Information about Breast Cancer Research
Every year, around 232,000 women in the United States will be diagnosed with breast cancer. But astonishing leaps forward in treatment mean breast cancer is a manageable condition for many, if not most, women. Down the line, experts anticipate that almost everyone will survive early-stage breast cancer. "I'm even optimistic about women who have aggressive breast cancer. We're pretty close with hormonal treatments for that," says Paul Kelly Marcom, M.D., clinical director, breast medical oncology, Duke University Medical Center, Durham, NC.
Newly diagnosed women are faced with a huge amount of information and options, making it easy to feel overwhelmed. "Their biggest pitfall," Dr. Marcom says, "is the feeling 'I have to have that cancer taken out tomorrow.' It's hard to accept that you have time to deliberate, but most mistakes are made by rushing into treatment. We know from a lot of clinical studies that you generally have two to four weeks to think it through. A lot of patients opt for a mastectomy when they could conserve the breast."
He suggests that patients find a team of physicians who will work together on their care. This team should include surgical, medical and radiation oncologists who see a lot of breast cancer. It is also important to include a breast imager, who can evaluate breast abnormalities with image-guided biopsies. "In most parts of the country, those teams exist, and you just have to seek them out," he says. Another reason we're doing better with breast cancer is because we're offering good, coordinated care. "It's not that breast cancer won't happen," he adds, "but the advances coming along mean the risk will be low when cancer is found."
What Are My Treatment Options?
The main treatments for breast cancer include:
- Chemotherapy (drugs that kill cancer cells, stop them from spreading or slow their growth; may be used before or after surgery and/or radiation)
- Radiation (high-energy x-rays or other types of radiation that kill cancer cells or keep them from growing in targeted spots)
- Surgery (mastectomy, lumpectomy)
- Hormonal therapy (either by blocking hormones that fuel cancer, reducing their production, or removing or shutting down the ovaries, which secrete hormones)
- Targeted therapy (which helps your immune system fight cancer)
These are often combined. Your doctor will evaluate your particular circumstances and type of cancer before making a recommendation.
Mammography: Still the Gold Standard?
Since experimental studies proved the effectiveness of breast cancer screening in the early 1970s, mammography has demonstrated over and over that it's the most effective way to detect breast cancer early, when it's most treatable. In addition, today we have many improvements, alternatives and "increasingly tailored technologies or combination of technologies," says Robert A. Smith, Ph.D, director of cancer screening for the American Cancer Society (ACS). Here's a guide to screening techniques:
Mammograms use x-rays to visualize the inside of the breast. Over time, there have been improvements in reducing radiation dosage, enhancing image quality and improving how films are interpreted. "There's always a desire for a test that is simpler, less expensive and less painful," says Smith. "But right now a significant percentage of women have not been screened recently, and are not being screened regularly according to recommended guidelines. We're missing a lot of opportunities using the tried-and-true technologies that are available." The ACS recommends that women age 40 and up have a clinical breast exam and screening mammogram every year.
Other technologies are available in various circumstances. "We are still accumulating sufficient data on how to use these tools for women's best advantageto not use them unnecessarily but use them to enhance mammography," says Smith. These include:
- Magnetic resonance imaging (MRI). The ACS recommends it for screening women at high risk due to a strong family history of breast or ovarian cancer or because they were treated with radiation for Hodgkin's disease. Note that some cancers are detectable only by MRI and some only by mammography.
- Ultrasound, or sonography. High-frequency sound waves are bounced off tissue to produce a picture. Usually used to evaluate lumps that are hard to see on a mammogram. Not used for routine screening as it can't consistently detect certain early signs of cancer.
- Positron emission tomography (PET). Creates computer images of chemical changes in tissue, highlighted by the injection of radioactive sugar that is absorbed by cancer cells. Most helpful in determining if cancer has spread to distant organs.
- Computer-aided detection (CAD). Uses computers to highlight suspicious areas, after radiologist has reviewed the initial mammogram.
- Experimental techniques. These include 3D mammography; CT scans; and molecular breast imaging (MBI), which shows promise in finding small lesions; it requires much lighter compression of the breast.