and the Oncopole in Toulouse, are also key players.
“French researchers are perceived abroad as highly rigorous, innovative and very active, particularly in clinical research, participating in numerous international clinical trials. We are good recruiters and provide high-quality work, which explains why France is one of the leading countries in the world for breast cancer research,” Professor Florence Dalenc, oncologist and co-director of the senology committee at the IUCT-Oncopole in Toulouse.
“Barely 10 years after its creation, Toulouse’s Oncopole is playing in the big league“, says Professor Florence Dalenc with some satisfaction. 2800 patients are treated here every year. More than a dozen open clinical trials are underway as well.
One study focuses on the mechanisms of resistance to breast cancer treatments, in particular to PARP inhibitors, drugs commonly used to treat women with genetically predisposed breast cancer. Another study beginning soon will be aimed at confirming the tumor’s origin and clarifying the role of circulating tumor cells expressing both epithelial cell and macrophage markers (cells involved in the immune system). This will help researchers better understand the mechanisms involved in the metastatic process.
“Artificial intelligence should ultimately help us to diagnose breast cancers pathologically, to better refine the prognosis of each one and enable us to personalize treatments,” explains Prof Dalenc.
On October 11 and 13, the Oncopole organized two days devoted to life after cancer and metastatic cancer, as part of the Pink October campaign. Season 3 of their web series Le Chemin d’Emilie, about a young woman rebuilding her life after cancer, has just been announced. Raising awareness of breast cancer also means destigmatizing the disease. And here too, France is demonstrating its expertise, with a touch of creativity.