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October - as Breast Cancer Awareness Month - shines a spotlight on the battle against breast cancer and the developments in diagnosing and treating the disease that inspire hope for the future.
'Breast cancer remains very common. It's still the most common cancer in women,” said Dr. Ingrid Lizarraga, a clinical associate professor of surgery and breast surgeon at the University of Iowa Hospitals and Clinics in Iowa City.
'But it is no longer the most common cause of death for women - it is now the second most common cause of cancer death for women after lung cancer. We know a lot
more about breast cancer than we ever did before. The vast majority of women who have breast cancer will do great.”
Admittedly, a breast cancer prognosis largely depends on the type of breast cancer you have and the stage at which it is diagnosed. The good news is that the prognosis has improved considerably over the years.
'Mortality rates are decreasing, thanks to improved screenings and improved treatment,” said Dr. Rasa Buntinas, an oncologist at PCI in Cedar Rapids. 'At our cancer center, 80 percent of women are diagnosed at an early stage - stage 0 or stage 1 - and that means a better chance of survival.”
BEGIN SCREENING AT 40
More screening options have become available in recent years.
'Mammograms are still what we recommend,” Lizarraga said. '3-D mammograms have been around for about five years and can be really helpful for women with dense
breasts. The recognition that breast density affects how you screen is important. Whole breast ultrasounds can also be useful.”
For women with abnormal findings, a breast MRI is an option.
Discussing your personal risk factors with your doctor is the best way to determine what screenings are best for you.
The latest developments in genetic testing can further pinpoint specific risk factors.
'We've identified a set of genes that puts you at high risk for developing breast cancer, and we can test for this gene,” Lizarraga said. 'The trick is to find those at risk who need the genetic testing. If you have concerns, talk to your doctor so they can assess your risk and give you better guidance on a screening regimen.”
Today, the widely accepted recommendation is for most women to begin getting an annual mammogram at age 40.
'If you have any risk factors at all, start at 40. But the latest you should start is at age 45. And you should screen every year,” Lizarraga said. 'When you're younger, the odds are lower, but the stakes are higher.”
In the past, all women were encouraged to do a monthly self-exam, but that's no longer the case.
'Self-exams are no longer recommended,” Buntinas said. 'They tended to lead to more testing and biopsies but really didn't improve outcomes. The recommendation now
is ‘breast self-awareness.' Be aware of how your breasts look and feel, and report changes to your doctor.”
Lizarraga agrees that a woman should trust her instincts if she senses something is wrong.
'You know your body better than anyone else,” she said. 'It doesn't just have to be a lump - it could be a different appearance of the skin or the nipple. Pay attention to how you feel and how you look, and advocate for yourself if you notice something.”
Many developments have been made in treating breast cancer, particularly metastatic breast cancer, Buntinas said.
'We're really getting a much better understanding of tumor biology,” she said. 'Specific targets are being identified to better improve treatments and provide more of a personalized medicine approach. In practice, these treatments are really improving survival.”
It's an exciting time in the treatment of breast cancer, Lizarraga said, 'because things pretty much change every day.”
If a woman needs a mastectomy, 'we can give you a result that looks much closer to what your native breast looks like,” she said. 'The attitude used to be that you shouldn't worry about how it looks, because you should be grateful you don't have cancer, but that's not accepted anymore.”
Advancements also are being made in addressing the side effects of treatment, like lymphedema, the swelling of a woman's arm or hand that can follow the removal of lymph nodes.
'We've gotten better at figuring out more effective techniques that result in less lymphedema,” Lizarraga said. 'We're also now better able to save a woman's breasts if she prefers to do that.”
The biggest advances in treatment, however, have been in systemic therapies, or the use of drugs to reach cancer cells anywhere in the body, she said.
Almost all women with breast cancer will get some form of systemic treatment - pills or therapy.
'We've become increasingly targeted with treatment,” Lizarraga said. 'We start by figuring out which type of breast cancer you have. We now have genomic tests, so we can test the DNA of the tumor itself to see how likely it is to recur. That actually allows us to figure out whether a woman will benefit from chemotherapy or not.
'That's huge because we can limit the toxic treatment when it's not going to be beneficial.”
Treatment is more targeted than ever.
'We match severity of treatment to the severity of disease,” Lizarraga said. 'We've figured out how to make things more personal - in a lot of cases, we've changed the timing of treatment. In the past, you often came in, had surgery and then began the next form of treatment, like chemotherapy or pills.
'Now, we often provide treatment before surgery and then personalize what is needed next.”
Lizarraga said women of all ages need to know breast cancer is common but treatable, as long as it's caught early.
'If you do have a family history, be sure to get evaluated to see if genetic testing is appropriate,” she said.
'And know that who treats you is important, too.”
'Get a second opinion - make sure the person you're seeing is someone who knows specifically about breast cancer treatment and the latest developments. Advocate for
Both doctors agree the prognosis for breast cancer patients is brighter than ever.
'The outlook is very positive and hopeful for the future,” Buntinas said.