Breast Cancer More Treatable Than Ever

Most women know the numbers: one in eight will develop invasive breast cancer, and it’s the second-most-common cancer (next to skin cancer) affecting American women.

Here’s the good news: breast-cancer death rates have been declining for more than 20 years due to better screening and treatments. Today, the American Cancer Society estimates, there are nearly 3 million breast cancer survivors in the U.S. So ‘one in eight’ does not mean that one in eight will die from the disease.

Rather, the prognosis for the vast majority of women diagnosed with early-stage breast cancer today is overwhelmingly good. The expectation is cure, with the result that the patient can live a healthy life in the majority of cases.

Breast cancer is not a single disease. Some cancers are more aggressive than others, and physicians have many tools available to understand how much of a risk the individual patient faces. Breast-cancer care and research are constantly advancing, and each study adds vital information to our knowledge — as well as raises new questions to ask and new areas to investigate.

Most often, treatment for breast cancer typically begins with surgery to remove the cancer. Specialists then analyze the tumor, determine its characteristics, and see if the cancer has spread. That approach helps the physician decide about additional therapies that will minimize the risk of the cancer returning. Those subsequent treatments, such as radiation, chemotherapy, or medication, can be tailored to the individual patient.

Surgical options include a lumpectomy, surgery in which only the tumor and some surrounding tissue is removed, or a mastectomy, removal of all or part of the affected breast. Many physicians believe the goal should be to allow the patient to keep her breast, as studies have demonstrated that the survival rates comparing women who have mastectomies versus those who don’t are the same.

Mammography has long been the standard of preventive care for breast cancer, but differing opinions among healthcare professionals about its effectiveness have raised some concern and confusion. Some think that frequent mammograms lead to over-diagnosis and overtreatment.

Mammograms tend to identify cancers that grow slowly and are perhaps less dangerous, and they may not be as effective in younger women (age 40-50) as they are in older women. But the technology is getting better, and, despite limitations, mammography remains the only screening tool that has been proven to decrease death from breast cancer. The American Cancer Society’s current recommendation is that women should begin mammograms at age 40, particularly if they have a family history of breast cancer.

Magnetic resonance imaging (MRI) is another screening option and has been shown to be better at diagnosis. But MRIs tend to create more false positives (which lead to anxiety and emotional stress) because they see much more than a mammogram. This type of screening is better suited to women who have a higher lifetime risk of breast cancer.

Adding to the concerns about breast health is genetic testing for BRCA 1 and BRCA 2, genes associated with hereditary breast and ovarian cancers. These genes identify a risk present from birth but cannot predict when or if cancer will develop. Prophylactic mastectomy, or the removal of a healthy breast as a preventive measure, is perhaps the most extreme form of prevention and may be considered by women who have the highest lifetime risk of breast cancer, such as those with an inherited BRCA 1 or BRCA 2 mutation.

Predicting who will get breast cancer is difficult, as most women who get the disease don’t have a family history of the condition and don’t have strong risk factors. Age remains the primary risk factor, as three out of four women who get breast cancer develop the disease after age 50.

Breast care and treatment have become highly personalized, and no one standard approach exists. The decisions about mammography, genetic testing, treatments, and preventive mastectomy are clearly ones to be made by the individual patient in consultation with her physician and team of cancer specialists. –

Dr. Nadine Tung is director of the Cancer Genetics and Prevention Program, and Dr. Gerburg Wulf is a medical oncologist and researcher at the Cancer Center at Beth Israel Deaconess Medical Center in Boston. This article is a public service of the Mass. Medical Society.

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