South Florida Hospital News
Sunday September 22, 2019
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October 2015 - Volume 12 - Issue 4

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Advances in the Fight Against Breast Cancer

In the United States, breast cancer is the most common cancer in women and the second most common cause of death from cancer. One of every eight women will develop breast cancer during her lifetime. The risk of breast cancer increases with age and peaks between 60 and 65 years. In addition to inherited genetic factors, other factors increase the risk. Models have been developed to estimate the individual relative risk that each woman has of developing breast cancer, for example, this one developed by the National Cancer Institute (http://www.cancer.gov/bcrisktool/). This simple questionnaire is available to anyone to predict their risk compared to the general population.
 
A major advance in breast cancer prevention in the last 15 years has been the demonstration that pharmacologic intervention with certain drugs, Tamoxifen, Raloxifen, and Aromatase inhibitors, for example, can reduce the relative risk of breast cancer up to 65% in women who have a high risk. This effective prevention approach called chemoprevention unfortunately has been grossly underutilized.
In the area of early detection, an advance has been the introduction of magnetic resonance imaging in order to detect small tumors in breasts with fibrocystic disease or dense areas of connective tissue. In these women MRI screening is needed with mammography and ultrasound studies are negative.
The magnitude or size of the surgical intervention has been shrinking steadily without compromising the probability of a cure. The crippling classic Halstead Radical Mastectomy that was the standard of care for more than 60 years has been replaced by the Conservation Surgery approach in which only the tumor and a limited area of normal breast tissue surrounding it are excised. It is the lumpectomy of segmental mastectomy that preserves more of the breast tissue.
 
In the past few years studies by the American Surgeons Oncology Group (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874252/) and others have shown that the customary dissection of axillary lymph nodes when the so-called sentinel nodes are positive for metastasis is not necessary in many cases thus eliminating the dreadful upper extremity lymphedema that complicates the axillary dissection.
 
Another step forward in the search for less invasive treatment modalities has been a realization that in many women, especially the elderly with small, hormone receptor-positive tumors, the customary radiation of the breast remaining after the lumpectomy can be omitted.
 
Another major advance is the development of tests that analyze the expression of a number of genes in the tumor to predict if the addition of chemotherapy to hormonal treatment will or will not improve the probability of a cure (the Oncotype DX assay). This is also beneficial for determining treatment plans for colon and prostate cancers.
 
The development of a new class of drugs that are not “chemotherapy” and work by blocking the entrance of growth factors into the tumor cells or by interrupting the growth pathways within the tumor cells has been explosive during the past decade and has significantly improved the survival among breast cancer patients. The use of these drugs that spare normal cells is known as targeted therapy of cancer. They belong to the class of “monoclonal antibodies” or “tyrosine kinase inhibitors.”
 
In summary, we are winning the battle against breast cancer. Age adjusted breast cancer mortality rates have declined about 2% per year over the period from 2002 to 2011 and patients live longer. Still, the key to a cure remains early diagnosis. The 20-year breast cancer-specific disease free survival for women without axillary lymph nodes metastasis and tumors smaller than 1.0 centimeter is 92%. To this effect it is essential that all women with an average risk of breast cancer start annual routine mammography screening at the age of 40 years. All women should consult their primary care physician, specialist, and/or an authorized health care organization about their particular risk category and early diagnosis recommendations.
Dr. Carlos Dominguez is Director, Hematology/Oncology Program, Larkin Community Hospital. He can be reached at the Larkin Outpatient Multispecialty Center at (305) 228-4675.
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