October is National Breast Cancer Awareness Month, a time to reflect on where we are in treating this disease and how far we need to go to cure it. In addition, Oct. 16 has been designated Breast Reconstruction Awareness Day, an initiative designed to promote education, awareness and access for women who may wish to consider breast reconstruction. Sadly, both observances remain extremely critical as the scourge of breast cancer has not been eliminated yet.
This year, the American Cancer Society predicts that there will be 232,340 women diagnosed with new breast cancers in the United States. Each year, an estimated 50,000 mastectomies are performed and more than 300,000 partial mastectomies or lumpectomies, as well. Yet despite the magnitude of this problem, there is still a great need for sharing information.
For women with a diagnosis of breast cancer, treatment consists of surgery and possibly radiation therapy, chemotherapy and/or hormonal therapy. A breast-conserving lumpectomy is the choice of most women, as long as the cancer can be safely removed with clear margins. In order for the cure rate to be equivalent between mastectomy and breast conservation, lumpectomy must be combined with a course of postoperative radiation therapy. This usually requires daily treatments five times weekly for a total of five weeks. Some excitement has been generated about the possibility of lowering the requirement for postoperative radiation with the use of a new technology called IORT, or intraoperative radiation therapy. For now, IORT is typically combined with postoperative radiation therapy, while research into expanding its uses is ongoing.
While surgery and radiation are directed at control of the disease within the breast area, systemic therapy is aimed at preventing or treating the spread of breast cancer elsewhere in the body. The two types of medical treatments for breast cancer are traditional chemotherapy and hormonal therapy, with Tamoxifen still the most common hormonal medication. In addition to its role in treating breast cancer, Tamoxifen can help prevent the development of breast cancer in a high-risk group of patients. The amount of information on this topic can be overwhelming, so consultation with an oncologist is a critical part of the treatment of patients with breast cancer.
A very exciting aspect of our understanding of the development of breast cancer and a possible guide to its treatment has been the advancement of our knowledge of the human genome and specific genes that are associated with the development of breast and ovarian cancer. The BRCA genes have been identified in a number of women who develop breast cancer and we have learned that those women with the BRCA genes are at a very high risk. While there is no specific gene therapy that has been developed yet, we can use this knowledge to guide and advise women regarding the treatment options available to them. When faced with a known BRCA gene mutation, doctors can offer women the option of a prophylactic mastectomy to prevent the subsequent development of a cancer. With the advancement of the techniques available to us for breast reconstruction, these women can receive nipple-sparing surgery and immediate reconstruction to make their chests look balanced when they are wearing a bra or swimsuit, to regain their breast shape permanently and to avoid use of an external prosthesis.
So how can you protect yourself and the women in your life? First and foremost is the recognition that the earlier breast cancer is detected, the better and more effective are our treatment options. Women starting in their 20s and 30s should have regular breast examinations with health care providers and starting at age 40 obtain a mammogram on a regular basis and an ultrasound examination if indicated. For women who fall into a higher risk group, MRI, or magnetic resonance imaging, should also be considered.
For all of us, support of ongoing research holds the hope of cure for this disease. Studies to identify risk factors, better treatment options and even nutritional or other behavior modifications to prevent breast cancer need our support. During this month, join us in one of the many walks for a cure, use the breast cancer stamp when you mail letters (a portion of the money raises funds for research) and support the organizations that are committed to research into a cure. Breast cancer affects all of us and it will take all of us working together to beat this disease.
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