BY HAILEY HUDSON OCT 2019
Any kind of cancer is terrifying, and breast cancer is no exception. This type of cancer is common—it’s the second most commonly diagnosed cancer in women, right after skin cancer— and unfortunately, thousands of women will die from the disease every year. However, there is a lot of research being done to help doctors learn how to combat this disease, and scientists are making strides in the way breast cancer is diagnosed and treated. Here’s how:
Breast Cancer Statistics
According to the National Cancer Institute, based on current incidence rates, 12.4% of women born in the United States today will develop breast cancer at some time during their lives. This estimate, from the most recent SEER Cancer Statistics Review (a report published annually by the National Cancer Institute’s [NCI] Surveillance, Epidemiology, and End Results [SEER] Program), is based on breast cancer statistics for the years 2007 through 2009. The news isn’t all bad, however—death rates have been decreasing since 1989, possibly due to less women using hormone replacement therapy, which causes an increased breast cancer risk.
Innovations in Diagnosis
Breast cancer is often diagnosed through a breast exam, mammogram, breast ultrasound, biopsy, or possibly an MRI. The medical field is quickly changing, however, and the methods used to detect breast cancer are increasing and becoming more efficient.
The Dana-Farber Cancer Institute, the fifth largest cancer center in the U.S., states they offer one or more of the following procedures:
• Mammogram: X-ray images of the breast. At DF/BWCC, we use digital mammograms, which provide a clear two-dimensional image highlighting unusual structures such as calcifications or masses, which may need further evaluation. Three-dimensional imaging is an FDA-approved advanced technology that takes multiple images, or X-rays of breast tissue to create a 3D picture of the breast. You may also hear it called breast tomosynthesis. Unlike a traditional mammogram, which only takes one single image, breast tomosynthesis takes multiple images. These multiple images of breast tissue slices give doctors a clearer image of breast masses, and makes it easier to detect breast cancer.
• MRI (magnetic resonance imaging): Imaging that may show abnormal tissue more clearly than a mammogram. MRIs are used in special situations, often for individuals who have a genetic predisposition to breast cancer, and unclear mammograms.
• Ultrasound: Imaging that can capture the size and structure of a potential tumor. Ultrasound is rarely used for cancer screening because not all cancers are visible on ultrasound. However, in conjunction with mammography, it is a highly useful tool for diagnosis. For example, ultrasound can further characterize an abnormality seen on a mammogram, or help guide the needle during a breast biopsy. It can also help in patients with fibrocystic breasts.
• CT (computed tomography): In some cases, more extensive imaging may be necessary to determine whether breast cancer has spread beyond the breast. When this is the case, CT scans and/or bone scans may be used. In select cases, a PET (positron emission tomography) scan may also be necessary.
“Here at Navicent Health, we diagnose over 200 cases of breast cancer per year,” says Jill Hancock, RN, BSN, OCN, Nurse Director for Breast Care Center at Navicent Health. “We have three certified trained Breast Health Specialists to help assist the patients along their breast cancer journey.”
Within the last several years, we have seen the introduction to 3D tomosynthesis mammography. She explains that this 3D technology can locate cancers at an earlier stage. “When added to standard 2D digital mammography, 3D tomosynthesis depicts an additional one to two cancers per thousand women screened in the first round of screening.”
Ninety-five percent of the time with regular mamography, callbacks end up being a false positive—normal overlapping tissue, or benign cysts. These false positives can cause unnecessary radiation plus a lot of stress and fear. Tomosynthesis, however, reduces the number of false positive studies, so it reduces worry and heartache, too.
According to Kendra Brown, Radiology Manager at Pavilion Diagnostic Center at Houston Healthcare, the center has been providing 3D mammography services (breast tomosynthesis) at both the Pavilion Diagnostic Center and Perry Hospital for more than two years. The technology for 3D mammography allows for a clearer image of the breast tissue and provides the radiologist with more detailed images. This advanced technology has the ability to find tumors and other abnormalities not seen with 2D mammography alone.
All screening mammograms at Houston Healthcare are routinely completed using the combination of 2D and 3D mammography, with the exception of specific cases where 2D is best suited for an individual patient’s needs and will be discussed with a radiologist. 3D mammography is approved and recommended for all women who need a standard mammogram and is particularly useful for women with dense breasts or a history of breast cancer.
“By the time a woman feels something in her breast, it can be up to 2.5 centimeters,” Brown says. “With 3D mammography, it can be seen when it’s less than a centimeter. The earlier breast cancer is found, the easier it is to treat.”
Innovations in Treatment
According to the Mayo Clinic, breast cancer can be treated in several different ways depending on what stage the cancer is in. Many women undergo surgery such as a lumpectomy (which removes the breast cancer) or a mastectomy (which removes the entire breast). After surgery, patients may need radiation therapy, chemotherapy, or hormone therapy. Targeted therapy drugs, immunotherapy, and alternative medicine can also play a part in a treatment plan. These are all common methods of treatment, but even more sophisticated treatments are becoming a reality, too.
Navicent Health has recently introduced two new technologies: Intraoperative Radiation Therapy (IORT) and Savi Scout. IORT is a treatment that allows eligible patients to receive radiation in a one-time dose in the operating room instead of coming to daily radiation for six weeks.
“This can greatly improve the quality of life of a breast cancer patient, increase recovery time, and decrease additional time missed from work,” Hancock says.
She adds that Savi Scout has similar benefits. “Prior to this technology, when a patient needed a breast biopsy or cancer removed from their breast, it was necessary to go in the day of surgery and have a needle placed in the breast by a radiologist for the surgeon to easily locate the lesion or tumor. Now, a small detector can be placed in the breast even months prior to surgery, and the surgeon can locate it using sonar technology in the operating room, without having the patient have a needle placed in their breast.”
These aren’t the only new treatment methods that work for breast cancer. Research at NIH recently reported that ribociclib (Kisqali) reduces breast cancer mortality by one-third. One form of breast cancer is fueled by estrogen, and whereas traditional cancer treatments use therapies that block the production of estrogen, Kisqali actually targets cancer-cell promoting enzymes instead. Kisqali is less toxic than chemotherapy. It has not been on the market for more than a couple of years, so do your diligence and carefully check out the advantages and disadvantages of the drug before using it.
Breast Cancer Prevention
Are there steps you can take to lower your risk of getting breast cancer? To some extent, yes.
“No matter what some people do, they will be more susceptible to breast cancer based on their genetic makeup,” Hancock says. According to the American College of Radiology, however, yearly screening mammography is extremely important to detect breast cancers as early as possible. And women can further help decrease risks by eating a well-balanced diet, exercising regularly, and not smoking.
The American College of Radiology (ACR) recommends that women start getting annual mammograms at age 40, but if you have a family history of breast cancer, you may want to consider beginning screenings at an earlier age. If your breasts look different or if you feel a new lump during self-screening, you should make an appointment immediately with your doctor.
If you are diagnosed with breast cancer, what should you do?
“The most important thing,” Hancock says, “for patients to do, is educate themselves using reliable sources.” She points out that the Internet can be a scary place for someone who has just been diagnosed with cancer—there’s a plethora of information, much of it false, at their fingertips. That’s why getting a second opinion is important.
However, research-based information can save your life. See our sidebar for a list of websites you can search for accurate and current information on the diagnosis and treatment of breast cancer.
Breast cancer is a terrifying disease, but researchers are working hard to find the best methods of diagnosis and treatment for this form of cancer. Staying up to date on the latest research can help you feel empowered and in the know. #