Early detection, improved treatment increases breast cancer survival

Published 11:34 am Wednesday, October 14, 2015

Breast cancer.

For a woman or a man, those words strike a chord of fear.

In some ways it should. According to the American Cancer Society, breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer, and about 1 in 8, or 12 percent, of the women in the U.S. will develop invasive breast cancer during their lifetime.

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The American Cancer Society’s estimates for breast cancer in the United States for 2015 indicate about 40,290 women will die from breast cancer.

But among the projections is some good news. After increasing for more than two decades, female breast cancer incidence rates began decreasing in 2000, then dropped by about 7 percent from 2002 to 2003, according to the Cancer Society.

Death rates from breast cancer have been declining since about 1989, with larger decreases in women younger than 50.

At this time, according to the Cancer Society, there are more than 2.8 million breast cancer survivors in the United States, including women still being treated and those who have completed treatment.

Part of the reason is more awareness and the recognition of early detection, and improved treatment options that in some cases can cure breast cancer or help women with cancer live longer, said Dr. Barbara Clark, associate professor of medicine at the University of Mississippi Medical Center and director of UMMC’s Breast Cancer Treatment and Prevention Program.

The first key in the process, she said, is detection.

Detected early, there is a good chance of cure and treatment for the cancer, and it can be less expensive and shorter period depending on the patient, she said.

“Currently the guidelines say starting at age 40, women should get a yearly mammogram and should see their OBGYN or family medicine doctor — their primary care doctor — once a year to get a clinical breast exam, and we recommend they do self-breast exams once a month. If they find anything abnormal, they should call their doctor.”

Although breast cancer in men is still uncommon — generally less than 5 percent of all cases — men should also do self-examinations. If they find any lump, Clark said, they should see their doctor and get it checked out, and that examination may include a mammogram and ultra sound.

She said women who can’t afford cancer care or mammogram can contact the Mississippi State Health Department, which has a Breast and Cervical Cancer Program. If patients get in contact with the department early, she said, MDH workers can assist with that.

“It’s the best option for women in the state,” she said, adding other sources are through The American Cancer Society and the Susan G. Komen Foundation.

Clark said there are some genetic indicators that may put someone at risk for breast cancer, but added, “now most cases of breast cancer are still sporadic, but most are not associated with a genetic mutation, but there are probably about 5 to 10 percent of all cases can be associated with a breast cancer mutation.” “It’s important for people to know their family history,” she said, “And if they have history of breast cancer in a first-degree relative, in a relative who is young, or a family member who has breast cancer in both breasts, see their doctor.” A first-degree relative, Clark said, is immediate relative like a mother, sister or brother.

If a breast cancer is found either on examination or by imaging, she said, “the first thing we do is get a biopsy. That can be done either by the radiologist or the surgeon. The best way is to get a core needle biopsy, which is done with a bigger needle, and it goes in and samples either the mass, if they find it on examination, or the abnormal area on the mammogram.”

Depending on the size of the tumor, or whether doctors believe the lymph nodes next to the breast are involved, there may be a need further imaging or examination looking for more disease, or surgery may be recommended. Clark said the decision depends on the patient and how much of the disease doctors think the person has.

“Sometimes, we start with chemotherapy before surgery,” she said.

Chemotherapy, the use of strong drugs to treat cancer, is based on each individual case, Clark said.

“Every case is individual. It depends on the patient. Sometimes we do chemo before surgery, sometimes after surgery,” she said. “Not everybody requires chemotherapy.”

She said doctors now have better medications now that can support a patient’s white blood cell count and reduce some of the other side effects. “It really depends on the patient and how well they do,” she said.

Another treatment alternative is radiation, which can be part of the treatment for breast cancer.

“Usually, if a patient is going to get radiation, it’s after surgery and usually after chemotherapy,” Clark said. “It is possible to get both treatments.”

Radiation, she said, can cause fatigue, but usually not as much as chemotherapy, and can cause skin irritation.

The length of time a person receives either chemotherapy or radiation depends on the person and the treatment plan.

“If we’re going for a cure, usually, they (patients) get treatment for six months,” Clark said. “Usually, if it is curable, the patient is always going to get surgery.”

Doctors rarely perform mastectomies, where the breast is removed, she said.

“For a lot of patients, we’re doing what’s called breast conservation therapy. Breast conservation means they just usually just take out the cancer, and they always check the lymph nodes if a patient has cancer, but they don’t always have to remove the whole breast.”

Some patients, she said, still request a mastectomy some people opt for it.

But if the cancer spreads to other places, she said, a patient may not have surgery.

“Usually we pick that up before surgery,” she said. “What we do is ask patients about their symptoms, sometimes, depending on how big the cancer is, that’s when we’ll do further imaging to see if it’s spread to other places. If it’s spread to other places, usually we’ll hold off on surgery and try things like chemotherapy.”

For people with breast cancer in its early stage, or even local disease, she said, “We have a good cure rate. One good thing about breast cancer is we have more targeted therapies these days that people can respond to without many side effects, so we are seeing people live longer, even with metastatic disease (cancer that has spread to other places).”

After a patient is cured, Clark said, they still make regular visits to their doctor.

“We follow them lifelong,” she said. “And their higher risk of recurrence usually in the first two to five years, so we see them more frequently early on, and the further out they go, the less we need to see them.

They’re still at risk for the rest of their lives, but it’s less common the farther out they get.”




About John Surratt

John Surratt is a graduate of Louisiana State University with a degree in general studies. He has worked as an editor, reporter and photographer for newspapers in Louisiana, Mississippi and Alabama. He has been a member of The Vicksburg Post staff since 2011 and covers city government. He and his wife attend St. Paul Catholic Church and he is a member of the Port City Kiwanis Club.

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