Dr. Kevin Most: Breast Cancer
1 in 8 Women will be diagnosed with Breast cancer in their lifetime. It is a disease that will impact all of us.
Each year we discuss breast cancer awareness month and the need for women to get their screening mammogram, we will cover that again, but more importantly we will share the impact the screening has had, as we look at the number of lives saved by this screening as results of new studies have been released. Estimates show that the new treatment and screening have saved close to 325,000 lives since 1990.
Let’s also make sure we celebrate and acknowledge those individuals who have breast cancer. Understanding what they are going thru allows us to understand the impact it makes on an individual. It also allows us to show true empathy and support as we have a better understanding of what they are going thru as they are receiving treatment. Remember many of those receiving treatment are heroes as they are participating in clinical trials that have allowed us to advance the treatment that has saved the lives we noted. Individuals who have been brave enough to try a new treatment modality while knowing that the side effects may be worse, and that the additional treatment may add no value to their fight.
First let’s do some basic information. Although we have made great advancements in the treatment of Breast cancer, it remains the most commonly diagnosed cancer in women, and is the second leading cause of cancer death in women. In the United States we have over 250,000 new cases each year diagnosed. We also will see over 40,000 deaths due to this terrible cancer. To put this in perspective while listening to this short segment 8 women will be diagnosed and 1 woman will die from Breast cancer. That being said we also need to celebrate our successes as we have over 3.3 million Breast cancer survivors in the United States right now.
So let’s start with the simple part, screening. The current recommendations for screening mammography is biennial screening for women between the ages of 50- 74. Now some may move the screening up and start earlier but this is an individual decision and done while balancing the benefit of the earlier exam with the risks of potential harm due to earlier screening. The risk include false positive screening that results in unnecessary biopsies or receiving treatment for cancer. We do know however that individuals with a parent, a sibling or a child with Breast Cancer may benefit from beginning screening in their 40’s. Individuals who fall into this group should have that discussion with their physician.
Although the US recommendations are for a simple digital mammogram, we are seeing more and more women opting for the mammogram with tomosynthesis. This technology has been shown to increase the cancer detection rate as well as reduce the false positive rate. Tomosynthesis is also known as 3 D imaging, it allows for multiple images to be captured and then the computer puts the images together. The standard mammogram takes 2 x rays of each breast and the images are used to identify cancer. For Tomosynthesis multiple x rays are taken and the computer puts them together to form an image. Think of regular mammogram as a circle and a mammogram with tomo as a ball. This is also a much more comfortable exam as well.
One great thing about the push that has been made to have mammograms available for all women is that we are now seeing the impact. In a study released earlier this week, it showed that Breast Cancer deaths have dropped almost 40% since 1989, and the trend shows a continued downward trend. Although we continue to see high death rates in black women from breast cancer it is improving. Much of this is attributed to the ease of obtaining a mammogram in some mainly black urban areas is improving and the cancers are being identified much earlier. Previous studies showed that often black woman with breast cancer were identified when they had more advanced stage cancer and thus could not benefit from some of the advances that had been noted. We still have treatment and screening advances that we need to spread to all areas of the country. The social, economic and insurance coverage issues are becoming less of a hindrance to get the screening in all areas of the country.
Individuals who have a positive exam will then undergo a biopsy, this is where a needle is placed in the tumor and a portion of cells are removed. The cells are then reviewed by a pathologist who will give his opinion on the make up of the cells. He will identify the type of cancer and report that back to the physician. It is at this point where the patient and doctor will sit and discuss what the options are for treatment and what is recommended based on the type of cancer, size, location, spread and age of the patient.
Treatment options vary dramatically as you put all the information together. It varies based on the stage of cancer and may include chemotherapy, hormone medication, forms of radiation and surgery. It may be that surgery is recommended and deciding on the size of the tumor it may be removed by doing what is termed a lumpectomy, removing the tumor while maintaining the breast, or in other cases removal of the breast may be the option. We may also use radiation therapy including proton therapy in some cases. Medications may be used including hormone based medication and chemotherapy. As we have seen great advancement in slowing the death rate due to cancer, it is those who had cancer that we need to thank.
As I noted before these are the true heroes, they are the ones who allowed us to try different forms of chemotherapy, different strengths, different timing , different sequence….. the list goes on. This is one disease where research is making an impact and the dollars raised by Breast Cancer awareness programs have allowed the death rate to decrease, have allowed for safer and more effective treatments and have saved lives. Although we talk about the great physicians who are doing this research we also need to acknowledge the strength and unselfish behavior of the patients who stood up and agreed to be in a clinical trial. The clinical trial work over the past decades has gotten us to where we are today. So a huge Thank You to all of the survivors and those who passed but had the courage to be one of the patients that has now allowed hundreds of thousands of women to not have to go thru what they did.
We also have to realize that this disease is a lifelong disease even in survivors. They are given medication to prevent reoccurrence , they need to take medications to prevent other issues due to the side effects of the treatment. I will give you just a single view but there are many.
Upon completion of the recommended therapy, many are placed on medication to help them prevent a reoccurrence. Tamoxifen is a drug that has been shown to reduce the chance of reoccurrence for breast cancers that are found to be hormone positive breast cancers. Tamoxifen is a hormone therapy that essentially blocks the effects of estrogen on the receptors on the cancer cells. Although this medication reduces the chance of the cancer it does come with side effects. These include hot flashes and bone loss in younger woman. The bone loss for woman can be serious and often needs treatment beyond simple calcium supplements and exercise. For many of these patients, they have won the battle and now need to take medication to prevent it from coming back. These patients often have bone density loss due to a side effect of the medication preventing the reoccurrence. Many of these patients will be placed on a drug called Fosamax. This drug helps slow bone loss while increasing bone mass. This is needed as osteoporosis results in bone fractures for many patients. This drug has side effects as well, including nausea, heartburn, joint pain and dizziness are just a few.
The point being made is although a patient has “beat breast cancer” they still have medical conditions that they need to work thru. We should all be aware of this and continue to show empathy and encouragement to these patients.
Overall it is a great message about breast cancer in this country and it starts with a simple mammogram and courageous patients to help us continue to improve on this disease and the impact it will make of the generations to follow.