Technology Advances in the War Against Breast Cancer

Breast cancer is the number one cause of cancer death among hispanic women and the second among other ethnic groups making it crucial to all of society to have more control over the treatment, prevention and diagnosis of breast cancer.

According to the american cancer society, of the 192,000 cases of invasive breast cancer that they estimate will be diagnosed in women this year, 40,000 women will likely die from breast cancer. However, death rates from breast cancer have declined steadily since 1990.

“The steady drop in the breast cancer death rate means that this year alone, about 15,000 breast cancer deaths were avoided that would have occurred had rates not begun to drop,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society in an article published by the American Cancer Society. “Since the early 1990s, that decline adds up to more than 130,000 grandmothers, mothers, and daughters who were alive, perhaps to celebrate another birthday, and even to go on to live a full, rich life.”

A big factor in the drop of mortality rates caused by breast cancer have to do with awareness and early detection, but a lot of it also has to do with the growing technology that uses innovative ways to detect and treat breast cancer.

There is now more than one way to perform a breast screening from mammograms to digital mammograms and an MRI.

Although many oncologists are calling the MRI the new “Golden Standard” of breast cancer screening, Karen Milligan, a medical oncologist at the Nevada Cancer Institute says that is not the case, at least not quite yet.

“It may be at some point, but the standard of care is still the mammography. Most patients can get good images with a mammography. An MRI (magnetic resonance imaging) is a much more complicated test and it is only for patients who have higher rates of cancer in their family or who have a very dense breast,” Milligan said.

Aside from that, Milligan pointed out that a lot of insurance companies still consider the mammography the standard of care and will not always cover an MRI for a breast cancer screening.

An MRI is most often used for patient who are high risk, have excessive scar tissue from breast implants or breast surgery and who are young and have dense breasts, it is also used for assessments for responses to treatments.

A lot of times if a woman shows a potential tumor in the mammography then an MRI will be performed to have a better view of the tumor and to look for others.

According to the American Cancer Society an MRI should be used in addition to not instead of a mammography because although a mammography is more sensitive it can still miss images than a mammography can catch.

More of what has changed and has made a big difference in survival rates are the technology advancements in treatment options.

A mastectomy and painful chemotherapy, while not completely eradicated from the breast cancer treatment process, are no longer the standard of treatment.

One of the new medical advancements is the stereotactic biopsy, a mammographically guided biopsy. This procedure provides a less invasive way to test whether a lump is benign or cancerous; it is an outpatient procedure saving the patient from the risk of anesthesia or an operating room. With this procedure the doctor uses imaging that pinpoints the exact location of a breast mass that allows the radiologist to insert a needle through the skin allowing it to remove tissue samples to test.

According to Dr. Milligan this is usually only a 30 minute procedure, which in the past prior to stereotactic technology could only be done by putting a patient to sleep and performing the procedure in the OR.

Another type of less invasive biopsy is the sentinel lymph node biopsy; Anu Thumala, an oncologist at Comprehensive Cancer Center, performs this type of testing procedure. In this type of procedure the doctor inject a blue dye into the area of the cancer site and it makes a map patter of lymphatic fluid. The map shows where the cancer is likely to spread and which lymph node is most likely to have cancer cells so that they can take out the lymph node if it tests positive for cancer cells or keep an eye on it in case trouble develops in the future.

The reason that this procedure is so important is because if there is cancer present in any other part of the body the cancer is likely to spread to a lymph node next.

“The chance of error is very small that you are going to miss and some surgeons have adopted this as the standard of care,” Thumala said.

The actual removal of tumors and cancer cells have also evolved from having a mastectomy to a lumpectomy which is a surgery in which only the tumor and some of the surrounding tissue is removed instead of the entire breast.

“The procedure is such that a radiologist knows where the cancer is and we use a clip to localize a needle, usually installed in place the day of surgery that allows them to use techniques to go straight to the area of lumpectomy rather than a mastectomy,” Milligan explained.

Another type of needle localization treatment is a MammoSite, which is more of targeted radiation therapy because the tumor still needs to be removed in some cases a MammoSite might be a follow-up procedure to a lumpectomy.

A MammoSite involves using a balloon that is attached to a catheter that is placed inside the lumpectomy cavity. The balloon is inflated with a small portion of the catheter that remains outside the breast where treatment can by performed by oncologists by inserting radiation therapy directly to the spot and because it is performed to a specific location the treatment can be stronger and shorter.

“That procedure is very strict by the criteria and not everyone can qualify,” added Thumala.

The actual treatment option and drugs have also evolved, Thumala points out that while for a long time Tamoxifen was the standard treatment for hormonal therapy there are now other choices such as Aromatase Inhibitors which are highly selective estrogen receptive drugs that inhibit enzyme and deprive the estrogen production which slows the growth of cancers. Another type of hormonal therapy is Her2/neu which stands for “Human Epidermal growth factor Receptor 2” which is a protein giving higher aggressiveness in breast cancers. Approximately 30 percent of cancer cells have the HER2 gene and over expression of this protein can be associated with increased disease recurrence and prognosis. This drug controls the overproduction an decreased the chance of reoccurrence, Thumala said.

As far as the chemotherapy is concerned, Thumala explains that all the drugs previously used have improved response rates.

“We also have better drugs to deal with nausea and deal with other symptoms of the treatment,” she said.

The amount of chemotherapy can also be controlled using growth inhibitors that prevent the growth of blood vessels in the tumors in the early stage to prevent going into stage four treatments.

Oncotype testing is another way of deciding a treatment plan, this procedure samples tumor tissue and rates it for a specific genetic analysis that predicts the recurrence of cancer within ten years after the original diagnosis. Patients with a high score are recommended to get stronger chemotherapy to prevent the recurrence of cancer while patients with a low score do not benefit from chemotherapy and can avoid the procedure.

“It is very neat. Previously everyone got chemotherapy and now we are selective as who gets it and the beauty of it is that it looks at the genes so it is very accurate,” said Thumala.

Thumala says she sees more biological-targeted treatment in the future and hopes they could use less and less chemotherapy in the future.

Another problem with treatment that hasn’t changed is the hair loss and according to Thumala it is one of the most important factors.

“Hair loss is my biggest issue, they are not more concerned about the nausea but they are more concerned about their appearance and the deformities they have to go through by losing a breast or their hair,” said Thumala.

Even so, Thumala is very grateful for the medical advancements and what it means for the patients.

“I would say this is one of the best cancers to take care of because you have so many options and so many of the treatments most women can undergo while they work full-time and maintain their same quality of life,” said Thumala.

Even so there remains on medical advancement that Thumala and all women and doctors long for and that is a cure.

“I will say that I am optimistic that we will get there one day,” she said.