New Issues in Breast Cancer

Stephanie R. Moline, M.D.
Breast Surgeon
Cancer Care Northwest

Breast cancer strikes fear in the hearts of many women. It is the second deadliest cancer in the US and 192,000 new cases were expected in 2001. Breast cancer is feared because it involves a woman’s self image in a way that other diseases may not. An estimated 40,000 women died of breast cancer in 2001, but the number of deaths has decreased significantly in recent years, with largest decrease in younger women. This is due in large part to progress in diagnosis, treatment, and prevention research.

Mammography is under scrutiny in the media after recent studies say that mammograms do not help you live longer. American Cancer Society recommendations include mammograms starting at age 40, but no study has ever proven that this would save lives. Statistical analysis and differences between studies in the past make conclusions difficult, and many researchers still disagree. Until another test to find breast cancer can be found, mammograms are accepted as the best way to find cancer at the smallest possible stage, before cancer can be felt. Finding breast cancer early is thought to be the best way to beat it.

A recent large study of hormone replacement was suspended due to an increased rate of breast cancer in women on hormone replacement. Although this is important news, it has long been known that estrogen for more than short-term use after menopause increases the risk of developing breast cancer. The thought was that benefits outweighed risks, and this is now more questionable. More evaluation is still needed. Hormone replacement remains an individual decision between a woman and her physician, but this recent information adds weight to avoiding routine long term post menopausal estrogen use.

Clinical trials are important in all medicine, and trials helped establish current standard breast cancer treatments such as breast conservation, different chemotherapies, and hormone therapies. New trials show the benefits of prevention, using hormonal therapy in high-risk women to reduce the incidence of breast cancer. Ongoing surgical trials evaluate the use of sentinel lymph node biopsy, skin-sparing mastectomies, and the role of reconstruction. Other studies involve evaluation of radiation therapy, a mainstay in the treatment of breast cancer, by studying the need for radiation after mastectomy, as well as comparing partial and whole breast radiation.

New treatments on the horizon include treatments to increase or fix the body’s natural ability to fight breast cancer, such as vaccinating a patient against her tumor, or use medicine to prevent new blood vessels to grow into tumor. Also under study are better ways to target toxic chemotherapy to tumor cells.

Ongoing trials in diagnosis, treatment, and prevention will help women and breast cancer physicians make important decisions in the future. Mammography is still recommended until a better screening test can be found, and new frontiers of prevention are being explored. Treatment options are answered today in a multi-disciplinary fashion, including surgery, medical therapy, and radiation oncology fields, as well as others. Research is ongoing in many of these areas, and answers will be found by multiple specialists working together in cooperation.