From the development of new drugs to innovative surgical procedures, advances are being made in the fight against breast cancer.

The drugs tamoxifen and raloxifene have been used to treat breast cancer in high-risk individuals for more than 20 years, surgical oncologist at the Mississippi Breast Center in Jackson Dr. Phillip Ley said, but now a class of drugs referred to as callaromatase inhibitors have been added to the list.

Since estrogen stimulates the growth of hormone-receptor-positive breast cancer cells, Ley, who focuses primarily on surgery for cancers of the breast, said the new drugs work by restricting the amount of estrogen released in the body.

“All of these drugs are used in the adjuvant (postoperative) treatment of hormone receptor-positive breast cancer and all act to reduce breast cancer incidence through negating the effect of endogenous (body-produced) estrogen in the breast,” he said.

Also revolutionizing the fight against breast cancer are targeted therapies and personalized treatment plans.

“FDA approval of Herceptin for patients with her2neu-positive tumors, in the (postoperative) treatment of early-stage breast cancers has dramatically changed outcomes for that patient group,” Ley said, and shrinking breast cancer tumors prior to surgery with the use of Herceptin along with Perjeta, another monoclonal antibody, is leading to impressive clinical responses and improved outcomes.

“It has heightened interest in preoperative treatment in general, which I have been doing since 1996,” he said.

Genetic testing and counseling are also gaining traction in breast cancer advances.

“Research into the genetic roots of breast cancer at the basic science level is ongoing,” Ley said, and he advised that if a family has multiple cancers, early-onset cancers or rare cancers, genetic testing should be considered.

Families seeking providers for genetic testing should look for a company that has excellent quality control, patient support and a sound, extensive and accurate database, Ley said.

“The Hereditary Cancer Risk Assessment program at Mississippi Breast Center uses two longstanding, reputable companies and has a clinical research trial relationship with City of Hope National Medical Center, a national comprehensive cancer center in Duarte, Calif. As part of City of Hope’s Clinical Cancer Genomics National Research Network, we have access to trials for patients whose family histories suggest a genetic link who have negative commercial assays, and for patients potentially at risk who may have an inability to financially access commercial testing, but qualify for a clinical trial,” Ley said. “This is a new step for us, and we are excited about it, as is City of Hope, as it expands their clinical research access to large African-American families.”

In addition to the new drugs being used and genetic testing, early detection is also key in the battle.

While the use of digital mammography is just about universally available in Mississippi, Ley said, a new dimension in breast cancer detection is breast tomosynthesis.

“Breast tomosynthesis is, in essence, a 3D mammogram that is especially useful for finding small tumors in dense breasts, but is not universally reimbursed for screening and diagnostic purposes. I am continuing my quest to get an automated whole breast ultrasound unit in our service area for low-cost screening of patients with dense breasts. Like techniques on the horizon such as molecular breast imaging and circulating tumor cell assays, implementation is dependent on studies documenting clinical validation and third-party reimbursement,” he said.

As for advances on the surgical front, oncoplastic surgery is a course of action Ley said he has been using increasingly.

“Oncoplastic surgery is the use of plastic surgical techniques in cancer management and has particular application in breast cancer management, where it can permit wider margins and expand the indications for breast conservation,” Ley said.

“Skin and nipple-sparing total mastectomies, breast-conserving operations combined with breast reductions and lifts, cosmetic incision placement, tissue rearrangements to maintain shape and contour following lumpectomies are all part of oncoplastic breast surgery,” Ley said, adding oncoplastic surgery is much more than devices and technology.

“It is about adherence to sound oncologic surgical principles while maintaining a thoughtful eye to cosmetic outcome,” Ley said, and added that he along with Dr. Scott Runnels, who is a certified plastic surgeon, have performed close to 200 lumpectomies and reductions/lifts, with excellent cosmetic results and very low recurrence rates.

While many of the advances are promising, prevention is an important element.

As an advisor to the Mississippi affiliate of the American Cancer Society, a supporter of the Mississippi Witness Project, a group of community–minded individuals who have had a personal experience with breast cancer, and an advocate for breast cancer awareness who speaks regularly to cancer support groups and healthcare forums around the state, Ley advises a person who is at average risk of developing breast cancer, that maintaining a healthy lifestyle could help thwart the disease.

“Achieving and maintaining a normal body mass index through diet and exercise has a mild to moderate effect on breast cancer risk,” he said. “Alcohol use limited to casual or occasional intake is also helpful at mildly reducing risk, and limiting the use of combined hormone replacement therapy, with estrogen and progesterone, to a few (2-3) years also avoids increasing risk.”