Breast cancer treatment in Israel

Effective treatment of breast cancer (BC) remains a high-priority task for Israeli healthcare. The country ranks 26th in the world in incidence. This is due to the genetic predisposition of the Israeli population to this type of cancer.

Currently, Israeli oncology has achieved impressive results in the treatment of breast cancer. According to The Israel Cancer Association, 90% of patients with stage I and II recover. The 5-year survival rate for cancer III is about 70%. In women with stage IV, oncologists achieve long-term remissions with a satisfactory quality of life.

The goal of Israeli oncologists is not only to cure a woman of cancer in the shortest possible time and with minimal damage to health, but also to preserve her breasts and a good quality of life during and after treatment. Numerous reviews about the treatment of RZhM cancer in Israel confirm that this is how this disease is treated in Israeli clinics.

Therefore, one of the most popular destinations for foreign patients is the treatment of breast cancer in Israel. They come to be treated at oncology centers, which are available in all major Israeli clinics, such as, for example, Rambam Medical Center.

Treatment of breast cancer in Israel begins with accurate high-tech diagnostics. It includes imaging and biopsy of the tumor and laboratory examination of malignant cells to determine molecular genetic characteristics.

Tumor Imaging

Israeli doctors visualize a suspicious formation in the mammary gland using three types of studies:

• mammography;
• ultrasound;
• MRI.

Mammography is a specialized CT scan of the breasts that shows the tumor long before it can be detected by a doctor’s examination and self-examination. Especially if this type of tomography is carried out in the digital tomosynthesis mode (3D mammography).

The identified neoplasm may also be benign. Therefore, an ultrasound of the mammary gland is performed, which shows the internal structure: a cyst with fluid, a dense tumor, or a combination of both. MRI of the mammary glands visualizes various tissues in even more detail and reveals small pathological foci that are not visible on mammography.

Tumor Biopsy

When a tumor formation in the breast is detected, Israeli oncologists perform the main diagnostic procedure – a biopsy (taking a microfragment of tissues from the tumor). Only this study makes it possible to exclude or confirm the diagnosis of cancer.

In Israel, oncologists perform:

• puncture biopsy (fine-needle aspiration) if the neoplasm looks like a cyst and is not deep;
• TRU-CUT core biopsy if the tumor is firm and deep.

In Israeli oncology centers, this procedure is safe and always highly informative, as it is performed by qualified specialists using digital mammography with tomosynthesis, ultrasound, or MRI navigation.

Cancer cell research and disease staging

In Israeli clinics, several laboratory studies of tumor cells obtained by biopsy are carried out:

• histological – determination of the type of cancer cells (adenocarcinoma, squamous cell carcinoma) and the degree of their malignancy and invasiveness (invasive or non-invasive cancer);
• immunohistochemical – detection of HER2 protein receptors in cells and hormone receptors: estrogen – ER, progesterone – PR;
• genetic (detection of mutations in the BRCA1 and BRCA2 genes) with a family history of breast cancer.

After histological confirmation of the diagnosis, the doctor prescribes an additional examination to clarify the stage of cancer and determine the general condition of the patient before starting treatment. To detect regional and distant metastases, CT, MRI, PET-CT, or PET-MRI, osteoscintigraphy can be performed.

This diagnostics of breast cancer in Israel is mandatory and takes only 2-3 days.

After clarifying the diagnosis, which reflects the type and stage of cancer, hormonal, HER2, BRCA1 / BRCA2 tumor status, a multidisciplinary team of oncologists (surgeon, internist, radiologist) develops a treatment plan. They also take into account a number of molecular genetic features of cells and the latest recommendations for the treatment of BC from international specialized communities.

A positive attitude of patients during treatment is provided by an oncopsychologist. Patients with hereditary cancer are consulted by a geneticist. Fertility specialists help young women maintain their ability to have children after they recover from cancer.

Treatment of BC in Israel most often includes all three basic methods – surgery, radiotherapy, systemic (drug) therapy, which includes chemotherapy, hormone therapy, and targeted therapy.

Surgery of the breast with preservation/restoration of the breast in Israel

The main treatment for breast cancer is surgery. In stage I, some cancers are cured with a successful operation. Israeli breast surgeons perform two types of interventions:

• lumpectomy – removal of the tumor within healthy tissue while preserving the breast;
• mastectomy – removal of the mammary gland while preserving the skin and nipple, which involves the restoration of the breast with the help of an artificial implant or/and one’s own fat and muscle tissue.

Radical mastectomy is performed extremely rarely, and only in a modified version that is gentle on the patient’s body.

