The 411 on breast cancer
The latest information about breast cancer treatment - and what's on the horizon.
The numbers are still sobering: One in eight women gets breast cancer at some point. This year, the American Cancer Society estimates that 182,460 in the U.S. will be diagnosed, and as local breast cancer crusader Dr. Marisa Weiss says forthrightly: "It's a devastating disease. It snatches away people's quality of life."
But the outlook for patients keeps improving. Nine out of 10 women with early stage breast cancer now survive it for at least 5 years. Surgery is often less invasive than patients fear it will be. And follow-up care to keep the cancer from spreading or returning has become more individualized, making it more effective.
The tumors that surgeons remove from women's breasts now undergo batteries of special tests so doctors can determine what kind of breast cancer they're up against and decide how to proceed, an approach sometimes called targeted therapy.
Weiss, a radiation oncologist at Lankenau Hospital, is the founder and president of breastcancer.org, a nationally acclaimed resource for patients. She says it's critical to know there's no one-size-fits-all "best" treatment. "There are so many different types of breast cancer," she says. "It requires a very careful diagnostic intelligence gathering."
Today's care
Often combines surgery with one or more adjuvant (after-surgery) treatments, which attack any traces of cancer that might remain or come back.
In early stage breast cancer, lumpectomy surgery followed by radiation is medically as effective as a mastectomy. Still, some women choose to have a mastectomy and it's an equally valid option.
Lumpectomies are almost always followed by radiation, and mastectomies sometimes are. Some patients also get chemotherapy, take some type of medicine (either by pill or injection), or do both.
After the tumor is removed, pathologists test it so doctors can custom-design follow-up treatments. If the pathologist sees that the tumor is the type of breast cancer that's fed by estrogen, doctors may prescribe tamoxifen pills or a class of drugs called aromatase inhibitors, also taken as pills.
If the pathologist finds that the tumor is "HER2-positive," doctors may prescribe Herceptin, a medicine that's taken intravenously or, for stubborn cases, Tykerb, taken as a pill.
Some women with advanced breast cancer may benefit from clinical trials that add new medicines to established treatments to see if they offer better results.
If you've just been diagnosed, a call to the American Cancer Society's toll-free helpline is a good way to begin sorting things out. The number is 800-227-2345.
On the horizon
A new drug for advanced breast cancer. In February, the FDA fast-tracked a temporary approval for a new targeted therapy using the medicine Avastin to treat advanced breast cancer. It's noteworthy because it's a new class of breast-cancer medicine. The steps that could lead to permanent FDA approval are under way.
More convenient radiation. After a lumpectomy, women now visit the hospital daily for six-plus weeks of radiation. Doctors are experimenting with a new approach called accelerated partial breast irradiation (APBI) that might shorten the duration for some patients to just a week or two.
New diagnostics. An emerging test called Oncotype DX looks at 21 different genes in a breast-cancer tumor. It can help doctors figure out if a woman with early stage cancer may be able to avoid chemotherapy. Insurance companies are just beginning to cover the costs.
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