More than 200,000 women nationwide are diagnosed with breast cancer annually. Most commonly, breast cancer is detected by screening mammogram. When found and treated early, breast cancer is usually curable. When not curable, breast cancer may still be treated to prolong and improve quality of life. Ongoing improvements in detection and therapy continue to incrementally drive better patient outcomes.
Some breast cancers, including several cases in high profile patients, have a hereditary nature, but the vast majority of breast cancers are not hereditary. Breast cancer can occur in men as well as women, and most commonly occurs essentially randomly. However, some women may be at higher risk of developing breast cancer, particularly those carrying uncommon gene mutations or those with a significant family history.
The American Cancer Society recommends yearly mammograms starting at age 40, including in those with no family history of breast cancer. MRI and ultrasound are other tools used in certain circumstances. In some cases, symptoms lead to the workup and diagnosis, but most of the time, routine mammogram detects an abnormality. The next step for formal diagnosis is a tissue biopsy, with mammographic or ultrasound guidance. If breast cancer is identified, further testing is performed on the tissue to fully characterize and provide information on prognosis.
Treatment is managed using multiple modalities, which may include surgery, systemic therapy and radiation therapy. Surgical options often include mastectomy or Breast Conservation Surgery, also called partial mastectomy, segmental mastectomy or lumpectomy. These approaches aim to remove the tumor plus enough normal tissue (“margin”) while sparing the remaining breast. Repeat surgery or re-excision may be necessary in some cases to ensure there are no tumor cells at the edge of the removed tissue. A lymph node biopsy often is also done to complete tumor staging.
Radiation therapy is frequently used after surgery to help prevent recurrences and improve likelihood for cure. Using sophisticated planning software as well as a safe and highly technical treatment machine, precise and accurate doses of radiation are delivered to the tissue. Radiation therapy is part of the breast conservation strategy. However, some situations even after mastectomy may still warrant radiation.
Systemic therapy includes hormone manipulation, chemotherapy, immune therapy and targeted therapy, which are all anti-cancer therapies used selectively in breast cancer to improve patient outcomes. Estrogen promotes the growth of breast cancers that are estrogen sensitive (so-called estrogen receptor positive or ER positive cancer). Hormone manipulation takes advantage of this by either lowering estrogen levels in the body or blocking estrogen receptors on cancer cells. Chemotherapy is often not necessary, but when it is used, it helps destroy cancer cells. Chemotherapy can be delivered before or after surgery. Regardless of when chemotherapy is delivered with respect to surgery, chemotherapy is typically delivered prior to radiation.
An individual is considered a breast cancer survivor from the moment of diagnosis. There are millions of breast cancer survivors. Patients will often remain on estrogen manipulation for many years. Regular visits to healthcare providers are important for ongoing evaluation, management of side effects and any potential complications. While in remission, surveillance often includes clinical history, exam and mammography for breast cancer, and routine screenings for other cancers. Depending on initial presentation and ongoing or new symptoms, other imaging may be utilized. Genetic counseling may be recommended. It is important to pay attention to physical and psychological well-being and make healthy lifestyle and diet choices.
Receiving a diagnosis of cancer affects not only patients, but also partners, spouses, children and others. There are many challenges that emerge after diagnosis, including changing roles, emotional needs and intimacy issues, among others. Lowering the fear bar around diagnosis and treatment requires a commitment to open and transparent communication with your partner and your treatment team. Asking questions, gathering information and getting involved with organizations that provide cancer support resources are important ways to manage throughout the treatment and recovery process.
Disclaimer: The information contained herein represents general medical information not intended to be perceived as diagnostic or medical advice. Please contact your healthcare provider or physician with medical concerns.
Dr. Jonathan Abelson is part of the Coastal Radiation Oncology Medical Group, one of the largest radiation providers in California. Coastal’s Board-Certified doctors have extensive training from some of the leading institutions in the country. Coastal’s cancer care teams provide comfort, support and detailed cancer treatment information to patients and their families in four locations in Ventura County, including Ventura, Thousand Oaks, Westlake Village and Simi Valley. For more information, visit CoastalRadiationOncology.com.