Also, surgeons always strive to minimize the amount of surgery during a mastectomy and not remove the axillary lymph nodes, as this often leads to lymphedema (chronic swelling of the limb). Therefore, before or during surgery, the doctor performs a biopsy of the sentinel (closest to the tumor) lymph node. If it is “clean”, without cancer cells, then the axillary lymph nodes are preserved.

If a mastectomy is scheduled for the patient, then she should consult a plastic surgeon to assess the possibility of one-stage breast reconstruction. Israeli surgeons can perform breast reconstruction not only during the operation but also later as a separate procedure. The timing of the operation depends both on the preferences of the patient and on the need and timing of radiotherapy and systemic therapy. In the vast majority of cases, after surgery, patients are prescribed radiotherapy.

The main treatment for breast cancer is surgery. In stage I, some cancers are cured with a successful operation. Israeli breast surgeons perform two types of interventions:

• lumpectomy – removal of the tumor within healthy tissue while preserving the breast;
• mastectomy – removal of the mammary gland while preserving the skin and nipple, which involves the restoration of the breast with the help of an artificial implant or/and one’s own fat and muscle tissue.

Radical mastectomy is performed extremely rarely, and only in a modified version that is gentle on the patient’s body.

Also, surgeons always strive to minimize the amount of surgery during a mastectomy and not remove the axillary lymph nodes, as this often leads to lymphedema (chronic swelling of the limb). Therefore, before or during surgery, the doctor performs a biopsy of the sentinel (closest to the tumor) lymph node. If it is “clean”, without cancer cells, then the axillary lymph nodes are preserved.

If a mastectomy is scheduled for the patient, then she should consult a plastic surgeon to assess the possibility of one-stage breast reconstruction. Israeli surgeons can perform breast reconstruction not only during the operation but also later as a separate procedure. The timing of the operation depends both on the preferences of the patient and on the need and timing of radiotherapy and systemic therapy. In the vast majority of cases, after surgery, patients are prescribed radiotherapy.

In Israeli clinics, three types of radiation therapy are performed:

• remote radiation therapy is a course of daily irradiation with small doses;
• brachytherapy is the irradiation of breast tissue by placing radioactive substances in it for several days;
• intraoperative radiation therapy is a single irradiation of the tumor bed after its removal in the operating room.

The use of the latest generation of linear accelerators and advanced radiation technologies shortens the period of radiotherapy and minimizes complications.

Modern systemic (drug) antitumor therapy for breast cancer with intravenous administration of drugs destroys cancer cells throughout the body. Depending on the stage of cancer, this therapy ensures complete recovery, prevents the development of cancer recurrence, and prolongs life. In Israel, 4 types of systemic therapy for breast cancer are used:

• Chemotherapy

Chemotherapy in the treatment of BC in Israel can complement surgery and radiotherapy, and be the main method of treatment for inoperable cancer, relapse and triple-negative breast cancer (there are no HER2, ER, PR receptors in the tumor cells). In Israel, chemotherapy regimens are used, including the latest generation of drugs.

• Hormone therapy

Hormonal or endocrine therapy is prescribed for hormone-sensitive (ER, PR positive) tumors. The drugs block the body’s ability to produce hormones or interfere with hormones’ effect on breast cancer cells. This stops the growth of the tumor.

• Targeted therapy

Targeted drugs destroy various molecular genetic mechanisms and proteins that stimulate tumor growth. For example, they block HER-2 protein receptors in malignant cells in HER2-positive cancer. That is, they affect only cancer cells, not affecting healthy ones.

• Immunotherapy

This is a special type of targeted therapy that restores the body’s immune defense against cancer. For example, drugs that stimulate T-lymphocytes are used, which destroy cancer cells.

The protocol of systemic therapy after surgery is adjusted by the oncologist taking into account the results of a surgical biopsy – a comprehensive analysis of tumor cells removed during surgery. In the arsenal of Israeli oncologists, there are several dozen chemotherapy drugs, hormonal, targeted, including immune drugs. Patients with relapses who have not been helped by therapies according to the appropriate protocols can be treated with the latest drugs in clinical trials.

Treatment of breast cancer at the level of the best world standards is carried out in cancer centers in the USA, Germany, Finland, South Korea, and Turkey, as well as in Israeli clinics. With many comparable survival rates for patients with different stages of cancer, the treatment of BC in Israel has a number of advantages.

Treatment of breast cancer in Israel is carried out in large medical centers, such as Sheba Medical Center. It includes a cancer research institute, including genetic laboratories. There is also a service for the selection of drugs in accordance with the molecular genetic characteristics of malignant tumor cells.

