Breast cancer remains the most common oncological disease among women worldwide and in the CIS countries. Over the past 20 years, it has transformed from a fatal diagnosis into a potentially curable disease — provided that treatment begins in a timely manner and is based on accurate molecular diagnostics of the tumor. The Sourasky (Ichilov) Medical Center in Tel Aviv — the largest public hospital in Israel — is among the leading global centers for breast cancer treatment. Here, thousands of patients undergo diagnostics and therapy for breast tumors at all stages each year: from ductal carcinoma in situ to metastatic disease. The Ichilov program is built around a multidisciplinary team, modern surgical techniques with breast preservation and immediate reconstruction, precise radiation therapy with deep inspiration breath hold (DIBH), targeted and immunotherapy, as well as direct access to international clinical trials. Below is a detailed analysis of how Ichilov approaches the diagnosis and treatment of breast cancer, the differences between tumor subtypes, the doctors who manage patients, and what is needed to obtain an individualized treatment program.
What is this disease
Breast cancer (BC, breast cancer) is a malignant tumor that develops from the epithelium of the milk ducts or lobules. Approximately 2.3 million new cases are diagnosed worldwide each year. In the CIS countries, the peak incidence occurs between the ages of 55 and 65, although the diagnosis is increasingly being made in women under 45. Men are diagnosed with breast cancer about 100 times less frequently — but the disease usually progresses more aggressively due to late diagnosis.
Significant risk factors include: early onset of menstruation (before age 12) and late menopause, nulliparity or first childbirth after age 30, prolonged use of hormone replacement therapy, obesity in postmenopause, alcohol abuse, a family history of breast cancer, and carrying mutations in the BRCA1, BRCA2, PALB2, CHEK2, TP53, and PIK3CA genes. For BRCA1/2 carriers, the cumulative risk of breast cancer by age 70 reaches 55–70%, so these patients require monitoring under an extended protocol and discussion of risk-reducing measures.
Classic symptoms include a firm, painless lump in the breast, changes in the shape or skin of the breast (the “orange peel” symptom, retraction), discharge from the nipple (especially bloody), and enlargement of the axillary lymph nodes. In the inflammatory form (inflammatory breast cancer), the breast becomes swollen, hot, and red — and this condition requires urgent medical attention due to its aggressive course.
From a biological perspective, Ichilov identifies four key tumor subtypes, which directly influence treatment strategy: hormone-positive (luminal A/B, ER+ and/or PR+), HER2-positive (with HER2 receptor overexpression), triple-negative (TNBC — lacking ER, PR, and HER2), and inflammatory. Each subtype is sensitive to different drugs, and the molecular profile of the tumor determines the therapy regimen at the Sourasky clinic.
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Diagnostics at Ichilov Clinic
The diagnostic pathway at Ichilov is designed to take 3–5 working days and is based on a “one-stop shop” principle: the patient undergoes all necessary examinations in one center and receives an integrated conclusion from the multidisciplinary team.
Initial imaging methods include digital mammography with tomosynthesis (3D mammography) and breast ultrasound with elastography. Tomosynthesis increases the detection of small tumors in women with dense breast tissue and reduces the rate of false-positive results. In cases of ambiguous data, in young patients, and in BRCA mutation carriers, MRI of the breasts with contrast is mandatory — a method with a sensitivity of over 90% for invasive forms.
Morphological verification is a key step. Ichilov practices vacuum-assisted stereotactic biopsy (mammotome) under ultrasound or mammography guidance: this allows for sufficient tissue volume to perform comprehensive immunohistochemical analysis (IHC) and molecular diagnostics without open surgery. IHC determines ER, PR, HER2, and the proliferation index Ki-67 — four markers essential for therapy assignment. In borderline HER2 results (2+), FISH or ISH testing is performed.
Additionally, genetic testing (BRCA1/2, PALB2, CHEK2) is conducted, and in cases of metastatic or triple-negative breast cancer, extended NGS sequencing is performed to determine PIK3CA, ESR1, PD-L1 expression, and, if necessary, HRD status. For staging, CT scans of the chest and abdomen, PET-CT with FDG (for stage III–IV, inflammatory form, and suspicion of regional or distant metastases), and bone scintigraphy are used. The complete set of studies at Ichilov typically takes about a week, and the decision from the tumor board — consisting of an oncologist, breast surgeon, radiation therapist, pathologist, and radiologist — is communicated to the patient in person, along with a translator.
Treatment Methods
Treatment of breast cancer at the Sourasky clinic is always comprehensive. The standard is a combination of local methods (surgery and radiation therapy) with systemic therapy (chemotherapy, hormone therapy, targeted therapy, and immunotherapy). The specific sequence depends on the stage and biological subtype of the tumor.
Breast-conserving surgery (BCS, lumpectomy). For tumors up to 3–4 cm without multiple foci and signs of inflammatory form, a segmental resection with intraoperative margin assessment is performed. The sentinel lymph node is also removed — if it is clear, complete axillary lymph node dissection is not required, significantly reducing the risk of arm lymphedema.
