Advances in Detection and Treatment Improve Breast Cancer Outlook
The Toledo Clinic Cancer Centers
Charu Trivedi, MD
Though approximately 200,000 women
are diagnosed with breast cancer each
year and by 2010 there will be
approximately 2.9 million breast cancer
survivors in United States, the survival
rate and quality of life for those
diagnosed continues to improve with
advances in detection and treatment. But
the key to an optimal prognosis is early
detection. The outlook for women with
breast cancer is best when the disease is
caught and treated early—ideally before
symptoms begin to manifest themselves.
According to the American Cancer
Society, possible symptoms of breast
cancer include:
*A new lump or mass in the breast
*Swelling of all or part of a breast
(even if no distinct lump is felt)
*Skin irritation or dimpling
*Breast or nipple pain
*Nipple retraction (turning inward)
*Redness, scaliness, or thickening of
the nipple or breast skin
*A nipple discharge other than breast
milk
“However,” notes Dr. Charu Trivedi of the
Toledo Clinic Cancer Centers, “breast
cancer often causes no symptoms in
the earliest stage. It’s usually detected
through a
screening mammogram, which is why
it’s so important for women to get an
initial mammogram at age 40—or even
earlier if they are high-risk.gh-risk women
include those with a family history and
genetic predisposition to have breast
cancer, including families with positive
(reprint with permission from HLN, Oct. 2010)
BRCA mutations and multi cancer
genetic syndromes, such as Li-Fraumeni
(breast cancer, sarcomas, brain tumors,
adrenocortical cancers, leukemias) and
Cowden's syndrome (thyroid, uterine,
and breast cancer).
Dr. Trivedi explains that women with a
family history of breast cancer should get
a mammogram ten years earlier than the
youngest family member
With breast cancer. In other words, if the
earliest diagnosis in your family was at
age 40, you should get an initial
mammogram at age 30. “Of course, if
you feel a lump in your breast at age 20,
you should go to see your doctor
regardless,” she adds.
Today’s digital mammography yields
images that are superior to those
produced with traditional film-screen
mammography and, typically, requires
lower doses of radiation. Also, there’s no
waiting for films to be processed; the
image is available in seconds so the
radiologist can determine immediately
whether additional screening or biopsy is
needed. Ultrasonograpy is also used
in conjunction with mammography to
differentiate between cystic (usually
benign) and solid (mostly malignant)
nodules.
Though not a standard screening tool,
Magnetic Resonance Imaging, or MRI,
can also be utilized for women who
are high-risk or in cases where
mammogram can’t produce a good
image, such as in women with very
dense breasts.
In addition to age and personal and
family history, other risk factors for
developing breast cancer include having
a first full-term pregnancy at a later age,
early menarche (first
occurrence of menstruation), late
menopause, the use of hormones,
radiation exposure, multiple breast
biopsies, and proliferative breast disease
(atypical hyperplasia, sclerosing
adenosis, etc.).
Recent research has also implicated
alcohol consumption, high-fat diet, and
obesity as significant risk factors. In fact,
according to one recent study, women
who consume more than six grams of
alcohol per day have a 1.5-fold greater
risk of dying from breast cancer and a
1.3-fold greater risk of recurrence. Also,
women with a body mass index, or BMI,
over 25 are at greater risk of dying from
the disease.
The good news is, breast cancer is being
diagnosed earlier and advanced
treatment methods are improving the
cure rate and lowering the mortality rate.
As Dr. Trivedi states, “Treatments are
becoming more tumor-targeted as well as
more patient-targeted, so we’re seeing a
lot more survivorship with fewer longterm consequences.”
The preferred treatment for early stage
breast cancer typically combines
localized treatment of the tumor (surgery
with or without radiation) and systemic
treatment with antihormonal agents,
other targeted therapies, and
chemotherapy. Significant advances
have been made in both of these areas.
Whereas breast cancer surgery in the
past typically meant simple and radical
mastectomy—the removal of all the
breast tissue, lymph nodes, and
underlying muscle—the emphasis today
is on tissue preservation and lessinvasive surgical procedures. Hence,
lumpectomy, or the removal of only the
tumor and a small amount of surrounding
tissue, is currently favored over
mastectomy when appropriate and when
the tumor is localized in one area and not
multifocal (more than one tumor has
arisen from the original tumor). Sentinal
lymph node (the lymph node in the
vicinity of the tumor) biopsy technique
has helped to avoid major dissection of
lymph nodes, especially if they are
negative, and doing less invasive surgery
helps to minimize the risk of postoperative lymphedema.
