Breast Cancer - Spotlight on Breast Cancer
Breast cancer is the most common cancer in women in the United States. Approximately 225,000 new breast cancers will be diagnosed in this country in 2005. Almost one in every eight women will develop breast cancer during her lifetime. The risk of getting breast cancer increases with age; therefore, the risk in an eighty-year old is greater than the risk in a sixty-year old. About 45,000 women will die of breast cancer in 2005. Despite the increasing numbers of patients who are diagnosed with breast cancer, the risk of dying of the disease remains the same or is diminishing slightly. Earlier diagnosis is the primary reason for these improved cure rates, although better treatments also play a role.
Many risk factors influence the chance that any woman will develop breast cancer. Most important is family history. The greatest risk is in women who have a mother, daughter, or sister with the disease, especially if they developed breast cancer before menopause or if both breasts were affected. Families with a history of male breast cancer or relatives with ovarian cancer are also at increased risk. Breast cancer genes can be detected in about 5% of breast cancer patients. Individuals with one of the above risk factors are more likely to have the breast cancer gene. Patients who fit the above criteria should ask their doctor if they are candidates for a genetic risk assessment program. Other factors which increase the risk of breast cancer include: early onset of menstrual periods (age 10 or younger), first term pregnancy after age 30, no term pregnancies, late menopause (after age 55).
There are no proven ways to prevent breast cancer. Diet, cigarette and alcohol use have been suggested to increase your risk for getting breast cancer, however, that has not been proven. Early diagnosis is really the key to lowering the risk of dying from breast cancer. Every woman should have a baseline mammogram at about age 35. Annual mammography should begin at age 40. Ultrasound is used to aid in further evaluation in certain mammogram findings. MRI can also be very useful in high-risk patients or in those where mammograms are difficult to interpret. Because mammograms still fail to identify 10-15% of all cancers, an annual physical examination should be performed by a qualified examiner. Abnormal findings on either mammogram or physical examination must be followed by some type of biopsy to determine it there is cancer.
Surgery is still the primary treatment for breast cancer. The tumor must be removed, but in most cases this can be done without sacrificing the breast, a “lumpectomy.” Some patients still require the removal of the entire breast, a “mastectomy.” Most patients who have mastectomy are able to have plastic surgery to reconstruct a new breast. Most patients who have a lumpectomy require radiation treatments to reduce the risk of cancer returning in the treated breast. At the time of surgery, many patients undergo removal of the lymph glands in the armpit to determine whether cancer cells have spread to that area. A new procedure called a sentinel lymph node biopsy is now being used in many centers to avoid removing all lymph glands in many patients.
After recovery from surgery, chemotherapy is recommended for a large number of patients. Need for such treatments is determined by the type and size of the tumor, presence of involved lymph nodes, the patient’s age and general health status, as well as other factors. These treatments can lower the risk of the tumor returning, or delay its reappearance. Side effects of chemotherapy include loss of hair, nausea and vomiting, and lowering of blood counts with increased risk or infection. Additionally, some patients are given hormone-blocking drugs which have less significant side effects than chemotherapy but are also effective in increasing the cure rate in selected patients.
Although breast cancer still affects many women in this country, early diagnosis and treatment have had a positive effect on increasing cure rates in recent years. Ongoing research is aimed at identifying ways to prevent breast cancer, improving diagnostic methods, finding less invasive surgical treatments, and developing safer and more effective drugs to prevent tumors from returning.
Robert D. Smink, Jr. MD is a Fellow of the College of Physicians of Philadelphia. He is Chief of Surgery at Lankenau Hospital, http://www.mainlinehealth.org/lh/
