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.chomed.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 atPhysicianFocus@mms.org
