You’re sitting in your gown in the chilly mammography waiting area, listening for your name to be called and sneaking occasional peeks at the other women seated there, wondering if they’re as nervous as you are. Could this be the year that you’ll be diagnosed with breast cancer?
Breast cancer statistics can be scary. According to the American Cancer Society, about 266,120 new cases of invasive breast cancer and about 63,960 new cases of carcinoma in situ (the non-invasive, earliest form of breast cancer) will be diagnosed in women during 2018. The average risk of developing breast cancer sometime during your life is one in eight. And most women know at least one, if not more, persons who have developed this disease – definitely raising the scare factor.
But it’s not all bad news, claimed James C. Wurzer, M.D., Ph.D., medical director of the Oncology Program and of Radiation Oncology at AtlantiCare Cancer Care Institute in New Jersey. “Though the rate of breast cancer remains extremely elevated, the death rate has been declining,” he said.
Dr. Wurzer attributes this to several factors. The use of mammography has resulted in earlier detection of breast cancers, at a point where there are better treatment outcomes. And over the past decade, he added, “our understanding of breast cancer has improved dramatically.”
Scientists now understand that breast cancer is not just one disease, but has many unique forms and characteristics. It can originate in different parts of the breast. It can be detected at non-invasive, invasive, or metastatic (having spread to another part of the body such as the liver or bone) stages, and it may or may not have spread to nearby lymph nodes.
Breast cancer cells may have estrogen receptors or progesterone receptors, proteins that allow the cancer cells to attach to these hormones in the body, fueling cancer cell growth. It might also be “HER2 positive,” meaning that the cancer makes too much of a protein that causes aggressive cellular growth, and also increases the likelihood of recurrence after treatment.
A greater understanding of the differences between breast cancers allows oncologists to employ a variety of treatments, said Dr. Wurzer. In addition to surgery, radiation, and chemotherapy, today’s doctors have in their medical arsenal hormonal manipulation and targeted therapies. For example, if estrogen or progesterone receptors are present on the patient’s cancer cells, an oncologist might administer endocrine therapy that either lowers hormone levels or prevents cancer cells from responding to the hormones.
If the cancer is HER2 positive, doctors can use a targeted treatment called “monoclonal antibody treatment,” which blocks the HER2 protein, improving the chance of survival.
Research resulting in greater understanding of breast cancer characteristics can also reduce the amount of treatment needed, said Seema Khan, MD, surgical oncologist at Northwestern Memorial Hospital in Chicago, Illinois.
A case in point, she explained, is the recently published TAILORx trial (Trial Assigning Individualized Options for Treatment). This study analyzed the genetic profile of early cancer tumors in over 10,000 women, assessing the expression of 21 genes associated with breast cancer recurrence. The overall conclusion was that for 70 percent of women with the most common type of breast cancer, hormone treatment alone was as effective as hormone therapy combined with chemotherapy. “The quality of life can be improved by reducing unnecessary treatment,” said Dr. Khan.
Even for women with advanced breast cancer, there is hope for longer survival and an improved quality of life, she added. Taxane therapy, a chemotherapy drug originally derived from the bark of the Pacific Yew Tree, is now a standard treatment, often used in conjunction with other medications, for metastatic breast cancers.
The overall message here: Breast cancer is not necessarily a death sentence. With early detection and individualized treatment, your chances for surviving breast cancer are greater than ever before.
BOOSTING BREAST HEALTH
The greatest risk factors for breast cancer are being a woman and getting older (the incidence of breast cancer rises significantly after age 50). Early menstrual periods (before age 12) and late menopause (after age 55) expose you to hormones for a longer period of time, raising your risk of getting breast cancer, too. And a woman’s risk for breast cancer is higher if she has a first degree relative (mother, sister or daughter) who have had breast cancer, especially if it developed before age 40.
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These are things you can’t change. But there are things you can do to lower your risk of developing breast cancer, and if you do develop it, to increase your chances of survival. According to Seema Khan, MD, surgical oncologist at Northwestern Memorial Hospital in Chicago, Illinois, preventive tips include:
- Keeping your weight down. Excess body fat after menopause increases estrogen levels and the risk for breast cancer. But, said Dr. Khan, “If you’re overweight at 40, it’s not likely you’re going to lose the weight at menopause. So it’s good to achieve and maintain a healthy weight earlier in life.”
- Exercising regularly. Exercise lowers estrogen levels and breast cancer risk.
- Eating a healthy diet. A major study published in 2018 in BMJ showed that those who eat an increased amount of ultra-processed foods have a higher risk for several cancers, including breast cancer. Your best bet, said Dr. Khan, is a diet rich in fruits, vegetables, and whole grains and low in animal fats.
- Avoiding hormone treatments during menopause. For those with severe menopausal symptoms, taking the lowest possible dose for the least amount of time is best.
- Reducing alcohol intake. Alcohol can affect your body’s hormone levels, so if you drink, make it no more than three drinks per week, advised Dr. Khan.
Despite following these preventive tips, you may still develop breast cancer. Increase your odds of beating this disease by:
- Getting regular mammograms. Mammograms are an effective screening tool for breast cancer and can detect the disease at an earlier and more treatable stage. Recommendations for when to begin screening, how often to do it, and how long in life to continue screening vary among medical organizations such as the American Cancer Society and the U.S. Preventive Services Task Force. Talk to your health care provider about your personal risk factors to determine when to begin screening and how often to repeat it.
- Asking your doctor about your breast density score. For yet unknown reasons, women with dense breast tissue (as opposed to fatty tissue) are four to five times more likely to develop breast cancer, said Linda Greer, MD, Medical Director, HonorHealth Breast Health and Research Center in Phoenix, Arizona. And dense breasts make it harder to detect breast cancers. A recent study has added to a growing body of research showing that digital breast tomosynthesis (DBT), or 3D screening mammography is the gold standard of care for breast screening. According to Dr. Greer, the Genius 3D Mammography exam detects detects 20-65 percent more invasive breast cancers compared to traditional 2D mammography alone, and is the only mammogram approved by the FDA as superior for women with dense breasts compared to 2D alone.
- Considering gene testing if you have a family history of breast cancer. The BRCA1 and BRCA2 and the PALB2 gene tests use DNA analysis to determine whether you have mutations in your genes that increase your risk for breast and ovarian cancers. If you’re positive on any of these tests, you can discuss with your doctor options for decreasing your risks, such as preventive hormonal therapy or even preventive mastectomy.
WHERE TO START?
If you’ve just been diagnosed with breast cancer, it’s likely that you’re feeling overwhelmed. You may not even know where to begin. According to James C. Wurzer, M.D., Ph.D., medical director of the Oncology Program and of Radiation Oncology at AtlantiCare Cancer Care Institute in New Jersey, it’s best to seek treatment at a center offering multi-specialty care. “The patient should be cared for by a team of specialists who both communicate and coordinate the care for optimal outcome,” he advised.
These specialists, he added, would include a breast surgeon, medical oncologist, radiation oncologist, and plastic surgeon if breast reconstruction is needed. Other specialists might include a genetics counselor to help make complex treatment decisions, an oncology navigator (a nurse or other health care specialist who acts as an advocate and coordinates appointments), a dietician to help with nutritional needs, and a social worker.
And of course, you should include your primary care provider and gynecologist in this health care plan.
Some good online resources for additional information include:
- The American Cancer Society
- National Comprehensive Cancer Network
- The Susan G Komen Breast Cancer Foundation Inc.
- The National Cancer Institute
By Linda Hepler, BSN, RN