Mastectomy and oncoplastic surgery. For large or multicentric tumors, inability to achieve clear margins, or at the patient's request, complete removal of the breast is performed. Ichilov surgeons widely use skin-sparing and nipple-sparing techniques, which create a foundation for aesthetic reconstruction.
Immediate reconstruction. In the breast reconstructive surgery department of Sourasky Medical Center, both implant-based reconstructions using tissue expanders and ADM matrices, as well as autologous flaps — DIEP-flap (flap on the lower epigastric artery), SIEA, PAP, and TUG flaps — are performed. DIEP is considered the “gold standard” of autologous reconstruction: the patient's own abdominal fat provides a natural appearance and preserves the abdominal wall muscles. Reconstruction is performed simultaneously with mastectomy, which is psychologically important and does not worsen the oncological prognosis.
Radiation therapy. A linear accelerator with IMRT/VMAT and the DIBH (Deep Inspiration Breath Hold) system is used — breath-holding during inhalation physically moves the heart away from the radiation fields of the left breast and significantly reduces cardiotoxicity. In favorable factors (small tumor, clear margins, age over 50, ER+), accelerated partial breast irradiation (APBI) is applied — the course is shortened from 5–6 weeks to 5 days, with comparable effectiveness.
Chemotherapy. Standard regimens include AC-T (doxorubicin, cyclophosphamide, followed by a taxane), including a dose-dense variant with G-CSF support; TCH (docetaxel, carboplatin, trastuzumab) for HER2+ cancer; neoadjuvant chemotherapy for locally advanced tumors and TNBC. In some patients with early-stage ER+ HER2- breast cancer, the decision for chemotherapy is made based on the 21-gene test Oncotype DX or Mammaprint, which helps avoid overtreatment.
Targeted therapy. For HER2+ subtype, trastuzumab and pertuzumab are used — often in combination with taxanes. For residual tumor after neoadjuvant therapy, T-DM1 (ado-trastuzumab emtansine) or the next-generation conjugate T-DXd (enhertu), which has shown impressive efficacy even in “HER2-low” tumors in DESTINY studies, is prescribed. For metastatic ER+ HER2- cancer, the baseline treatment includes CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib) in combination with an aromatase inhibitor or fulvestrant. For PIK3CA mutation, alpelisib is available, and for BRCA mutation, olaparib or talazoparib is used.
Immunotherapy. For triple-negative cancer with PD-L1 expression, pembrolizumab is used in combination with chemotherapy (KEYNOTE-522 protocol in neoadjuvant and KEYNOTE-355 in metastatic lines). Atezolizumab is also used in certain clinical scenarios. Immunotherapy is one of the areas where Ichilov actively offers patients participation in clinical trials with early access to next-generation drugs.
Hormonal therapy. For ER+ and/or PR+ tumors, long-term (5–10 years) endocrine therapy is prescribed after local treatment: tamoxifen for premenopausal patients, aromatase inhibitors (letrozole, anastrozole, exemestane) for postmenopausal patients, and ovarian suppression if necessary (goserelin, leuprolide). For metastatic disease, fulvestrant — a selective estrogen receptor downregulator — is widely used.
Clinical trials. The Sourasky oncology center participates in dozens of international phase III–IV studies. This opens up access for patients to experimental antibody-drug conjugates, new PI3K/AKT/mTOR inhibitors, HER2 vaccines, and other methods not yet registered in the CIS.
Treatment Program — Stages
The program for a patient from the CIS at Ichilov is usually structured according to the following algorithm:
Stage 1. Remote consultation and preparation. A Russian-speaking coordinator collects medical documents, translates discharge summaries, and the biopsy slides and blocks are sent to the pathology department at Sourasky for review. This is critical: up to 20% of histological conclusions from the CIS are clarified or changed after review.
Stage 2. Arrival and in-person diagnostics. Within the first 3–5 working days, the patient undergoes an examination by a leading breast oncologist, repeats imaging according to the Ichilov protocol (mammography, ultrasound, MRI), and if necessary, a repeat biopsy, PET-CT, and laboratory tests.
Stage 3. Multidisciplinary tumor board (Tumor Board). An oncologist, surgeon, radiation therapist, pathologist, radiologist, geneticist, and psycho-oncologist jointly discuss the case and formulate a personal plan. The patient receives a written conclusion with recommendations.
Stage 4. Treatment. Surgery usually requires 1–2 days of hospitalization plus 7–10 days of outpatient monitoring. Chemotherapy and targeted therapy are administered in cycles of 3 weeks, with some cycles potentially conducted at home under the online supervision of an Ichilov oncologist. Radiation therapy consists of 3–6 weeks of daily sessions.
Stage 5. Follow-up. After the active phase ends, the patient receives a follow-up schedule, prescriptions for hormone therapy, and the option for telemedicine consultations from the CIS.
