Breast Cancer Basics -- More Screening, Better Treatments Aid Women in Fight Against Breast Cancer

October 6 , 2009

MMS Physician Focus: October 2009
By Carol Mei, M.D.

With corporations, newspapers, schools, and even the National Football League supporting the cause, breast cancer awareness has soared. And that’s good news, because according to American Cancer Society estimates, the disease will claim than 40,000 lives in 2009, and the number of new cases will exceed 192,000.

As a medical oncologist, I can tell you that awareness, so critical, must also be constant. The disease is the second most common cancer for women after skin cancer, and it’s the second leading cause of cancer death, after lung cancer. The odds of a woman getting breast cancer are about one in eight. 

Progress against breast cancer is being made. After more than two decades of increased incidence, breast cancer rates are actually declining, down an average of 2.2 percent each year between 1995 and 2005.

This positive trend results from increased levels of screening and better treatments. Improved screening means earlier detection, to find the disease when it’s most treatable, and better treatments mean more women are living longer, fuller lives. At the same time, more women are making healthy lifestyle choices, which decrease the likelihood of cancer. 

Among women, risk factors include advanced age, family history of breast or ovarian cancer, obesity, being childless, and having a mutation in breast cancer genes. Women with a genetic predisposition may consider going for genetic counseling. 

While there are no sure ways to prevent breast cancer, women can reduce their risks by eating well, maintaining a healthy weight, exercising, not smoking, and limiting alcohol intake. For those diagnosed with breast cancer, recent studies have found that active women are less likely to die from the disease.

Screening Guidelines
The latest screening guidelines from the American Cancer Society and National Comprehensive Cancer Network recommend that for average-risk women, those 40 and over should have annual mammograms, which involve x-rays, with digital mammography preferred especially for younger women with denser breasts. Women over 20 should perform self examinations and have annual clinical breast examinations (CBEs) every one to three years. Women should also report any self-detected breast changes immediately to their healthcare provider. 

Screening for women at increased risk should include yearly CBEs. Ironically, women over 65, who are at greatest risk, are the least likely to undergo screening procedures. That’s why it’s important to be informed and take an active role in your medical care. Mammograms are usually a sufficient means of screening but may be complemented by ultrasounds and Magnetic Resonance Imaging (MRIs), especially with dense tissue. 

Treatments
The main treatments for breast cancer are surgery, chemotherapy, and radiation therapy. Often, a combination of these therapies is required.

For surgery, the least invasive procedures are preferred. For most early-stage cancer, breast conservation—where a lumpectomy (removal of the tumor) with lymph node sampling is followed by radiation—produces survivor rates as high as mastectomies (removal of the entire breast). For women who don’t have the option of breast conservation, the alternatives are mastectomy with or without breast reconstruction.

Chemotherapy, which uses drugs to kill cancer cells, is administered orally or intravenously. In disease limited to the breast, chemotherapy administered before surgery can shrink tumors and increase chances for breast conservation. Chemotherapy given before or after surgery also reduces the risk of recurrent cancer.

Radiation uses high-energy x-rays to shrink tumors. It is given after surgery to reduce the risk of recurrence within the breast or adjacent lymph nodes. Dramatic advances in this field include Intensity Modulated Radiation Therapy, or the transmission of high-dose, precisely targeted radiation beams that destroy cancer cells and spare surrounding healthy tissue. 

Survival Rates
Breast cancer survivors number about 2.5 million in the United States today. The five-year survival for breast cancer patients has improved from 63 percent in the early 1960s to 89 percent today, so there’s much reason for hope in the war against breast cancer. Women can make a difference by playing an active role in the prevention, detection, and management of their cancer. They should adopt healthy lifestyles, abide by the recommended screening guidelines, and seek support services during and after treatment, as needed. 

After Breast Cancer Awareness Month and the publicity and promotion end, women should remember to stay vigilant and informed. To do so, visit the National Cancer Institute at www.cancer.gov and the American Cancer Society at www.cancer.org. To view the 2008 Nationally Accepted Screening Guidelines on breast cancer (and other types), visit www.commonwealthatrius.com.
 
Carol T. Mei, M.D. is a Medical Oncologist with Commonwealth Hematology-Oncology in the Commonwealth Atrius Cancer Center in Weymouth, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult their personal physician for treatment. Comments are welcome at PhysicianFocus@mms.org