Brought to you by: Memorial Medical Center, Modesto
What’s the good news about breast cancer? Thanks to modern scientific breakthroughs, the disease is more curable than ever.
“We’re finding breast cancers earlier and earlier, when they’re much smaller and haven’t spread elsewhere in the body,” reports David Shiba, MD, medical oncologist at Sutter Gould Medical Foundation and medical director for Memorial Medical Center’s Cancer Services. “Breast cancers that are large and have spread to the lymph notes, liver, lung, bone or brain are becoming few and far between.”
According to Dr. Shiba, the trend results from increased emphasis on screening and regular annual mammograms. “This has contributed to a significant increase in survival for women diagnosed with breast cancer,” he observes.
Medical advances are further influencing today’s breast cancer survival rates.
“Modern medications have the potential for preventing breast cancer in patients who are at higher risk,” says Dr. Shiba. “We now have two drugs approved to treat patients who don’t have breast cancer but have a high risk of breast cancer. Patients who take these medications for five years have reduced their incidence of breast cancer by 50 to 60 percent.”
Breast cancer treatment has changed significantly, Dr. Shiba observes. “With current surgical treatment, the emphasis is on trying to preserve the breast with a lumpectomy, followed by radiation.”
State-of-the-art radiation treatment uses sophisticated machines that can spare the heart, lung and skin from damage while targeting the breast cancer.
Chemotherapy has changed, too. “We have better drugs and better combinations of drugs,” Dr. Shiba reflects. “We’re now finding that some combinations can avoid heart toxicity.”
Many of the newest breakthroughs have resulted from the Human Genome Project, a 13-year study coordinated by the U.S. Department of Energy and the National Institutes of Health. The project identified every single gene in the body and was completed in 2003.
“We understand breast cancer a lot better today,” Dr. Shiba says. “We are now able to identify a particular gene, HER-2. If a cancer has multiple copies of this gene, it is more aggressive and the prognosis is more serious.” Targeted therapy against HER-2 may increase survival if it is incorporated as part of chemotherapy.
“The Cancer Genome Atlas is a follow-up project in which scientists are taking three cancers at a time, studying thousands of specimens of these cancers, and identifying every single gene in these cancers to determine new targets for therapy,” Dr. Shiba explains. “Hopefully, new therapies will lead to new cures, increased survival rates and therapies that are more selective.”
The future holds the promise of additional advances in breast cancer diagnosis and treatment.
“We are now just beginning to be able to test the patient's breast cancer and personalize treatments for each patient,” says Dr. Shiba. “The OncotypeDx looks at 21 genes in the patient’s cancer and then can be used to help decide if the patient would be helped by chemotherapy or hormone therapy or no treatment. This is the first attempt to ‘personalize’ treatment for each patient instead of trying to treat based on studies of groups of patients.”
More advances are on the horizon.
“New technology involving the PET mammogram, currently in the testing phase, appears to be able to detect cancers as small as 1 to 2 mm,” adds Dr. Shiba (traditional technology detects cancers in the 5 to 10 mm range).
“Five to eight percent of all breast cancers are inherited,” Dr. Shiba continues. “New genetic tests may enable us to predetermine whether a patient’s child or sibling will have an increased risk of breast cancer, ovarian cancer and, to a lesser extent, prostate cancer.”
An estimated one in eight women will be diagnosed with breast cancer sometime during her life and more than 80 percent of breast cancers are found by women themselves.
“The most important thing for a woman to do is to perform monthly breast self-exams, obtain a yearly mammogram and receive a clinical breast exam performed by a health professional,” Dr. Shiba advises. “The earlier we diagnose breast cancer, the better chance we have for a cure.”