No matter what your age, a clean bill of health is one of the most important things you can have to help you be your best self. Besides visiting your physician regularly, be your own best health advocate by staying informed, being proactive and making positive lifestyle choices. In recognition of Breast Cancer Awareness Month, you will find insight into the latest advancements in breast cancer treatments plus a health checklist and fun and effective ways to stay fit.
Advancements in the Fight Against Breast Cancer
While there is no sure way to prevent breast cancer, there are many strategies for decreasing your risk for developing it. According to the American Cancer Society, death rates from breast cancer have been declining since 1990, with larger decreases in women under age 50. Thanks to new screening methods, innovative drugs and improved treatment options, doctors can better identify a patient’s individual risk factors and ultimately determine the best course of action.
Advancements in Screening Methods
With so much controversy surrounding the safety and reliability of mammograms, it can be difficult to know how often and at what age a woman should be screened for breast cancer. But most oncologists stand by the American Cancer Society’s guidelines that say mammography should start at age 40 and continue on a yearly basis. “A 30 percent decrease in death rate has been seen in this country since the use of mammography became widespread,” explains Dr. Lynn Baxter, a diagnostic radiologist at Northside Hospital. “Opponents of mammography say that it may lead to false positives, so women are then recalled for additional imaging when they do not actually have cancer. While this certainly can be stressful and inconvenient, in my mind it is not a reason to forgo a potentially life-saving test.”
Fortunately mammograms aren’t the only method of screening for breast cancer. For women who are at high risk due to strong family history, or the BRCA gene mutation, a breast MRI is also recommended. “With wider availability and usage of breast MRI, the results are earlier detection of tumors at lower stages offering better potential for a cure,” says Dr. Sandra L. Gregory, a radiation oncologist at Atlanta Oncology Associates.
Additionally, new tissue sampling diagnostics are providing increased characterization of the tumor, which often means less chemotherapy for the patient. “Oncotype DX testing helps to divide high-risk node-negative patients from low-risk node-negative patients, thus allowing some women to avoid chemotherapy,” Dr. Gregory says.
New Prognostic Factors
Once a breast cancer diagnosis is made, oncologists now have a better ability to classify a patient’s cancer into various risk categories. “As always, a patient will be given a stage of their cancer ranging from Stage 0 to Stage 4,” says Dr. Shannon Kahn, a radiation oncologist at St. Joseph’s Hospital. “However, we now understand the significance of prognostic factors beyond the stage of the cancer.”
These prognostic factors include the grade of the cancer, hormone receptor status, patient age and menopausal status. When examining all of these factors and the patient as a whole, a physician can identify the optimal treatment for each patient.
Another important prognostic factor is breast density. “This reflects the amount of breast tissue that is seen in a mammogram,” says Dr. Carl D’Orsi, director of breast imaging research at Emory University School of Medicine. “The more of this ‘white appearing’ tissue seen on the mammogram, the denser the breast.”
He says the importance of knowing your density is twofold. The first is that it can make breast cancer detection more difficult. The second is that it can be a risk factor for developing breast cancer. According to the National Breast Cancer Institute, mammograms can miss 20 to 40 percent of breast cancers in women with dense breast tissue, and these women are four times more likely to develop breast cancer than women with less dense breasts.
Alternative Treatment Options & Trends in Surgery
In June of 2012, the FDA approved a new drug called pertuzumab as a treatment option for patients with early stage metastatic breast cancer. Used in combination with two other drugs called trastuzumab and docetaxel, pertuzumab injections are believed to inhibit the growth of tumor cells.
• Partial Breast Irradiation
“The goal of partial breast irradiation is to treat the area of the breast that is at the highest risk of recurrence with minimal dose to the lungs, heart and surrounding breast tissue,” Dr. Kahn says. “In addition, this treatment can now be delivered over a five day time period which can be less physically and emotionally taxing.”
• Preventative Mastectomy
A growing trend among women who are at a high risk for developing breast cancer is a preventative (prophylactic) mastectomy, or the elective removal of their breasts. “Patients with a strong family history of breast cancer and those with precancerous cells on biopsy can also be a candidate,” says Dr. Grant Carlson, chief of surgical services at Winship Cancer Institute of Emory University.
This type of surgery removes a woman’s breast tumor plus enough of the surrounding tissue to clean up any errant cancer cells. At the same time, the surgeon fills the gap by reshaping the tissue around it.
