Wellness: Today's Medicine
Hope on the Horizon for Breast Cancer
Except for nonmelanoma skin cancer, breast cancer remains the most frequently diagnosed cancer in women. But cancer experts say that women should feel encouraged by the current breakthroughs in detection and treatment.
In recent years, researchers have discovered new and better ways to detect and treat breast cancer — and to keep it from coming back, the American Cancer Society (ACS) says. These new developments stem from a vast body of research. Recent advances, along with greater public awareness of the importance of breast exams, have caused a steady decline in breast cancer deaths in women since 1990.
Here's a roundup of what's on the horizon in the areas of mammography, surgery, and hormonal therapy. Keep in mind that all these advances are not yet widely available and many may not be appropriate for everyone. Any treatment decisions must be made by a woman and her doctor, based on her particular cancer, her medical and physical history, her personal preferences, and her doctor's clinical judgment.
No doubt about it: Finding breast cancer early increases treatment options and saves lives. Study after study has shown that regular mammograms play a vital role in early cancer detection.
Thanks to advances in digital technology, mammography may become an even more valuable tool in the future. Currently, standard mammography captures images on film or digitally on computers. But research centers around the country are now testing 3D digital mammography or tomosynthesis, an extension of digital mammography. Tomosynthesis allows the breast to be viewed as many thin slices, which can be combined into a 3D picture. It may allow doctors to detect smaller lesions or ones that would otherwise be hidden with standard mammograms. But its role in breast cancer screening and diagnosis is not yet clear.
Another way to find cancer
An alternative to using X-rays is magnetic resonance imaging (MRI), which uses radio waves and strong magnets to view body tissue. Although MRIs are common in helping to diagnose other diseases, they must be specially adapted to scan the breast. They can be used as a follow-up after mammography has found cancer in the breast, or to screen women at high risk for breast cancer. More research is needed, however, to find out if MRIs are any better than mammography at finding small breast cancers. In 2007, the ACS recommended new guidelines that include screening MRI with mammography for certain high-risk women.
Ultrasound may also be a useful imaging method to supplement mammography. Ultrasound is used to evaluate breast masses found during mammograph. And for women with dense breasts, automated whole-breast ultrasound (AWBUS) is a supplementary ultrasound examination of both breasts that can find small cancers that mammography may miss.
Advances in biopsies
Before an abnormality on a mammogram is diagnosed as cancer, doctors typically need to do a biopsy. This is a procedure in which a doctor removes a small tissue sample from the breast and examines it under a microscope. This is the only way to tell if cancer is really present. The sample may be removed using a needle or open surgery. When using a needle to perform the biopsy, the doctor usually guides it into the area by feeling the lump. If a lump is too small to be felt, doctors can use ultrasound or an MRI to help guide the needle.
The newest biopsy technique in use is called a vacuum-assisted biopsy. For these, a small cut is made in the skin of the breast and a hollow probe is put through the cut into the abnormal area of breast tissue. The probe can be guided into place using X-rays, ultrasound, or MRI. A cylinder of tissue is then suctioned in through a hole in the side of the probe, and a rotating knife inside the probe cuts the tissue sample free. Many samples can be taken from the same cut. This type of biopsy usually removes more tissue than needle biopsies.
Breast reconstruction surgery
Once breast cancer has been diagnosed, most women have some type of surgery to treat it. A lumpectomy removes only the breast lump with a small amount of tissue around it. Partial, or segmental, mastectomy removes more breast tissue than a lumpectomy. A mastectomy removes the whole breast.
For women who undergo a mastectomy with immediate breast reconstruction, a procedure called skin-sparing mastectomy (SSM) is becoming more popular, the ACS says. In a traditional mastectomy, the skin of the breast is removed along with other tissue. In SSM, however, the cancer surgeon removes the breast tissue, but leaves the skin that covers the breast in place. Implants or tissue from other parts of the body is then used to reconstruct the breast.
This approach has not been used as long as standard mastectomy, but some women prefer it because it gives the advantage of less scar tissue and a more natural appearance to the reconstructed breast.
Detecting the spread of cancer
During a lumpectomy or mastectomy, lymph nodes under the arm may be removed to check whether the cancer has spread. In the past, several lymph nodes had to be removed, which sometimes led to uncomfortable side effects such as numbness or swelling of the arm. Today, however, a less extensive procedure known as sentinel node biopsy may be another option, the ACS says. Research suggests that it may be just as effective at indicating whether cancer has spread.
In a sentinel node biopsy, a special dye or radioactive substance is injected near the tumor and carried by the lymph system to the first, or sentinel, node to which the tumor drains. Once this node has been identified, it can be removed and checked for cancer. If none is found, it may not be necessary to remove more nodes.
After surgery, many women receive additional treatment to destroy any remaining cancer cells. Radiation therapy uses high-energy rays to destroy cancer cells or to slow their growth. It can be used to target any cancer cells that may remain in the breast or in nearby tissues. Accelerated partial breast irradiation is now offered for women who need radiation after a lumpectomy. Its advantage is in accelerating the radiation treatment into less time, making it more convenient.
Systemic therapy, on the other hand, targets cancer cells that may have spread beyond the breast area. The 2 main types of systemic therapy are chemotherapy and hormonal therapy. Chemotherapy involves powerful anticancer drugs that are either injected into a vein or swallowed as a pill. Doctors are now studying new dosage regimens and drug combinations to find the ones that are most effective for women in specific situations. Some of these drug combinations use standard chemotherapy with new "targeted" drugs that specifically target genetic changes in cells that cause cancer.
Hormonal therapy refers to treatments that affect hormone levels in the body. Estrogen, a female hormone, causes some breast cancers to grow. For women with such cancers, various methods may be used to block the effects of estrogen or to lower estrogen levels. The most widely used estrogen-blocking drug is tamoxifen. A class of drugs called aromatase inhibitors is also available. Aromatase inhibitors include letrozole, anastrozole, and exemestane. These drugs, which stop the body from making estrogen, only work for women past menopause.
Improvements in breast cancer diagnosis and treatment are making a difference in women's lives. Today, the 5-year survival rate for women whose breast cancer is caught before it has spread outside the breast is close to 100%.