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Beating Breast Cancer

Photo by Brevin Blach
ONE OF THE PERSISTENT MYTHS about breast cancer is that it most frequently occurs in women who have a family history of the disease.

“I hear that all the time, and it means nothing,” says Dr. Anne Wallace, director of the breast care unit at the Moores UCSD Cancer Center and former chair of the California Breast Cancer Research Council. Women with a family history of breast cancer, either on the mother’s or father’s side, do have a higher risk of developing the disease, but in the vast majority of cases— about 80 percent, says Wallace—there’s no direct family link to the cancer.

Nearly 216,000 women in the United States will be diagnosed with invasive breast cancer this year, and about 40,000 will die from it, according to the American Cancer Society. There currently are more than 2 million women living in the United States who have been treated for the disease, the most common cancer among American women. The average woman, who doesn’t carry an abnormal breast cancer gene, has about a one in eight chance of developing the disease over her lifespan.

As daunting as these statistics appear, the good news is that survival rates for all types of breast cancer are improving across the board, says Wallace, including cases where the cancer has metastasized to other parts of the body. Increasingly, she says, better understanding of the biology of breast cancer and new treatment methods are leading medical science to view breast cancer as a chronic disease rather than a lethal one.

Mammograms remain one of the main tools in the early detection of breast cancer. While breast cancer can develop at any age in adulthood, the chance of its occurring increases with age, and 75 percent of cases are in women over 50.

In addition to an annual clinical exam by a doctor and performing self-examinations each month, women over 40 should have a mammogram every year. Use of MRI technology has been highly touted in recent years as a diagnostic tool for breast cancer, but for most women it should be used as an additional resource to a screening mammogram and one that is ordered by a breastcare specialist, not just a woman’s primary physician, Wallace says. The MRI is expensive, she adds, and indiscriminate use of it led one large insurance company to halt coverage (it has since been reinstated). “MRI use in the right person is fabulous,” Wallace says.

ONE OF THE MOST PROMISING developments in the hormonal treatment of breast cancer involves the manipulation of estrogen in patients, Wallace says. For more than 20 years, the drug tamoxifen, which blocks estrogen’s ability to activate cancer cells, has been shown in some cases to prevent cancer from occurring, progressing or recurring.

A newer class of drugs known as aromatase inhibitors limits the production of estrogen by keeping the hormone androgen from being converted to estrogen in post-menopausal women. Wallace says two recent studies indicate that use of certain aromatase inhibitors after treatment with tamoxifen may be an exceptionally powerful tool in fighting breast cancer.

In a major international study of breast cancer survivors released in October 2003, researchers said women taking the aromatase inhibitor letrozole after completing five years of drug therapy with tamoxifen were significantly less likely to have their breast cancers return than women who were not taking letrozole. In another large study released last March, it was found that women who took tamoxifen for two or three years after surgery to remove breast cancer, and then switched to the aromatase inhibitor exemestane, had fewer recurrences of breast cancer than women who stayed on tamoxifen for five years following surgery. Advancements also are being made in using radiation to treat breast cancer, specifically through a technique called brachytherapy. In this procedure, which involves partial breast irradiation, small radioactive seeds are implanted in tissue around the location of a removed tumor. A much shorter period of radiation is needed—about a week, rather than the standard six-week sessions, Wallace says, and maximum doses of radiation can be used without exposing other tissues or nearby organs.

For breast cancer patients who require reconstruction, Wallace says it’s important to know that such surgery is not considered cosmetic (which is not covered by insurance). “It’s a woman’s right to have both breasts reconstructed for symmetry,” she says. Wallace adds that it’s also a misconception that a woman who has been treated with radiation for breast cancer is not eligible for later reconstructive surgery. “It’s slightly more challenging, but it can be done,” she says.
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