As a surgical oncologist focused on treating breast cancer, I see daily how devastating a breast cancer diagnosis can be. But I also see daily how new and often cutting-edge treatments give women the hope and courage they need to help manage or overcome the physical, mental and emotional challenges of breast cancer, and in many cases, beat the disease altogether.
One in eight women will develop breast cancer in her lifetime. While the leading risk factors are well-known — older age, family history, mutations in certain genes — the most important risk factor for breast cancer is simply being a woman.
The fact that any woman can develop breast cancer is one reason annual mammograms and clinical breast exams are so important; regular screening helps detect cancer early. As with every type of cancer, when breast cancer is discovered early there are more treatment options available, survival rates are longer and the cure rate is higher.
In the U.S., trends in breast cancer are encouraging. Data from the National Cancer Institute (NCI) show consistent declines in both new cases and deaths from breast cancer since 1990. Further, the U.S. Centers for Disease Control and Prevention (CDC) reports that from 2001 to 2010 the incidence of breast cancer among U.S. women did not increase, while mortality decreased 2 percent annually.
What's most notable about these data is that breast cancer mortality is decreasing faster than incidence — meaning that women with breast cancer are living longer. That trend also is borne out by NCI data: Although only 75 percent of women with breast cancer survived more than five years in 1975, in 2011 more than 90 percent did.
There may be several reasons behind the decline in breast cancer deaths. However, new technologies and improvements in existing treatments are very likely contributing to higher survival rates and improved quality of life for women with breast cancer.
For example, a new technology called the MarginProbe System helps surgeons determine if cancer cells are present in the margins of tissue that has been removed. The technology helps reduce the rate of second surgeries following lumpectomy. In addition to continued refinements in breast-conserving and reconstructive oncoplastic surgery techniques, there is an array of advanced treatment technologies available today.
Genomic testing is an innovative new diagnostic tool that allows tumors to be examined on a genetic level. By identifying mutations that occur in a cancer cell's genome, doctors can better understand what caused the tumor and tailor treatment based on these findings. Genomic testing might suggest a drug normally used for another type of cancer could be an appropriate treatment for breast cancer based on the genetic properties of the tumor.
Another example is intraoperative radiation therapy (IORT), one of many new technologies that deliver radiation more precisely, helping minimize damage to healthy tissue and treatment times. With IORT, radiation is delivered directly to the tumor site after a surgeon has removed the tumor. A 30-minute dose of IORT can often replace weeks of traditional radiation.
In addition to radiation, there have been numerous advances in chemotherapy treatments for breast cancer. Targeted therapy blocks specific molecules involved in tumor growth by directing drugs or other specially created compounds (e.g., man-made immune system proteins) to attack cancer cells. A targeted therapy called chemoembolization delivers medication through a catheter directly into a tumor using image guidance. The chemotherapy drugs are mixed with particles, called microspheres, which block blood flow to the tumor.
With so many options available to treat breast cancer today, treatments can almost be tailored to the individual based on factors such as her genetic profile, location of the tumor, the type of tumor and whether the cancer has spread, among others. However, which treatment a woman ultimately chooses is a very personal decision best made in collaboration with her family, personal physician and oncologist.
The specter of breast cancer can be frightening, but it is important to remember that most women will not develop the disease. Women who are at an increased risk should talk to their doctors about how often they should receive mammograms and what other screenings, such as genetic testing, might be beneficial. Although breast cancer continues to claim too many lives — more than 40,000 this year — advanced treatment options are having a significant impact on survivability and quality of life.
Anita Johnson, M.D., FACS, is medical director of breast surgical oncology at Cancer Treatment Centers of America at Southeastern Regional Medical Center in Newnan, Georgia.