Radiation therapy has become more
targeted and only targeted to the tumor.
Also, lower doses are often used, so
there is less damage to surrounding
tissue. If chemotherapy is required,
doctors have a whole range of active,
tumor-targeted drugs as well as
excellent antinausea and supportive
medications and biologic response
modifiers (substances that stimulate
the body’s response to disease),
including growth factors. All of these
options help doctors treat breast
cancer with the most active drug that
causes the least, or most tolerable,
side effects.
“Chemotherapy and supportive care have
improved markedly. When I was trained,
the side effect of nausea and vomiting
with chemotherapy was so common that
many women ended up being admitted to
the hospital. This is rarely the case
today,” Dr. Trivedi says.
Another exciting advance in the
treatment of breast cancer is the
availability of drugs that specifically
target breast cancer tumors. There are
older antihormonal drugs that are
tumor-targeted as well as newer ones
like Herceptin and Avastin. Herceptin
works in a very targeted manner by
attaching to certain receptors on
breast cancer cells and blocking the
chemical signals that stimulate their
growth. This drug used to be prescribed
primarily for advanced breast cancers,
but recent research shows that it can
help women with early-stage breast
cancer survive longer, as well.
To help prevent breast cancer from
recurring in early stage breast cancer as
well as to help control advanced cases of
the disease, doctors can prescribe
antihormonal agents, like tamoxifen, and
newer, more active agents, such as
aromatase inhibitors. These drugs are
formulated to block certain hormone
receptors, such as estrogen or
progesterone, on tumor cells that can
stimulate the growth of breast cancer
cells.
Chemotherapy, targeted drugs, biological
response modifiers, and supportive
medications are used to treat all stages
of breast cancer. “Also, thanks to the
advent of Oncotype testing, we have a
new tool to help us determine the
likelihood of recurrence in early stage
hormone positive breast cancer patients
so we can decide who would benefit from
both chemotherapy and antihormonal
therapy—those in the high-risk group—
and who could benefit from antihormonal
therapy alone—those in the low risk
group,” comments Dr. Trivedi.
The goal in treating early stage breast
cancer is to achieve a cure, but for
advanced breast cancer, the treatment
goals are to slow the growth of the
cancer, control symptoms, and prolong
survival and a good quality of life. All of
the above-mentioned treatments can be
utilized based on the individual’s disease
and symptoms.
Because appropriate treatment for breast
cancer must address the physical,
emotional, and psychosocial components
of the disease, the Toledo Clinic Cancer
Centers and other area healthcare
institutions and universities are exploring
the option of establishing survivor clinics,
which will address the unique problems,
needs, and concerns of breast cancer
survivors. Furthermore, Dr. Trivedi
strongly encourages women
diagnosed with breast cancer to
participate in clinical trials if they
qualify. “Whatever we have to offer to
women today—all the newer drugs and
advanced techniques that are helping
them live longer and enjoy a better
quality of life—came out of prior clinical
trials. Your participation could make a
difference, not only in your own outlook,
but for generations of women to come.
Being a woman, I know that, like any
other woman, I can get breast cancer.
But given the advances in screening
and available treatments, I am not
scared. I am very optimistic and
confident that if that situation comes, I
can face it confidently with a positive
outlook,” she says.
More and more patients diagnosed with
cancer are choosing the comprehensive
outpatient cancer services available at
the Toledo Clinic Cancer Centers. The
multidisciplinary center, which consists of
eight board-certified hematologistoncologists and five nurse practitioners,
offers a full range of imaging services,
including X-ray, CAT scan, MRI, PET
scan, and ultrasound; chemotherapy
services; IV services; laboratory services;
an outpatient surgery center; and multiple
sites of service (including the main
location at 4235 Secor Road and satellite
centers in Maumee, Bowling Green,
Oregon, Adrian, and Monroe) for patient
convenience.
Toledo Clinic Cancer Centers also offers
patients access to all the latest cancer
research and studies going on in our
area through active participation in the
Toledo Community Hospital Oncology
Program (TCOP).
For more information about breast cancer
or the Toledo Clinic Cancer Centers,
please call 419-479-5605.