Professor Maria Luisa Gasparri is very active as a gynaecologist and breast surgeon. She is responsible for the Breast Cancer Research Board within the Senology Centre of Southern Switzerland, which, over the last few years, has evolved and introduced many changes to further improve the quality of the services offered to its patients. Although the number of cases of breast cancer is increasing, "the decline in breast cancer mortality observed in recent years demonstrates the progress made in combating this disease. This achievement can be attributed to the expansion of screening programs and ongoing innovations in therapies. However, these advancements are not equally accessible worldwide, leading to varying mortality rates among different nations. Unfortunately, the data remains unsatisfactory in developing countries," explained Professor Gasparri, reminding us that recovery rates also depend on the treatment centre you rely on.
According to epidemiological data from the European Union, by the end of 2025, breast cancer mortality rates are expected to decrease across all’age groups except for patients over the age of eighty. For this older demographic, a 7% increase in mortality rates is anticipated compared to the figures recorded between 2015 and 2019. "There could be many reasons for this increase," Professor Gasparri commented, "on the one hand, the increase in the average lifespan; on the other hand, the fact that, unfortunately, screening campaigns are aimed at the population only within a certain age group (in our Canton up to 69 years); moreover, in some cases, there is no possibility of maximising treatment in older patients due to comorbidity or frailty."
Reflecting on the recent evolution of the Senology Centre of Southern Switzerland (CSSI), the USI professor acknowledges the significant progress achieved: "We have made great strides in the field of research, inspired by the now consolidated notion, derived from numerous clinical studies, that better care is provided in centres where research is carried out. At the end of 2023, we established a multidisciplinary scientific research committee at our Centre, which I coordinate. This committee enables patients to access cutting-edge treatments and therapies typically available only at research excellence centres." As Professor Gasparri explained, this approach allows patients, following evaluation and approval by a committee of experts, to access experimental treatments that the general public is likely to receive in the coming months or years.
But how exactly does research work at the Senology Centre? To help listeners understand the work carried out, Professor Gasparri gave a concrete example: "When a researcher or group of researchers, based on the results currently available, believe that a specific surgical technique may be more beneficial for some patients than others, they develop a rigorous scientific protocol. This protocol must be reviewed and approved by relevant committees, such as the Ethics Committee. Once all necessary criteria are met, patients who qualify for the study can access this experimental treatment. Patients are provided with detailed information about the limitations and potential benefits of both conventional and experimental treatments, allowing them to make an informed decision about whether to participate."
The involvement in or promotion of research studies reflects quality for a centre, as explained by the USI professor: "A centre that conducts regular research activities must meet essential requirements, including specialised, qualified, and up-to-date medical personnel. Additionally, the infrastructures and treatment processes should regularly be subjected to internal and external quality checks."
Speaking of innovative treatments, Professor Gasparri mentioned the results she presented at one of the most important world congresses on senology (the Saint Gallen Breast Cancer Conference) regarding a new method of marking with radar. This technique can replace the metal wire commonly used in cases where it is necessary to locate a non-palpable breast tumour or a lymph node, offering technical advantages and less discomfort for patients. The data comes from a recent study she published with a group of researchers from EUBREAST, in which patients treated at the CSSI also participated. The CSSI is currently the only Centre in Ticino to offer this technique, and it is present in only a few other Swiss centres.
The scientific community is diligently working not only on treatment options but also on primary and secondary prevention strategies. Currently, research shows that following several key guidelines-such as engaging in regular physical activity, maintaining a healthy diet, minimising exposure to ionising radiation, and avoiding long-term hormone replacement therapy-can reduce the risk of developing breast cancer by more than 50%.
Professor Gasparri and her team are committed to searching for new disease markers, such as immune and inflammatory markers, and to evaluating how modifiable factors, such as diet, can influence them. "For example, we are working in collaboration with the tumour immunotherapy laboratory at the Institute o f Oncology Research (IOR) in Bellinzona to understand how the microbiota, that is, the collection of all the microorganisms such as bacteria, fungi, protozoa, that live with our body without damaging it, has an impact on the onset and/or prognosis of breast cancer. Each individual has a unique microbiota, which serves as a distinct biological imprint that differentiates us from one another. This microbiota, significantly influenced by our diet, acts as a vital barrier against harmful agents. It continuously stimulates and updates the immune response, allowing the body to tolerate the presence of various microorganisms by recognising them as allies. 70% of immune cells are found in the intestinal microbiota. Recent research indicates that the immune system plays a crucial role in the development of tumours. Therefore, exploring the relationship between microbiota and the immune system to identify new risk factors and early markers is vitally important. We are already aware of certain dietary guidelines, such as the recommendation to avoid animal fats due to their association with tumour development and to prioritise the consumption of vegetables. However, the emerging information about microbiota adds another layer to our understanding-it reveals how diet influences the unique microbiome profile of each individual and, indirectly, how this affects the immune system."
There are still many false myths about breast cancer circulating, unfortunately, including those propagated by the internet. Professor Gasparri has tried to clarify the situation: "If you type some keywords related to mammography on the internet, the most curious things come up; some sites even demonise it. A false myth concerns breast implants, for example, which many believe are a contraindication to mammography or that they can even cause breast cancer. What is true is that a standard mammogram may not allow for an adequate examination in patients who have undergone breast augmentation. Therefore, it is advisable to perform this examination with some radiological precautions and possibly associate it with additional examinations, such as resonance or breast ultrasound. As for the increased risk of developing breast cancer in the presence of implants, this is false. The case is different for a haematological tumour, called anaplastic large cell lymphoma, which develops in patients with breast implants. Still, it is a very rare disease and, if promptly diagnosed, has an excellent prognosis. However, due to the rarity of the disease and the lack of information about it, a lot of misinformation has spread."
Another topic that is frequently surrounded by misinformation is the relationship between the contraceptive pill and the risk of breast cancer. While this correlation is not entirely unfounded, it requires careful interpretation to be effectively applied in clinical practice, as noted by Professor Gasparri: "The use of combined hormonal contraceptives, which contain both estrogen and progestogen, is theoretically associated with a slightly increased risk of breast cancer, but only to a very limited extent. Specifically, this risk translates to an additional eight cases per 100,000 young women. While the risk is higher for women over 35, this group rarely uses estrogen-progestogen therapy as contraception. The correlation must therefore be evaluated on a case-by-case basis: in the presence of a low baseline risk, the absolute increase is small, therefore negligible, and must be counterbalanced with the associated benefits."
The full interview with Professor Maria Luisa Gasparri on "La consulenza" (Rete Uno - RSI) is available at the following.
