The American Cancer Society estimates that more women are diagnosed with breast cancer each year than any other form of cancer except for skin cancer. More than three million women living in this country right now have had the disease, and one in eight will be diagnosed with it.
Although women can get breast cancer at any age, the risk grows with age, starting at age 40 and rapidly increasing for women older than 50. Other important risk factors include a personal or family history of breast cancer, never having children or having a first child after age 30 and a long menstrual history (menstrual periods starting early and ending late in life). Breast cancer has also been linked to obesity, inactivity and consuming alcoholic beverages.
Early detection continues to be the single most important factor in battling breast cancer. The National Cancer Institute estimates a survival rate above 96 percent when cancer is diagnosed and treated early. Conventional X-ray mammography remains the primary diagnostic tool for detecting breast cancer even before a lump can be felt by a woman or her doctor.
Most breast health experts recommend that women age 40 and older have a yearly mammogram, an annual breast exam by their health care provider and conduct monthly breast self-exams. Those under age 40 should perform monthly breast self-exams and have a breast exam by a health care professional every three years.
However, remarkable new advances are being made in diagnosing and treating breast cancer, and many of them are available to patients in Southwest Florida.
Digital mammography, a process that stores images of breast tissue on a computer instead of film, is rapidly gaining attention and acceptance in the medical community. H. Lee Moffitt Cancer Center & Research Institute in Tampa, the only National Cancer Institute Comprehensive Cancer Center in Florida and one of only 40 in the nation, was one of the first centers to make digital mammography available to patients.
Dr. Charles E. Cox of the Comprehensive Breast Cancer Program at Moffitt says digital mammography offers advantages over traditional mammography in several important ways. "It uses one-third of the amount of radiation required in traditional mammography, allows images to be viewed at different angles and to be analyzed by computer assisted diagnosis (CAD) for greater accuracy," he says. "We hope that in the future, doctors at Moffitt can receive digital mammography images over the Internet for consultations or second opinions."
While Cox predicts that digital mammography will eventually phase out traditional mammography, don't expect it to happen overnight. "The equipment is extremely expensive, so it probably won't be widely available for years, and some minor limitations need to be ironed out," he says. "For example, the machine now only accommodates up to a C-cup breast, and that leaves out 25 to 30 percent of the population."
Moffitt was also on the forefront as the first center in Florida to offer a dedicated breast MRI, the most sensitive technology available for finding abnormalities in breast tissue. Although not a substitute for mammography, the technique produces exquisite images of the breast in multiple planes and can provide additional insight in specific cases, such as for women with breast implants or dense breast tissue. Dr. Cox also says breast MRI is an excellent tool to help determine treatment, plan surgery and detect recurrence.
On the cutting edge of breast cancer detection is seed localized biopsy. In this process, a tiny, low-dose radioactive seed is inserted into a suspicious lump through a needle as a diagnostic marker. A hand-held gamma probe is then passed over the breast to detect the exact location of the radioactive seed, pinpointing exactly where a biopsy needs to be done.
Although not brand-new, ultrasound technology continues to be a useful tool in the fight against breast cancer. This method uses high-frequency sound waves to create an image, and the higher frequency waves used today allow better image quality than was available just a few years ago.
Cox emphasizes that each patient's unique circumstances must be carefully considered when choosing one or more diagnostic tools to detect breast cancer. "It is critically important that women who detect a lump be proactive and get a final answer about their diagnosis that they are satisfied with," he says. "I've had long, detailed conversations with thousands of women explaining test results. To me, it's much better to do a lot of talking with patients than for them to have uncertainty about their health."
In recent years, phenomenal advances have also been made in treating breast cancer once it's found. "Across the board from early to advanced stages of breast cancer, we've seen much better survival rates, longer life expectancy and higher quality of life," Cox says.
In the past, most breast cancer patients' lymph nodes were routinely removed either because cancer had already spread there or as a precaution to prevent cancer from attacking the lymph nodes. Unfortunately, removing the lymph nodes can lead to pain, swelling, numbness and lack of mobility in the patient's arm, and reduced ability to fight off infections. Now, sentinel node mapping technology allows more accurate evaluation of whether cancer has spread to the lymph nodes.
In the procedure, Cox says, "We inject a radioactive substance and a blue dye into the breast around the tumor. The dye travels to the lymph glands and shows us the first lymph node where cancer could have spread. Then a small incision is made under the arm, the first lymph node is removed and sent to pathology for evaluation." Dr. Cox goes on to explain that 10 percent more cancer is found this way than by older techniques; and 70 percent of the time, patients' cancer hasn't spread to the lymph nodes, so their removal and resulting side effects may be completely avoided.
The newest way to treat breast cancer that doctors at Moffitt are studying is testing individual breast tumors for genetic patterns, then using this information to attack the tumor at the molecular level. Unlike chemotherapy, which blocks all cell division, this treatment selectively targets just cancer cells. The result can be less toxicity and fewer side effects.
In the realm of endocrine therapy, which aims to block estrogen and the growth of cancer cells, two new aromatase inhibitors called Arimidex and Letrozole offer promising results, including fewer instances of weight gain, hot flashes, mood swings, blood clots or strokes and other adverse side effects.
Ovarian suppression therapy, which also slows the growth of cancer cells, is a relatively new option often used along with endocrine therapy. Because this therapy doesn't compromise a woman's fertility, it's an increasingly popular choice for treating pre-menopausal women in their 30s and 40s who may still want to have children.
Within the past two to three years, promising new techniques have also been developed in radiation therapy delivery. In just 10 minutes, a hand-held positron emission device can now deliver radiation therapy that in the past would have required five weeks of treatment. New devices can also be inserted into a lumpectomy cavity to deliver radiation treatments, once again minimizing the length of treatment and reducing the radiation dosages.
Ongoing modifications of chemotherapy regimes are continually being fine-tuned, says Cox. Many new therapy schedules combined with advanced drugs that counteract side effects are showing extremely positive outcomes.
Of course surgical options such as lumpectomy (the cancerous lump is removed) and mastectomy (one-quarter to the entire breast is removed) continue to be used when necessary. But with the marked increase in early detection, fewer women than ever are losing their breasts in the fight against cancer.
While some of the most advanced diagnostic and treatment technologies for fighting breast cancer are not yet available locally, a recent affiliation between Sarasota Memorial Hospital and Moffitt Cancer Center may give Sarasota residents greater access to clinical studies and additional diagnostic tools or treatments at Moffitt when standard protocols are not effective.