Breast Cancer
October is Breast Cancer Awareness Month
Breast cancer is the most common cancer in women affecting 1 in every 8 women during her lifetime. The American Cancer Society estimates 211,000 women will be diagnosed with breast cancer in 2007; 1,180 of those women are in Nevada. Approximately 42,000 women will die from breast cancer in 2007. Because so many women are affected by this disease, breast cancer is one of the most heavily researched cancers at this time. The risk of dying of this disease is decreasing, making breast cancer more of a chronic illness than it was in the past and making survivorship a major issue to be addressed.
Breast cancer most commonly comes from the milk ducts in the breast and is called “ductal carcinoma.” Ductal cancers come in 2 different varieties: invasive and in situ. Invasive cancers mean that the cancer cells are intruding into normal tissue; in situ means the cancer cells are there, but they don’t have the ability to invade and travel yet. Breast cancer less often arises from the milk production lobule in the breast and is named lobular carcinoma.
Screening is extremely important in the early diagnosis of breast cancer. When found before a lump can be felt, cure is more likely. Mammogram is currently the most widely available and current standard method for screening. Magnetic Resonance Imaging (MRI) of the breast is used with mammography in certain women who have dense breast tissue or who are at higher risk of developing breast cancer than the average woman. Currently, we recommend beginning yearly screening at age 40 unless your doctor tells you otherwise.
Treatment of breast cancer remains multi-faceted. Many different types of doctors must work together to treat each woman with this disease. The team of doctors generally includes a breast surgeon, a medical oncologist and a radiation oncologist. Breast surgery is usually done to remove the cancer before any “systemic” treatment with medicines is prescribed (“neoadjuvant chemotherapy”). The surgery can be a mastectomy which removes the entire breast or a lumpectomy removing primarily the cancer itself. Most patients will need evaluation of the lymph nodes in the axilla (armpit) as well. If the cancer is greater than 5 cm or with skin involvement at the time of diagnosis, chemotherapy medicines are used to decrease the size of the cancer before surgery. Chemotherapy may also be recommended by a medical oncologist if cancer is found in the lymph nodes or if size or characteristics of the cancer make it more likely to recur (“adjuvant therapy”). Anti-hormonal pills such as tamoxifen or a class of medicines called aromatase inhibitors may be used if the cancer appears to be hormonally driven. If a lumpectomy is performed, then radiation to the breast will be needed to help prevent return of cancer in the same breast. It is important to remember that every patient with breast cancer will be evaluated as an individual and may not receive exactly the same care as the next patient.
If breast cancer is found to have spread throughout the body (also known as metastatic disease), it is most likely to go the bones, liver, lungs and brain. Many different treatment options are available. These options include standard chemotherapy, new targeted therapies and radiation therapy. In addition, there are many ongoing clinical trials in which a patient may participate including national studies and studies of new medications not yet available to the general public.
