Article for October, 2006

Breast Cancer Today

By Dr. Len Lichtenfeld, Deputy Chief Medical Officer,
American Cancer Society®

Breast cancer remains a significant health concern for women in the United States and throughout the world. In the United States, it is the most common form of cancer in women. After lung cancer, breast cancer is the second leading cause of cancer deaths in women.

This year, over 214,000 women in this country will be diagnosed with invasive breast cancer. An additional 62,000 women will be told they have an earlier, non-invasive form of the disease. 41,430 women will lose their lives to this disease. Women now face a 12 percent lifetime risk (or 1 in 8 chance) of developing breast cancer. All of those numbers are sobering, but there is some good news as well.

Five-year survival rates have increased from 75 percent in the mid-1970s to 90 percent in the most recent analysis. We know that if we find breast cancer early—before it spreads to the lymph nodes—the five-year survival approaches 98 percent. The number of new breast cancer cases, which has been increasing for several decades, is finally starting to level off.

There are several factors responsible for the improvements we have seen in the treatment of breast cancer over the past several decades.

High quality mammography is now available to most women who want it. Improved treatment approaches can conserve the breast for many women, if their cancer is found early when it is small and most easily treated. Improved approaches to adjuvant therapy (preventive treatment) after primary surgery and radiation therapy has improved outlook considerably. We also have better tests to identify women at high risk of developing breast cancer at an early age.

But we can do better, and we cannot rest on our accomplishments.

Women who are at average risk of developing breast cancer and who do not have a significant family history of breast cancer should have a mammogram and a clinical breast examination by a health care clinician every year. These annual mammograms and exams are so important to finding breast cancer at the earliest opportunity, when treatments can be most successful and chances of survival are best. Yet, more than 40 percent of eligible women did not have a mammogram in the past year. And only one out of three women without health insurance was able to get a mammogram in the past year.

And we need to address the needs of people who do not have health insurance or access to quality care. The Federal government, through the Centers for Disease Control and Prevention, funds a nationwide program called the National Breast and Cervical Cancer Early Detection Program. Although this program has been successful, funding limits mean that only one in five women who are eligible for this innovative program have access to the benefits it provides.

To this end, the American Cancer Society has adopted the theme "Every woman deserves a mammogram...every year" for this year's Breast Cancer Awareness Month.

When I started my medical oncology practice in the early 1970's, we thought "early diagnosis" of breast cancer was when a woman or her doctor was able to feel a lump in the breast. Many of these cancers had to be almost an inch in diameter before they were found. Today, many cancers are found long before the doctor or the patient can feel them.

While we used to perform radical surgery to remove the breast in order to "get it all," we now know that alternative approaches to remove just the cancer itself with a small margin of surrounding normal tissue is adequate.

We have also developed new techniques to sample the lymph nodes under the arm to see if they cancer has spread. For many women, this means that the swelling of the arm—called lymphedema—that used to accompany breast cancer treatment all too often is much less of a problem.

We have newer approaches to prevent the cancer from recurring after surgery. In addition, new treatments for post-menopausal women who have hormone sensitive cancers have improved survival.

Women who have a more aggressive form of breast cancer associated with an abnormal gene called HER2/neu can now receive one of the recently developed targeted therapies such as Herceptin, which significantly improves the odds that their cancer will not return. These newer targeted therapies hold the promise of providing hope to women who previously ran out of options when chemotherapy no longer worked if the cancer returned.

We have just learned about new efforts to map the abnormal genes in breast cancer, and discovered that there are many more abnormalities than we previously realized. That means in the future we will not only have a better understanding of how a cancer cell becomes cancerous, but we will also have more targets available to treat. We will be able to offer women with breast cancer a better understanding of their outlook, and even be able to tell them whether or not they need to receive preventive chemotherapy. For many women, that may mean they will be able to avoid the discomfort and costs of chemotherapy after their primary surgery and radiation therapy.

Using this new technology, we may be able in the future to find breast cancers before they are seen even on today's best mammography machine.

Today, we have treatments available that have been successful in preventing breast cancer in many women at high risk. We know that exercise on a regular basis can decrease the odds that a woman will develop breast cancer. We know that excess alcohol consumption can increase the risk of developing breast cancer.

But all of this knowledge and all of these advances don't mean much if women don't take the first step and get a mammogram every year. That means remembering, every year when you are 40 or over, that you need to get your mammogram and your clinical breast exam.

We can talk about lots of numbers, and sometimes those numbers can help us overlook the most important fact of all: each woman diagnosed with breast cancer is an individual and each has a life story. All are daughters, many are mothers and grandmothers, and many are wives and sisters. And all are important to those who surround them, love them, work with them and know them.

Every day that we lose someone to the scourge of cancer reminds us how precious life can be.

Medical science isn't perfect in its ability to detect every breast cancer at the earliest moment despite the improvements in mammography and other early detection techniques. That is why it remains very important to contact your health care clinician if you ever detect a change in your breast. This type of vigilance is the best tool for finding and treating breast cancer early.

So make up your mind today to do what you need to do. The life you save is important— to you, to those you love and those who love you. And always know that the American Cancer Society® is here to help you and answer your questions, 24 hours a day 7 days a week 52 weeks a year either at our web site (www.cancer.org) or our Cancer Information Center at 1-800-ACS-2345.

Current as of October 2006