Breast Cancer Treatment in Israel

Breast cancer is the most common oncological disease among women, but with timely diagnosis and appropriately selected therapy, it is one of the most treatable forms of cancer. At the Sourasky (Ichilov) Medical Center in Tel Aviv, treatment is structured according to international protocols from NCCN and ESMO, with mandatory determination of the molecular subtype of the tumor — this directly influences the choice of surgery, chemotherapy, targeted therapies, and immunotherapy.

A multidisciplinary tumor board at Ichilov meets weekly and includes a surgical mammologist, oncologist, radiation therapist, pathologist, radiologist, and plastic surgeon. This approach allows for a personalized treatment plan to be offered to the patient within the first 3–5 days after admission.

Breast Cancer Diagnosis at Ichilov

Diagnosis at the Sourasky (Ichilov) Clinic is based on the principle of a “one-stop clinic”: within 3–4 working days, the patient undergoes a full range of examinations and receives a ready treatment plan.

Imaging

• Digital mammography with tomosynthesis (3D) — the basic screening method; tomosynthesis increases the detection of invasive tumors by 27–40% compared to conventional 2D mammography.
• Ultrasound of the breasts and axillary lymph nodes — mandatory for women with dense glandular tissue and young patients; used for guidance during biopsy.
• Breast MRI with contrast — prescribed when multifocality is suspected, for BRCA1/2 carriers, with silicone implants, and to assess response to neoadjuvant chemotherapy.
• PET-CT — for staging in locally advanced and metastatic cancer.

Biopsy and Pathomorphology

• Core biopsy (trucut biopsy) under ultrasound or stereotactic control — the “gold standard”.
• Vacuum-assisted biopsy (Mammotome) — for microcalcifications.
• Sentinel lymph node biopsy (SLNB) with isotopic marking — instead of total axillary lymphadenectomy for most patients.

Immunohistochemistry (IHC) and Molecular Typing

The IHC panel determines the treatment strategy. At Ichilov, the following are evaluated:

• ER (estrogen receptors) and PR (progesterone receptors) — hormonal sensitivity.
• HER2/neu — receptor overexpression; if the IHC result is ambiguous (2+), FISH is performed.
• Ki-67 — proliferation index, differentiates luminal A (≤14%) and luminal B (>14%) subtypes.

Genetic Testing

In cases of family history, cancer before age 45, or triple-negative subtype, sequencing of BRCA1, BRCA2, PALB2, TP53, CHEK2, ATM is performed. BRCA1/2 carrier status alters the scope of surgery (prophylactic contralateral mastectomy), allows for the prescription of PARP inhibitors (olaparib, talazoparib), and recommends salpingo-oophorectomy.

Additionally, multigene prognostic tests Oncotype DX (21 genes) and MammaPrint (70 genes) are used — they help determine the need for adjuvant chemotherapy in hormone-positive HER2-negative early-stage cancer.

Treatment Methods by Molecular Subtypes

Hormone-positive (Luminal A and B) — 60–70% of cases

• Surgery: in 70–80% of cases, breast-conserving surgery (BCS) is possible, followed by mandatory radiation therapy.
• Hormonal therapy for 5–10 years: tamoxifen (in premenopausal women), aromatase inhibitors — letrozole, anastrozole, exemestane (in postmenopausal women); in high-risk cases — ovarian suppression with GnRH analogs (goserelin).
• CDK4/6 inhibitors: palbociclib (Ibrance), ribociclib (Kisqali), abemaciclib (Verzenio) — standard for metastatic ER+/HER2- and high-risk early cancer.
• Chemotherapy is added for luminal B with high Ki-67 or unfavorable Oncotype DX.

HER2-positive — 15–20% of cases

• Neoadjuvant regimen TCHP: docetaxel + carboplatin + trastuzumab (Herceptin) + pertuzumab (Perjeta) — dual HER2 blockade achieves a complete pathological response (pCR) in 60–70%.
• After surgery — adjuvant trastuzumab for up to a year; in case of residual tumor — T-DM1 (Kadcyla) for 14 cycles.
• In metastatic or refractory cases — trastuzumab deruxtecan (T-DXd, Enhertu) — a next-generation antibody-drug conjugate showing twice the progression-free survival compared to T-DM1.
• Additionally: tucatinib (effective for CNS metastases), lapatinib, neratinib.

