In Treatment
Hope is on the horizon as an increasing number of women beat breast cancer, thanks to the latest developments in screening and treatment.
In the last few years, there have been more developments in the fight against breast cancer than ever before. But in spite of all the new diagnostic tools and treatments available, breast cancer remains an epidemic among women. "One out of every eight women will develop breast cancer, which makes it as common as having blue eyes," says Bonni Guerin, MD, director of Breast Cancer Treatment at Overlook Hospital. In fact, breast cancer is still the No. 1 killer of women between the ages of 19 and 50.
Researchers and physicians are working every day to change these statistics, creating new weapons in the battle against this dreaded disease—and many experts are hopeful that a cure can be found.
Stepped-Up Screenings
"Even with all the new treatment options, early detection remains the greatest tool we have to fight cancer," says Guerin, "so many of the most beneficial advancements have come in the form of better screening methods." One such development is digital mammography with computer-assisted detection, also known as CAD. "The majority of breast cancers are diagnosed with a mammogram," says Guerin, "and digital mammography with CAD is a new, improved version."
With CAD, images of a patient's breast are taken digitally and then analyzed by a computer program before being evaluated by a radiologist. "This computer-aided screening can search for abnormalities like calcium deposits, cysts, and dense areas of tissue," explains Guerin. "Then the radiologist can go back and magnify these areas of concern or order additional tests like a targeted ultrasound or MRI." The computerized screening is so sensitive that it can detect even the smallest cancers and pre-cancerous lesions, meaning more cancers will be found in their early, highly treatable stages.
CAD does result in more women being called back for additional evaluation, but that's a small price to pay for the early-detection pay-off. Says Guerin, "For every 100,000 cancers detected by older mammography methods, CAD can pick up another 20,000, and more early detection means more survivors." Although digital mammography and CAD are relatively new, they have become the standard of care at Overlook. "Here we have only digital machines, so every single patient gets a digital mammogram," Guerin says.
Researchers have also discovered a new way to possibly prevent cancer in higher-risk patients. "About seven or eight years ago, a cancer gene was discovered called Her-2-Neu, that when mutated leads to much more aggressive forms of cancer," explains Guerin. "But we also found that the mutation could be corrected in cancer patients with a simple antibody." Doctors like Guerin are studying ways to use these corrective antibodies to reverse Her-2-Neu mutations in pre-cancerous findings, like ductal carcinoma in-situ (DCIS). "When we remove a DCIS, we can test it to see if the patient may have more trouble down the road," says Guerin. "If we find the mutated Her-2-Neu gene, we can treat it aggressively with a low dose of antibodies in the hopes of preventing cancer from ever developing."
Kinder, Gentler Treatments
Cancer treatments have come a long way in recent years, especially in the area of radiation therapy. "At Overlook we're using computerized treatment planning scans so we can specifically target the area we're irradiating, delivering higher doses of radiation where it is needed, while minimizing the effects to normal tissue," explains Louis Schwartz, MD, medical director of Radiation Oncology at Overlook Hospital.
Before receiving treatment, a patient gets a series of imaging scans so that the radiation can be delivered in the most targeted way possible, limiting exposure to organs like the heart and lungs as well as surrounding healthy tissue. When it's time for treatment to begin, doctors recently found that the way a patient's body is positioned for radiation therapy makes a world of difference. "In the past, patients would lie on their backs and lift the arm adjacent to the affected breast," explains Schwartz, "but this created skin folds in the armpit or under the breast that were vulnerable to being 'sunburned' during treatment, forcing us to use lower doses over longer periods of time."
Now, patients lie in the prone position on a special cushion that allows the affected breast to fall forward, keeping all healthy tissue out of the way. "This permits us to bring higher doses of radiation right to the cancer with no significant auxiliary skin reactions," says Schwartz. "The higher doses mean we can complete the treatment in 16 fractions rather than 28, with the same results." The side effects of prone breast radiation to the treated area are similar to those of traditional treatments and include "sunburn" (which can be mitigated with specially designed lanolin lotions), swelling of the breast, and tenderness of any surgical scars.
And there's more good news on the radiation front. Physicians have also been using a new radiation delivery technique called Mammosite. "This involves a surgeon placing a catheter in the breast, deigned to shoot radiation right into the spot where a tumor was removed," explains Schwartz. "This is another accelerated treatment option that allows patients to receive their radiation in just two treatments a day for five days."
Who benefits most from these accelerated, high-dose radiation treatments? "Generally women with early-stage cancer or who've had lumpectomies are the best candidates," says Schwartz. Patients with more advanced disease usually undergo chemotherapy, which can leave them highly sensitized to radiation. "For this reason, we need to use traditional, more conservative doses of radiation," says Schwartz, "although we still use the prone position for delivery." Mastectomy patients are not good candidates for prone breast radiation, since they tend to be at a higher risk for recurrence and need chemotherapy as well. But thanks to improved screening methods, more and more women are being diagnosed early and can take advantage of these groundbreaking treatment options.
For a referral to an oncologist, call 800-247-9580.
The Overlook Difference
A Breast Center Navigator is on hand to assist patients through the various services and treatments provided by the Breast Center, and everyone on staff is available to patients for guidance and support. Patients who test positive for breast cancer are transitioned to a Breast Nurse Navigator at Overlook's Carol G. Simon Cancer Center.
