Advances in the Fight Against Breast Cancer

Thursday, September 17, 2020

This year alone, more than 300,000 women in the U.S. will likely learn they have the disease. If you or a woman you love is one of them, you need to remember this: More than ever before, women are living longer—and better lives—with breast cancer.

Today, the five-year survival rate for most women with breast cancer is 90%. If cancer hasn't spread beyond the breast, that survival rate is higher. Strides in treatment are a key reason why these statistics are so reassuring.

Most women facing a breast cancer diagnosis will need surgery. Not so long ago, that meant women with breast cancer often had to choose between saving their lives and saving their breasts.

Today, many women with early-stage breast cancer can safely choose a lumpectomy (removing only the cancerous tumor plus some nearby healthy tissue) instead of a mastectomy (removing the entire breast).

When a mastectomy is necessary, some doctors often reconstruct the breast at the same time as the mastectomy. It spares women who opt for breast reconstruction the trauma of separate surgeries.

Doctors also do surgery to help stage breast cancer and find out if it's spread to underarm lymph nodes. Many women today are able to have only one or a few lymph nodes removed, which reduces the risk of lymphedema – a side effect of more aggressive surgeries that’s characterized by a persistent swelling in the arm or chest.

Radiation therapy lowers the odds that cancer will return in the breast following a lumpectomy. The most common type is external-beam radiation—where a machine delivers radiation to the breast.

Traditionally, women needed five days of radiation treatments for five to six weeks. Women today may be able to have far more rapid therapy, including:

• Hypofractionated radiation therapy. Women get larger doses of radiation with fewer treatments, usually for only three weeks.

• Intraoperative radiation therapy. Women get a single large dose of radiation in the operating room right after surgery.

• 3-D-conformal radio therapy. Women receive radiation that very precisely targets where the tumor was removed. This speeds up treatment to twice daily for five days.

Still another advance: Intracavitary brachytherapy. Here a device that delivers radiation is put in the space left in the chest from surgery. Treatment is typically over in five days when the device is removed.

Not all women with breast cancer need chemotherapy, but it's often advised after surgery to kill off any lingering cancer cells that can't be seen, even on imaging tests. It’s also the main treatment for women with advanced breast cancer.

Still, sometimes it's not clear if chemotherapy will be helpful, especially for early-stage breast cancers. The good news: Tests are now available that look at the patterns of certain genes after biopsy or surgery. This information helps sort out which patients will most likely benefit from chemo.

When it’s warranted, giving cycles of some chemo drugs closer together can also improve survival.

About 2 out of every 3 breast cancers grow in response to estrogen stimluation. They're known as estrogen-receptor (ER) positive or progesterone-receptor (PR) positive breast cancers.

Endocrine therapy prevents estrogen from helping these cancers grow. There are several types of hormone therapy, including:

• Tamoxifen, which stops estrogen from connecting to cancer cells.

• Aromatase inhibitors (AIs), which stop the production of estrogen. Generally, AIs are only used in post-menopausal women.

More than ever, doctors know how best to prescribe these drugs and extend lives.

As researchers have discovered more about abnormalities in cancer cells that make them grow uncontrollably, they've designed highly targeted therapies to address these changes.

A prime example: Trastuzumab (Herceptin). It and several other drugs were developed to treat the roughly 1 in 5 women with what's known as HER2-positive breast cancer. These cancer cells have too much of a growth-promoting protein called HER2. Targeted therapy interferes with that protein.

Other drugs, known as PARP inhibitors, destroy cancer cells by preventing the cells from fixing their damaged DNA in women with BRCA gene mutations.

Immunotherapy uses the body's own immune system to recognize and destroy cancer cells. Immunotherapy drugs are showing promise in treating triple-negative breast cancers, which aren't fueled by hormones or the HER2 protein. Compared to other breast cancers, they can be more difficult to treat.

You can read about our Watson Clinic's team of breast health experts and many available treatment options, by visiting Watson Clinic’s Breast Health Services page.

Sources: American Cancer Society; American Society of Clinical Oncologists; National Cancer Institute


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