Dr. Alberto Costa has seen major advances in 40 years as a breast-cancer surgeon but believes the work of ensuring all women get top-notch treatment is unfinished.
With 40 years of experience to draw on, what does Dr. Costa see as the next great innovation for BC and MBC patients? Without question, he says, the European Parliament’s recommendation that all European Union member states put so-called breast units in place. "The revolution for the future is that there will no longer be a ‘breast-cancer doctor,’ singular," says Dr. Costa, but rather a team of specialists – from surgeons to oncologists to radiologists to pathologists – to treat the disease holistically: "It’s only by putting together all the expertise and knowledge of the different disciplines that we can give the patient the best options."
Alberto Costa was working as a young orthopedic resident in 1976 when his medical-school rotation schedule called for him to do a turn in a cancer unit called the Instituto Nazionale dei Tumori in Milan. There, breast-cancer specialists were working on a revolutionary procedure, aiming to prove that removing the cancerous portion of the breast was as safe and effective as a complete mastectomy. "It was a turning point in the history of breast-cancer surgery," recalls Dr. Costa, "because it was the end of the dogma that the more you cut, the more you cure. And I had the pure luck, as a very young doctor, to be assigned to the trial. It was a great opportunity that life gave me."
Over the course of his career, Dr. Costa – now CEO of the European School of Oncology in Milan, a breast-cancer surgeon in Lugano, Switzerland, and co-chair of the International Consensus Conference for Advanced Breast Cancer – has witnessed many revolutions in breast-cancer treatment. One of the most important: The recognition, aided by the completion of the Human Genome Project in 2003, that "breast cancer" is an umbrella term for multiple diseases, each requiring tailored treatment. A slow-growing cancer with hormone receptors and no lymphatic presence, for instance, requires a radically different treatment regimen than one that proliferates quickly, doesn’t respond to hormones and has spread to the lymph nodes. "We started to understand why two breast-cancer patients who seemed to have the same disease responded differently to the same treatment," says Dr. Costa. “They both had carcinomas originating in the breast but they did not, in fact, have the same disease."
For patients with metastatic breast-cancer, a lifesaving surgical innovation has been the radically improved cooperation between cancer and reconstructive surgeons. As recently as a decade ago, says Dr. Costa, "we were diagnosing terrible tumors as inoperable, just because we didn’t know how to close the scar. It’s only by collaborating with plastic and reconstructive surgeons that we’ve learned that many things are feasible for the patient, but we just didn’t know how to do them." Apart from saving countless lives by enabling more surgery, the practical takeaway for patients with locally advanced breast cancer is clear: "Always get a second opinion," says Dr. Costa. "Just because one surgeon can’t operate does not mean the tumor is inoperable."