• Nipple Sparing Surgery
This procedure removes the breast tissue and preserves the entire breast skin envelope including the nipple areola complex.
Your health checklist
Prevention is key to avoiding potential health problems. These are broad guidelines based on national statistics. Please check with your primary care physician to schedule screenings that are based on your personal health profile and family history.
Cervical Cancer Screening
According to the American Cancer Society, any woman who is or has been sexually active can be affected with cervical cancer. Regular screenings are important, and an HPV test detects the virus that can cause these cancerous cell changes.The CDC recommends: • Get a Pap test every three years starting at 21 or younger if sexually active, and continue having a Pap test until 65. • Women 30 and above should discuss with their doctors if and when they should receive an HPV test.
Colorectal Cancer Screening
According to the CDC, colorectal cancer is one of the most commonly diagnosed cancers in the United States. Possible screenings include the High Sensitivity FOBT (stool test), and a Flexible Sigmoidoscopy or colonoscopy to check for polyps or cancer in the rectum and lower part of the colon.The CDC recommends: • Start having a screening test for colorectal cancer starting at age 50. • If you have a family history of colorectal cancer, talk with your doctor about when you should begin screening. • The High Sensitivity FOBT should be done yearly, a Flexible Sigmoidoscopy every five years, or a colonoscopy every 10 years.
Blood Pressure Screening
According to the American Heart Association, starting at age 65 or after menopause, women are more likely than men to have hypertension. Normal blood pressure is considered to be lower than 120/80mm Hg, readings over 140/90mm Hg signal high blood pressure. The American Heart Association recommends: • Get tested every two years if you have normal blood pressure (lower than 120/80). • Get tested once a year if you have blood pressure between 120/80 and 139/89. • Discuss treatment with your doctor or nurse if you have blood pressure 140/90 or higher.
Bone Density Screening
The National Osteoporosis Foundation states that 80 percent of those affected by osteoporosis are women. A bone density scan can determine your risk of fractures or decreases in bone density. The National Osteoporosis Foundation recommends bone density testing if: • You are a woman 65 or older or over 50 and have experienced a broken bone. • You are a postmenopausal woman under 65 with one or more risk factors for osteoporosis.
Breast Cancer Screening
The National Cancer Institute & American Cancer Society recommends: • Women age 40 or older should have mammograms every year. • Women at higher risk of breast cancer because of a family history or because they carry the BRCA1 or the BRCA2 gene, should talk with their doctors about how often to have a mammogram. • Women in their 20s and 30s should have a clinical breast exam (CBE) about every three years, and women age 40 and over should have this done every year. • Self-breast exam (SBE) is an option for women in their 20s.
Skin Cancer Screening
Yearly check-ups with a doctor can be done during a routine physical. Inspect the skin and look for any new moles or changes to existing moles to spot the early signs of skin cancer. The American Cancer Society recommends: • Women should have a skin examination done periodically – first by a general doctor to determine if existing moles or spots are normal, and then to get treated by a dermatologist if needed.
Heart Disease Screening
According to the U.S. Department of Health and Human Services, women account for just over half of the total heart disease deaths in the country each year. • Beware of your personal risk factors for developing heart disease – this will tell you how often to get checked. • Specific kinds of arterial plaque don’t show up on angiograms, so you may also need an intravascular ultrasound (IVUS) which is more suited to detecting plaque in women.
Get tested for diabetes with a fasting plasma glucose test. According to Mayo Clinic, a healthy blood sugar level is 70 to 99 mg/dL. A fasting blood sugar level between 100 and 125 mg/dL indicates pre-diabetes and 126 mg/dL or higher signals diabetes. Mayo Clinic recommends: • Screenings should begin at 45. If results are normal, get screened every three years thereafter. • Get tested if your blood pressure is higher than 135/80, you have a BMI over 25 or if you take medicine for high blood pressure.
American Cancer Society – www.cancer.org
American Heart Association – www.americanheart.org
Atlanta Oncology Associates – www.atlantacology.com
Centers for Disease Control and Prevention – www.cdc.gov
Emory University School of Medicine – www.med.emory.edu
Mayo Clinic – www.mayoclinic.com
National Cancer Institute – www.cancer.gov
The National Osteoporosis Foundation – www.nof.org
Northside Hospital – www.northside.com
St. Joseph’s Hospital – www.stjosephsatlanta.org
Winship Cancer Institute of Emory University – www.winshipcancer.emory.edu
U.S. Preventive Services Task Force – www.uspreventiveservicestaskforce.org