Breast Cancer: Continued Progress in Treatment and Care

By Mark L. Walker, MD, FACS

The very term breast cancer produces fear and tremendous anxiety for women throughout the world. These feelings are understandable given the toll that this illness has taken on women in general. This article seeks to dispel myths and anxieties concerning thediagnosis of breast cancer and to outline the progress that is being made in the treatment and care of women with this illness.

Cancer is not one disease. It is characterized by the site where it begins and the pattern of spread based on its point of origin. Cancer cells exhibit uncontrolled growth and the ability to spread widely throughout the body. Environmental factors along with genetic factors likely explain a large number of cancers. One of the most telling examples is tobacco smoking as a cause of lung cancer. This connection is unequivocal.

The cause of breast cancer is less clear-cut. Most breast cancers arise from a sporadic mutation, that is a change in a gene that occurs by chance. Environmental toxins, diet and even the aging process itself probably play some role in the development of breast cancer. 10% of breast cancers are explained by a genetic mutation that is transmitted in a family from one generation to the next. BRCA1 and BRCA2 gene mutations or changes may be present. Women of Jewish descent may carry one of these genes. If so, there is a high likelihood that invasive breast cancer may develop. For this reason prophylactic mastectomy may be recommended.

Let's review some general statistics regarding breast cancer. Roughly 260,000 women will develop some form of breast cancer in 2011. Almost 40,000 will die from this disease. It is estimated that 1 in 8 women in the United States will develop this illness at some point during their lives. The risk of breast cancer increases as a woman ages.There are more than 2.5 million breast cancer survivors in the United States. Breast cancer occurs in African-American women at a younger age and the mortality when itdoes occur is greater when compared to their white counterparts.

Screening for breast cancer should begin at age 40 with a baseline mammogram. Extensive studies from this country and from Europe confirm that screening is associated with a reduced mortality from breast cancer. Women age 40 and above should have an annual mammogram. Recently there has been controversy generated by recommendations suggesting that annual mammography was no longer needed for women age 50 and above. Consensus opinion supports continued screening for this age group. The earlier we detect a lesion, the greater the change for cure.

Breast cancer presents as a painless lump. A recommendation will be made for a biopsyand a referral to a general surgeon or a breast surgeon will be made. A complete history and physical examination will be done. An in office ultrasound of the breast is often done followed by a needle aspiration of the lump. Specimens will be submitted to the pathologist for evaluation.

If breast cancer is detected, a comprehensive discussion will occur regarding treatment options. In general, if invasive cancer has been detected by biopsy, a breast conserving approach may be appropriate, provided the lump is small and no advanced signs of local disease are present. Removing the lump and removing 2 or more sentry nodes (called sentinel nodes) is done with a breast conserving approach. Women with large tumors may be best served by mastectomy. If the axillary lymph nodes are involved, chemotherapy is recommended. Regiments including the taxane drugs have been found to be quite effective. Newer agents that target growth factors and other proteins that may stimulate breast cancer cells are being developed and several are in clinical trials now.

Hormonal therapy based on anti-estrogen drugs (tamoxifen and anastrazole) is quite effective. This approach works if the tumor is Estrogen positive. Another receptor marker is Her-2 neu. If this marker is present, the tumor may respond to a herceptin antibody. These are powerful medications and carry their own side effect profile. It must be emphasized that women are living productive lives, even though they have had a diagnosis of breast cancer, with many being cancer free.

There continues to be debate regarding whether women should aggressively pursue lumps that in most cases will prove to be benign. Some 80% of breast biopsies fall into this category. However, failure to detect a very treatable early breast cancer, because a lump was ignored does not provide women with the care and treatment they need and should have. My recommendation is for women to continue to do self-breast examination at home, usually after the end of the cycle and done the same time each month. Women should know their baseline and pursue changes with their physician. If bloody nipple discharge occurs, a new mass or dimpling of the skin or nipple, a physicians' evaluation is essential.

It is critical that women do not omit essential screenings that could detect a serious problem. Effective screening and comprehensive treatment may add many years to their lives.

Breast cancer should not be a lethal event. With the resources we currently have, women should be able to live long and productive lives in spite of this illness. Let's all commit ourselves, men, women, mothers, daughters, fathers, sons, aunts and uncles to this. Let's replace fear with hope. Let's replace anxiety with understanding. Let's replace pessimism with cautious optimism based on facts. Breast cancer can be cured.

Mark L. Walker, MD FACS
Surgical Health Collective
www.surgicalhealthcollective.com

 

 
 
 
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