Fighting
Breast Cancer: Early Detection Leads Defense
October
Is National Breast Cancer Awareness Month
Breakthrough
treatments for breast cancer, such as injecting antibodies that track
down and kill aggressive cancer cells, often grab the headlines and
the public's attention.
But when it comes to detailing the progress
in the war on breast cancer, the real star is early detection.
That is a message
that bears repeating in October, which is National Breast Cancer
Awareness Month.
"Two thirds
of the progress is early detection," says Dr. Robert Smith, director
of cancer screening for the American Cancer Society (ACS).
What else has helped to reduce the breast cancer death
rates, which have been declining since 1989?
"Women responding
to symptoms faster and incremental improvements in treatment,"
Dr. Smith adds.
Guidelines
Continue to Help Women
Nearly 212,000
new cases of breast cancer will be discovered in the US this year, according
to ACS estimates, and more than 40,000 women will die
of the disease.
"The recommendations for annual mammograms [for
women age 40 and older] are very important," Dr. Smith says. "Most
doctors' offices have reminder systems. If they don't, ask for them,
or find a way to mark the calendar so you'll remember, such as getting
it the month of your birthday."
In recent years, debate has flared over the role and
value of regular screening mammograms, with some researchers finding
that such tests have little or no lifesaving value. But more recent
studies have demonstrated their worth.
Authors of more recent studies say the older analyses
that claimed the exams had no life-saving value were scientifically
flawed.
In its new guidelines,
issued earlier this year, the ACS stands firm in its
recommendation that women age 40 and older get annual mammograms. Also
crucial for breast health, the ACS states, is a clinical
breast exam done by a health professional every year for women 40 and
older, and about every three years for women in their 20s and 30s.
While previous guidelines
recommended monthly breast self-exams, the new guidelines make these
optional. The reason is a lack of research showing the exams can reduce
deaths from breast cancer. But the ACS is reluctant
to discourage the practice, since it can make women more familiar with
their breasts and alert to changes.
Prevention
Still Needs Study
But even a woman
who follows the mammography screening recommendations might not be home
free, says Dr. John Glaspy, a professor of medicine at the University
of California Los Angeles Jonsson Cancer Center.
"Most of the things that drive a woman's risk [of
breast cancer] are out of her control," says Dr. Glaspy, referring
to genetic abnormalities such as the BRCA1 or BRCA2 genes that increase
breast cancer risk.
"In general, it is not a lifestyle cancer,"
Dr. Glaspy says.
"The important lesson is, we are not yet at the point where we
can make a woman in this country have a risk of breast cancer so trivial
that it should not be high on her radar screen as something to be aware
of."
Besides following the screening guidelines, a woman
can eat a low-fat diet, although Dr. Glaspy says that is not proven
to reduce breast cancer risk. "Eat for your heart [a low-fat diet]
and that's probably the best you can do at this point for breast health."
Regular physical activity has also been linked with
a lower risk of breast cancer.
At midlife, a woman can do one more thing to reduce
her risk, Dr. Glaspy suggests - avoid hormone replacement therapy (HRT).
"If a woman is taking estrogen and has the absolute
desire to lower her breast cancer risk, she shouldn't be taking estrogen,"
he says.
If a woman does get breast cancer regardless of close
attention to screening, some of the latest treatments may help. For
instance, Herceptin®, a monoclonal antibody given intravenously,
targets cancer cells that make too much of a protein and can help a
woman with metastatic breast cancer survive longer.
The future will bring more of these targeted treatments,
Dr. Glaspy predicts. "More targeted therapies are being looked
at, particularly in combination with Herceptin®," he says.
Advances in screening are progressing, too, Dr. Smith
says. Methods that look promising include digital mammography, in which
the image can be manipulated so specific areas of the breast can be
examined more carefully.
Always consult your
physician for more information.
Online
Resources
American
Cancer Society
American
Society for Clinical Oncology
Centers
for Disease Control and Prevention (CDC)
National
Cancer Institute (NCI)
National
Institutes of Health (NIH)
National
Women's Health Information Center
Susan
G. Komen Breast Cancer Foundation |
October 2003
In
This Issue:
Fighting
Breast Cancer: Early Detection Leads Defense
Guidelines
Continue to Help Women
Prevention
Still Needs Study
Breast
Cancers Can Be Different, Approach Should Vary
Online
Resources
Other
Resources:
St.
John's Mercy Cancer Services
Find
a St. John's Mercy Physician
Breast
Health Information
Women's
Health Information
St.
John's Mercy Classes and Programs
Breast
Cancers Can Be Different, Approach Should Vary
Not all breast cancer tumors
are alike, and not all play by the same rules. And that, in turn,
may dramatically affect the course of the disease and the choice of
treatment.
That
is the suggestion of a new study in the medical journal Cancer.
Here, researchers highlight the impact
of possible biological differences in the tumors of women whose cancer
is linked to the BRCA1 gene mutation - an inherited genetic defect
that appears to produce highly aggressive tumors.
"What this finding speaks to is
a difference in tumor biology," says study author Dr. William
D. Foulkes, director of cancer genetics at McGill University in Montreal.
"And the consequence of that is
we may need to apply a different set of rules when investigating,
for example, the benefits of screening, early detection, and treatment,
in carriers of BRCA1," Dr. Foulkes says.
According to Dr. Foulkes, in the past
most breast tumors were believed to be quite predictable, with a common
correlation between tumor size, the spread of the cancer cells to
the nearby lymph nodes, and the severity of the disease itself.
But contrary to this accepted cancer
logic, the new study found that even when tumors are small or the
breast cancer does not invade lymph nodes, women with the BRCA1 gene
mutation still frequently experience a virulent and aggressive form
of this disease.
"Now research shows not all tumors
play by the same rules, and that when a genetic mutation is present,
as in BRCA1, the rules are different," Dr. Foulkes says.
"And that fact can affect detection,
prevention, as well as treatment," he says.
The research group, led by Dr. Foulkes,
looked at a total of 1,555 women with invasive breast cancer.
Of the group, 276 women carried the BRCA1
gene, 136 had the BRCA2 gene (a slightly less aggressive gene mutation)
and 1,143 women had no known genetic link to breast cancer.
Each patient's disease was categorized
according to the size of her tumor. Based on that, the researchers
used a mathematical calculation to estimate the chance of lymph node
involvement.
When lymph nodes are involved, it generally
indicates a more aggressive form of the disease and the need for more
dramatic follow-up treatment, including chemotherapy.
Dr. Foulkes' team found a significant
correlation between tumor size and lymph node involvement in the women
who did not carry any gene mutations, as well as for women who carried
the BRCA2 gene.
Specifically, the larger the tumor, the
greater the chance the cancer would invade lymph nodes.
But the calculations did not apply to
the cancer patients who carried the BRCA1 genetic mutation.
For these women, Dr. Foulkes says, the
conventional breast cancer factors - tumor size and lymph node involvement
- did not appear to predict the course of disease.
Ultimately, he says, this may indicate
an entirely new and different disease progression when gene mutations
are a part of the diagnostic picture.
Always consult your physician for more
information.
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