Triple-negative breast cancer (TNBC) — 10–15% of cases

• Chemotherapy is the mainstay of treatment: anthracyclines (doxorubicin, epirubicin) + taxanes (paclitaxel, docetaxel), AC-T, dose-dense regimens.
• Immunotherapy: pembrolizumab (Keytruda) in combination with chemotherapy in neoadjuvant and adjuvant settings — standard for early-stage TNBC (protocol KEYNOTE-522). In metastatic TNBC with PD-L1 CPS ≥10 — pembrolizumab + nab-paclitaxel.
• PARP inhibitors (olaparib, talazoparib) — for BRCA mutations.
• Sacituzumab govitecan (Trodelvy) — conjugate against Trop-2 for metastatic TNBC in the second line.

Surgery and Reconstruction

• Lumpectomy / quadrantectomy with oncoplastic reconstruction.
• Mastectomy with skin-sparing and nipple-sparing — for small tumors without skin involvement.
• Immediate reconstruction — with implants (two-stage via expander) or autologous tissues (DIEP flap, TRAM, latissimus dorsi muscle).
• Intraoperative radiation therapy (IORT) for select patients.

Radiation Therapy

Administered on Varian TrueBeam and Elekta Versa HD linear accelerators. Techniques used include IMRT, VMAT, hypofractionation (15–16 sessions instead of 25), and protocol DIBH (breath-hold during inhalation) to protect the heart in left-sided localization.

Prices for Breast Cancer Treatment at Ichilov

Estimated costs (valid for 2026, final estimate provided after consultation):

• Consultation with a surgical oncologist — from 600 USD
• Full diagnostic package (3D mammography + ultrasound + MRI + biopsy + IHC + Ki-67) — 4,500–6,500 USD
• BRCA testing — 1,200–1,800 USD
• Oncotype DX — 3,800–4,200 USD
• Lumpectomy with SLNB — 15,000–19,000 USD
• Mastectomy with immediate implant reconstruction — 22,000–30,000 USD
• DIEP reconstruction — 35,000–45,000 USD
• Chemotherapy cycle (AC, TC) — from 2,400 USD
• Trastuzumab/pertuzumab (per cycle) — 4,500–7,500 USD
• Course of radiation therapy (hypofractionation) — 9,000–13,000 USD
• T-DXd (Enhertu), per cycle — from 10,500 USD

Leading Mammologists-Oncologists at Sourasky (Ichilov) Clinic

• Prof. Tamar Safra — head of the gynecologic oncology and breast cancer department, specialist in targeted therapy for BRCA-associated tumors.
• Prof. Moshe Papa — leading surgical mammologist, one of the pioneers of oncoplastic surgery in Israel, author of over 150 scientific publications.
• Dr. Itzhak Pepper — surgical mammologist, specialist in nipple-sparing mastectomy and sentinel lymph node biopsy.
• Prof. Meirav Ben-David — radiation therapist, expert in hypofractionation and IORT.
• Dr. Irina Stefanski — plastic surgeon, DIEP and TRAM reconstruction.
• Prof. Dan Greenberg — oncologist, conducts clinical research on CDK4/6 and immunotherapy for TNBC.

FAQ — Frequently Asked Questions

1. How long does diagnosis take at Ichilov?
The full range from the first consultation to the ready treatment protocol usually takes 4–5 working days. IHC results are ready in 3–5 days, FISH in 5–7 days, and Oncotype DX takes up to 10 days.

2. Is it possible to preserve the breast at stages 2–3?
Yes, in many cases. If the tumor is initially large, neoadjuvant therapy (chemo + targeted) is performed, which reduces the tumor by 2–4 times, followed by breast-conserving surgery with oncoplasty. In patients with HER2+ and TNBC, a complete response is achieved in 50–70% of cases.

3. Is chemotherapy mandatory for hormone-positive early-stage cancer?
No, not always. The decision is based on the Oncotype DX test: for a Recurrence Score ≤25 in postmenopausal patients, chemotherapy does not provide additional benefit; hormonal therapy is sufficient.

4. What is the benefit of dual HER2 blockade with trastuzumab and pertuzumab?
The combination of “Herceptin + Perjeta” with chemotherapy increases the rate of complete pathological response from 30% to 60–70%, which directly correlates with long-term survival. This is the standard neoadjuvant treatment for HER2+ cancer at Ichilov.

5. How is the trip organized for foreign patients to Tel Aviv?
The international department of the Sourasky (Ichilov) Clinic provides airport pickup at Ben Gurion, a Russian-speaking coordinator, translation of all documents, selection of a hotel near the clinic (5–10 minutes walk), accompaniment to appointments, and preparation of a complete discharge summary with recommendations in Russian.

The Sourasky (Ichilov) Medical Center is the largest public hospital in Israel, located in the center of Tel Aviv. The breast cancer treatment department sees over 2,000 new patients annually and participates in over 40 international clinical trials.