All this enables Israeli oncologists to apply the principles of personalized oncology, which increases the effectiveness of therapy and improves the outcome of the disease. At the same time, the cost of breast cancer treatment in Israel is significantly lower than in medical institutions of a similar level – in the United States and in Europe.

In Israel, personalized breast cancer treatment protocols are used. This means that when prescribing treatment, oncologists take into account not only the size of the primary tumor, the type and stage of cancer, the age and general condition of patients, but also the unique genetic profile of each specific tumor. In specialized laboratories, the genome (genes and DNA) in malignant cells is examined and targeted drugs are selected in accordance with the detected gene mutations that led to the development of cancer.

Innovative predictive molecular genomic tests to determine the likelihood of cancer recurrence and predict response to treatment are also used in Israel. For example, Oncotype DX Breast, Prosigna, SYMPHONY, MammaPrint. This makes it possible for patients with certain types of tumors, such as ER- and PR-positive cancers, not to undergo chemotherapy. Oncologists achieve recovery or long-term remission with the help of hormonal and targeted therapy.

Every year, new targeted and immune drugs with proven efficacy and a high safety profile developed in the USA appear in Israeli cancer centers. They are able to provide a relapse-free course of cancer for many years. Therefore, in Israel, individually tailored treatment protocols are used, which are available only in such well-known medical institutions as the Anderson Cancer Center in the USA. Despite the fact that the cost of breast cancer treatment in Israel is significantly lower than in American clinics.

In the conditions of Israeli clinics, patients with metastatic cancer, as well as patients with earlier stages of cancer, receive intensive treatment. Oncologists use high-tech methods of therapy and innovative drugs. Many of them are developed in Israel, so they are quickly introduced into clinical practice. To remove distant cancer metastases, the oncology team uses:

• radiosurgery;
• cryo- and ultrasonic ablation;
• embolization of tumor vessels with chemotherapy;
• irradiation of an inoperable tumor with the help of radioactive isotopes, which are introduced by a catheter into the blood vessels that feed it;
• hyperthermic intraperitoneal chemotherapy (HIPEC).

This treatment requires appropriate equipment and qualified professionals.

The main treatment for stage IV BC is personalized combined targeted therapy and chemotherapy, which doctors perform even in elderly and debilitated patients. As a result, the 5-year survival rates of patients with stage IV in Israel are much better than in many clinics in Europe.

The high overall level of breast cancer treatment in Israel allows a sufficiently large number of patients to choose the option of surgery and radiation therapy within the framework of a personalized treatment protocol.

In patients with certain types of cancer who are indicated for mastectomy but wish to retain their breasts, oncologists, with a favorable prognosis, may initially administer chemoradiation and/or hormonal therapy to shrink the tumor. After that, the surgeon performs an organ-preserving operation.

In some patients who are unwilling or unable for any reason to undergo conventional radiotherapy, after a thorough assessment of all risks, intraoperative radiotherapy or brachytherapy may be performed. The chemotherapist adjusts systemic therapy to ensure recovery in this case.

If the condition and type of cancer allows, in some patients, chemotherapy can be intensified and carried out in a shorter time.

This approach is especially often practiced in private clinics, for example, in Herzia Medical Center and Assuta, where they also have the opportunity to choose a surgeon.

Patients also like the lack of queues for doctors and procedures, professional care, spacious comfortable rooms, and VIP service.

Former patients of most Israeli both public and private clinics warmly recall the treatment of breast cancer in Israel. Reviews often begin with gratitude to the doctors, all the medical staff, and the coordinator-interpreter for their sensitive and sincere attitude. Patients also note that the treatment of BC in Israel is a chance for recovery.

Personalized treatment of breast cancer in Israel at the level of the best world standards, taking into account the individual needs of patients, does not imply the highest cost in the world, which is another advantage.

The cost of breast cancer treatment in Israel is 50% lower than in the US, but the same as in Turkey. Obviously, the Israeli price of therapy for this cancer is “average for a hospital”. Breast cancer treatment in Israel, taking into account the level of Israeli oncology, has an excellent cost/result ratio of treatment.

Judging by the reviews about the treatment of BC in Israel, it is obvious that the above-described benefits are received by patients of all cancer centers in this country, where there are both modern technologies and world-class specialists. However, the cost of certain types of diagnostics and treatment in public and private clinics, and, accordingly, the final price of therapy may vary.

Therefore, for foreign patients who would like to undergo breast cancer treatment in Israel, the most relevant issue is the choice of a clinic and specialists.

In such a vital issue as the treatment of breast cancer in Israel, it is advisable to take the help of professionals who have relevant experience and knowledge. These include expert medical coordinators who will provide comprehensive assistance free of charge – from the initial consultation on treatment in various medical centers to the organization of breast cancer treatment in Israel.