Breast Cancer: From Prevention to Treatment

Breast cancer is not a single disease, and there is no one treatment pathway that is right for every patient. The biological characteristics of the tumour, age, overall health, lifestyle and quality of life are among the factors that help shape an increasingly personalised treatment strategy.

We discussed this with Dr Veronica Prati, Head of the Breast Oncology Unit at ASL CN2, who specialises in breast and urological cancers.

Breast cancer: a personalised approach

“Not all breast cancers are the same.” This is Dr Prati’s starting point for explaining how the approach to the disease has changed.

Broadly speaking, breast cancers fall into three main groups: luminal tumours, which express hormone receptors; HER2-positive tumours, characterised by HER2 overexpression or gene amplification; and triple-negative tumours, which test negative for both hormone receptors and HER2. These biological differences guide the choice of very different treatments.

Understanding the tumour, however, is only part of the picture. “We must always consider the different factors relating to both the disease and the patient together,” the oncologist emphasises. Age, coexisting medical conditions, the ability to follow treatment plans and to recognise potential side effects all contribute to treatment decisions.

Personalisation also means listening. Patients have different needs in their daily lives, and preserving their quality of life, as far as possible, becomes an integral part of treatment planning. “We need to listen to our patients to understand which aspects of their everyday lives matter to them and should, wherever possible, be preserved,” Prati explains.

Treatment before surgery: the neoadjuvant approach

In some cases, breast cancer treatment begins before surgery. This is known as neoadjuvant therapy, an approach that takes into account both the extent of the disease and its biological characteristics.

“The purpose of neoadjuvant therapy is not simply to improve the surgical approach,” Prati explains. Particularly in triple-negative and HER2-positive breast cancers, the response to treatment before surgery also provides valuable information to guide subsequent treatment.

In the past, one of the main objectives was to shrink the tumour to make breast-conserving surgery possible. Today, preoperative treatment has a broader role.

One aim may be to reach surgery with no residual tumour detected on pathological examination, achieving what is known as a pathological complete response. As the oncologist explains, scientific evidence shows an association between this outcome and the patient’s prognosis.

Treating breast cancer involves more than surgery

One of the messages Prati stresses most strongly is the need to move beyond the idea that surgery alone constitutes the entire treatment.

“Breast cancer treatment does not end with surgery,” she emphasises. Care is multidisciplinary and may combine surgery, medical treatments and, when needed, radiotherapy.

The shift towards increasingly conservative surgery has gone hand in hand with the development and integration of other treatment options. The care pathway is therefore tailored to each patient, with the aim of controlling the disease while taking the other aspects of her life into account.

Prevention and early detection

Preventing cancer and detecting it early are not the same thing. Primary prevention addresses modifiable risk factors, while secondary prevention aims to identify an existing disease at the earliest possible stage.

For primary prevention, Dr Prati highlights the importance of lifestyle: avoiding smoking, eating a balanced diet, limiting alcohol consumption and being physically active. In her view, awareness should begin early.

“Education about these lifestyle habits should start at school age,” she observes.

Screening has a different role: it helps detect existing lesions early, allowing diagnostic assessment and treatment to begin promptly. “Detecting them early allows us to initiate the entire diagnostic and treatment pathway sooner,” Prati explains.

Balancing cancer control and breast preservation

Effectively treating the disease remains the priority, but modern medicine also considers the impact that treatment can have on a woman’s body and psychological wellbeing.

According to Prati, finding the right balance once again depends on personalisation and multidisciplinary care.

“Multidisciplinary care is now fundamental—not only in breast cancer—to personalising treatment and finding the right balance between effective cancer treatment and preserving the patient’s quality of life,” she explains.

In breast cancer, appearance is another consideration, and the oncologist cautions against dismissing it as superficial. The breast is closely connected to body image and a sense of femininity, and changes to it can add to the psychological impact of the diagnosis.

For this reason, when it is oncologically appropriate, preserving the appearance of the breast can help women adjust to changes in their bodies. Psychological support can also play an important role within multidisciplinary care, particularly because distress and fear are not always immediately apparent during consultations.

Challenging common myths

Despite medical advances, some misconceptions continue to undermine prevention. One of the most concerning, according to Prati, relates to screening.

“I have even heard people say that screening is unnecessary, which means we are not getting the message across about how important it is,” she says.

A similar problem is the tendency to underestimate the role of lifestyle, particularly among younger people. Smoking, alcohol consumption, diet and physical inactivity are sometimes seen as unrelated to cancer prevention.

Prati places particular emphasis on physical activity, which she believes should play an increasingly prominent role in cancer care: “Physical activity should be part of our prescriptions, alongside medication.”

To raise public awareness of these issues, the regional branch of AIOM and LILT signed an agreement in July 2026, as Prati reports, to promote initiatives across Piedmont highlighting the importance of exercise and healthy lifestyles.

The challenge of breast cancer extends beyond developing increasingly advanced drugs and surgical techniques. At the close of the interview, Dr Prati emphasises that prevention “also depends on our ability to inform, prevent and listen. Truly personalised medicine considers not only the biological characteristics of the tumour, but also the person who will go through the entire course of treatment.”