Prices and Costs
The exact cost of the program can only be determined after the tumor board — it depends on the stage, subtype of the tumor, extent of surgery, and systemic therapy. Estimated ranges at Ichilov (Sourasky) in USD:
Diagnostic package (consultations, mammography, ultrasound, MRI, biopsy review, IHC, PET-CT, laboratory tests, tumor board) — typically 4,500–8,500 USD depending on the extent of studies.
Breast-conserving surgery with sentinel node biopsy — from 12,000 to 22,000 USD (including anesthesia, hospitalization, and histology of the removed material).
Mastectomy with immediate reconstruction using implants — 25,000–40,000 USD; autologous reconstruction with DIEP flap — 45,000–65,000 USD.
Chemotherapy course — from 2,500 USD per cycle for standard regimens; targeted drugs (trastuzumab, pertuzumab, T-DXd) are billed separately and can increase the cycle cost to 10,000–15,000 USD.
Radiation therapy course (full IMRT/VMAT protocol with DIBH) — 12,000–20,000 USD; APBI is shorter and cheaper — starting from 8,000 USD.
The total budget for a one-year program at stage I–II typically ranges from 45,000 to 90,000 USD, while at stage III–IV with prolonged targeted therapy — higher. The clinic accepts international insurance policies; some studies under clinical protocols may be funded by research foundations.
Leading Doctors in the Field
The breast cancer treatment program at Ichilov is led by a team of specialists, each of whom has been dedicated to breast cancer for decades. Here are a few key doctors in the field — their full profiles are available on the oncology department's page.
Professor Moshe Papa — one of the most renowned breast surgeons in Israel. He leads the national program that unites breast surgery specialists in Israel. He develops and implements new breast-conserving and oncoplastic techniques, consulting patients from dozens of countries.
Dr. Yoav Barnea — head of the breast surgery department at Sourasky Medical Center (Tel Aviv). One of Israel's leading specialists in all types of breast surgeries — oncological, aesthetic, and reconstructive. A particular focus is on reconstruction after mastectomy, including autologous flaps and nipple-sparing techniques.
Professor Moshe Inbar — an authoritative oncologist with many years of experience; specializes in combined therapy for breast cancer using modern chemotherapy and targeted therapy regimens, as well as radiation treatment. He is the author of numerous scientific papers.
Professor Ilan Ron — a medical oncologist with over 20 years of experience in treating malignant tumors of the breast and gastrointestinal tract. He manages complex cases of metastatic breast cancer and oversees clinical trial protocols.
FAQ
What language is used for communication with patients from the CIS?
Ichilov has an international department with Russian-speaking coordinators and medical translators. All consultations, tumor boards, conclusions, and prescriptions are provided with translation into Russian. If desired by the patient, translation into Ukrainian is also possible.
What documents need to be prepared before arrival?
A sufficient set includes what most patients have: discharge summaries from local clinics, results of mammography, ultrasound, and MRI (preferably on a disk in DICOM format), biopsy conclusions, and, if possible, the slides and paraffin blocks for review. Everything else can be completed at Ichilov.
How long will breast cancer treatment take?
Early stages (I–II) with breast-conserving surgery and radiation therapy typically require 6–10 weeks of active phase. If chemotherapy is added — 4–6 months. Hormonal therapy in pill form continues for 5–10 years and is usually conducted at home under remote supervision by an Ichilov physician.
Is an advance payment required and how is payment arranged?
Before starting the program, an official contract is signed with the medical center, and a deposit is made under a specific examination and treatment plan; final invoices are issued based on the services provided. Stage payments and working with international insurance policies are possible.
Is a multidisciplinary tumor board mandatory?
Yes, the tumor board (Tumor Board) is the standard for breast cancer treatment at Ichilov. It includes an oncologist, breast surgeon, radiation therapist, pathologist, radiologist, and, if necessary, a geneticist and plastic surgeon. This format reduces the risk of errors and ensures that recommendations align with current international protocols.
Can a second opinion be obtained at Ichilov without relocating?
Yes, a remote second opinion service is available: the patient sends documents and images, and the leading oncologist at Sourasky provides a written conclusion regarding the diagnosis and treatment plan. This often helps clarify the treatment plan without leaving their country.
Does the clinic work with international insurance companies?
Ichilov accepts most international insurance policies, as well as employer programs and special funds. The international department assists with the preparation of guarantee letters and direct settlements with insurers.
How is follow-up organized after returning home?
After the active treatment phase, the patient receives an individualized follow-up schedule: typically examinations and tumor markers every 3–6 months, mammography once a year, and MRI as indicated. Online consultations with the treating physician at Ichilov are available from any CIS country.
How to obtain a treatment program
To receive a personalized breast cancer treatment plan at the Sourasky (Ichilov) clinic, fill out the application form on the website or write to a Russian-speaking coordinator. Within 24 hours, a consulting physician will contact you: discuss the diagnosis, request any missing documents, and propose a preliminary examination plan. After evaluating the conclusion from the leading breast oncologist, you will receive a cost estimate for the program and a schedule for your arrival in Tel Aviv. If the situation does not require urgent hospitalization, some preparatory steps — review of slides, consultations, remote second opinion — can be conducted without leaving your country.