For some, getting a mammogram is a routine; for others, maybe not so. But in either case, there’s a certain amount of nervousness the patient experiences as she awaits the results.
“Most of the time, there’s no bad news,” says Karen Rizzo, MD, 2015 president of the Pennsylvania Medical Society and a practicing physician in Lancaster. “Unfortunately though, some will be told they should have a biopsy, possibly leading to those dreaded words ‘you have breast cancer.’”
What happens next depends upon the patient and her situation, says Dr. Rizzo, but there are a few similarities from patient to patient as they fight cancer.
Risk and Diagnosis
Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The disease occurs almost entirely in women, but men can get it, too.
For American women, breast cancer is the second most common cancer (second only to skin cancer), with an estimated lifetime prevalence of 12 percent. In 2014, an estimated 232,670 new cases of invasive breast cancer and 62,570 cases of carcinoma in situ (a non-invasive breast cancer) will be diagnosed in U.S. women. Forty-thousand of them will die from it.
Although overall incidence is highest for Caucasian women, African Americans have the highest mortality rate from breast cancer. Caucasian women have the second highest mortality rate, followed by American Indian/Alaska Natives, Hispanic/Latinos, and Asian American/ Pacific Islanders.
While more work remains to be done, mortality statistics reflect a substantial drop in breast cancer deaths over the past two decades. The decline is attributed to a better understanding of the disease, earlier detection, and improved treatments.
“The battle against breast cancer often starts in a medical office specializing in women’s health,” says Kurt T. Barnhart, MD, MSCE, chair of the Pennsylvania Section of the American Congress of Obstetricians and Gynecologists (PA ACOG). “Some patients come in knowing t hey have a lump, but many others discover they have a lump through imaging which is one reason why seeing an obstetrician regularly is so important to women’s health.”
According to Dr. Barnhart, who is a practicing OB/GYN in Philadelphia, physicians diagnose breast cancer by combining physical exams, imaging, and biopsies.
“Unfortunately, there’s no way to prevent breast cancer, although women can reduce the risk by doing a few things such as getting regular physical activity and limiting alcohol intake to lower their risks,” says Dr. Barnhart. “Needless to say, exams play an important role.”
The battle
Once tests and exams come back indicating cancer, says David S. Parda, MD, FACP, past president of the Pennsylvania Society of Oncology & Hematology, it’s time for the patient and her physician-led health care team to come up with a plan to fight it.
Dr. Parda, who practices oncology in Pittsburgh, says that many types of physicians are likely to be a part of a patient’s cancer care team including a medical oncologist, breast surgeon, surgical oncologist, plastic surgeon, and radiation oncologist as well as their ob/gyn. Some patients may also need or want a psychiatrist on their team. Also, nurses specializing in cancer care are likely to be a part of the team, as well as other health care professionals such as care coordinators.
In general, the main types of treatment are:
- Surgery
- Radiation therapy
- Chemotherapy
- Hormone therapy
- Targeted therapy
- Bone-directed therapy
Most women, says Dr. Parda, have some type of surgery, as a tumor often needs to be removed. “If this is the case, decisions may need to be made between breast-conserving surgery and mastectomy,” says Dr. Parda.
A decision-tree like the one pictured above can be used to aid treatment decisions after diagnosis and staging of breast cancer.
Both physical and emotional scars should be anticipated. Fortunately, with the help of plastic surgeons and psychiatrists respectively, those scars can be addressed.
Physically, says Benjamin Schlechter, MD, FACS, president of the Robert H. Ivy Society of Plastic Surgeons, surgery to remove cancer can leave the body with a range of scars from small to large. In the most severe scenario, those undergoing radical mastectomy (a surgical procedure in which the breast, underlying chest muscle, and lymph nodes of the axilla are removed) may choose to also have breast reconstructive surgery.
“Even before having the cancer removed by a mastectomy,” says Dr. Schlechter who practices in Wyomissing, “the patient should talk with her breast surgeon and plastic surgeon so that both are working together to best position the patient for reconstruction.”
According to Dr. Schlechter, there are different types of reconstruction, and timing may depend on the patient’s medical situation and personal preference. In some cases, a patient may have reconstruction at the same time of the mastectomy, while others may choose a later date.
The decision-tree above is designed to help breast cancer patients choose the best type of breast reconstruction surgery for their individual needs and preferences.
“Today’s techniques and procedures are better than ever before,” says Dr. Schlechter. “Clearly, for a patient having a mastectomy, much can be done afterwards for appearance purposes.”
A New Beginning: Moving Past Breast Cancer
PAMED’s Dr. Rizzo applauds the many breast cancer survivors, both women and men. Their courageous fight can inspire others, she says.
“The survival rate is improving, and thanks to dedicated health care teams and groups, this disease has a formidable enemy determined to wipe it out,” says Dr. Rizzo. “The best survival rates are the result of those being diagnosed in early stages, which is why patients should have regularly scheduled, age-appropriate screenings.”
According to the American Cancer Society, when detected and treated early, the 5-year relative survival rate for localized breast cancer is 99 percent. For regional disease, it is 84 percent. However, if the cancer has spread to distant organs (known as metastasis), 5-year survival drops to 24 percent. Larger tumor size at diagnosis is also associated with decreased survival.
“Statistics clearly show why it’s so important for breast cancer to be caught early,” says PA ACOG’s Dr. Barnhart. “The survival rate is so much higher when this disease is discovered and treated before it has a chance to spread.”
According to Dr. Barnhart, knowing what matters most often drives breast cancer patients past the disease. “We often hear stories from survivors that cancer shows them what is important in life, and the people who are most important to them” says Dr. Barnhart. “Typically, that’s gives them the energy to beat cancer and then start a new beginning as they move past the disease.”