Breast Cancer Treatment
Breast Cancer Overview
Breast cancer is the most commonly diagnosed cancer of women, and the second leading cause of cancer deaths among American women between 40 and 55 years of age. Regular mammography and clinical breast exams are essential for early detection of breast cancer. For women between 50 and 69 years of age, having regular mammograms can reduce the chance of death from breast cancer by one-third or more.
During the most recent 5-year period, mortality rates among Caucasian women declined for all decades between 30 and 79 years of age, and for all decades among African American women from 30 to 69 years of age. Despite these numbers, only about 30% of women actually have a regular mammogram.
A woman’s chances of getting breast cancer changes with age: by age 40, 1 in 217 women will face breast cancer; by age 70, 1 in 14 will be diagnosed with the disease. Although death rates from breast cancer declined 4.6% between 1991 and 1995, breast cancer accounts for 31% of all cancers diagnosed among women.
Approximately 180,000 new cases of breast cancer are estimated for 1998, and about 43,500 women are expected to die from breast cancer. It is estimated that 1.5 million American women will be diagnosed with breast cancer this decade, and breast cancer will claim nearly half a million lives.
With proper early detection and treatment, the chances of surviving breast cancer are improving. Breast cancer mortality trends among African American and Caucasian women have improved markedly since the 1980s. The greatest reductions in death rates were among younger women (7.6%) and Caucasian women (5.3%), with more modest reductions among African Americans (1.6%).
Over 2 million breast cancer survivors exist in the U.S. today.
FREQUENTLY ASKED QUESTIONS
Q. How is breast cancer treated?
A. There are treatments for all patients with breast cancer. Four types of treatment are used:
Surgery (taking out the cancer in an operation)
-Radiation therapy (using high-dose x-rays to kill cancer cells)
-Chemotherapy (using drugs to kill cancer cells)
-Hormone therapy (using hormones to stop the cells from growing).
-Biological therapy (using your body’s immune system to fight cancer) and bone marrow transplantation are being tested in clinical trials.
Treatment depends on the size and location of the tumor in the breast, the results of lab tests, and the stage (or extent) of the disease. The doctor is the best person to answer questions about treatment for a particular patient: what her treatment choices are, how successful the treatment is expected to be, and how much it is likely to cost.
Q. What are the risk factors for developing breast cancer?
A. The two most important risk factors are getting older and being a woman. In fact, almost 75 percent of women with breast cancer are over 50 years of age. The risk also is increased if a woman:
-Has a history of breast cancer in her family
-Has never had children
-Has had her first child after age 30
-Began menstruating before age 12
-Completed menopause after age 55
It is important to keep in mind that these factors do not cause cancer but are merely associations that may increase cancer risk. Having one or more of the risk factors does not mean a woman is certain to develop breast cancer.
There is no proven way to prevent breast cancer, so finding the disease as early as possible is the goal. Used on a regular basis, a mammogram (with or without a breast exam by a doctor or nurse) offers the best chance of saving lives. Studies have shown that, for women 50 to 69 years of age, having a regular mammogram (with or without breast exams by a doctor or nurse) could reduce deaths from breast cancer by one-third or more.
Q. Is breast cancer inherited?
A. The genes in your cells carry the hereditary information that you got from your parents. Sometimes, a test can be done to look for a gene that may be associated with a certain hereditary trait. Recently, a gene was found to be defective in 5% of breast cancer patients. Hereditary breast cancer makes up approximately 5 to 10% of all breast cancer cases. Relatives of breast cancer patients who carry this defective gene may be more likely to develop breast or ovarian cancer. Tests are being developed to determine who has the genetic defect long before any cancer appears.
Q. If I do not have a family history of breast cancer, am I still at risk for developing it?
A. Yes. In fact, 80% of women who develop breast cancer have no family history of the disease. While chances of getting breast cancer increase if a family member also has had it, this does not mean that a woman is free from risk if no one in her family has had breast cancer.
Q. What about estrogen (hormone replacement therapy) and breast cancer?
A. A major issue surrounding hormone replacement therapy and estrogen replacement therapy is the influence of estrogen on breast cancer. Researchers believe that the longer a woman is exposed to naturally occurring estrogen, the greater risk of developing breast cancer. It has not been proven, however, that estrogen administered at menopause has the same effect. There is disagreement because of wide variations in the populations studied, as well as the doses, timing, and types of estrogen used. An analysis of previous studies suggests that low-dose estrogen taken on a short-term basis (10 years or less) does not pose increased risk of breast cancer. Long-term use (more than 10 years) at a high dose may significantly increase the risk. By how much is still a matter of heated debate. At the very most, researchers think long-term use could possibly increase the risk of getting breast cancer by 30%. This means that incidence would rise from 10 women per 10,000 each year to 13 women per 10,000 each year.
The WHI is a large-scale study of estrogen and combination estrogen plus progestin as preventive therapies for postmenopausal women, designed to access the long-term risks and benefits of estrogen replacement therapy (ERT) and combination HRT. It enrolled 27,000 women between 1993 and 1998, scheduled to conclude in 2005. A total of 16,608 women were randomized to combination HRT and placebo.
The combination HRT arm of the study was discontinued, citing as the main factor an increased risk of invasive breast cancer in the group receiving continuous combined HRT compared with the placebo group after an average follow-up of 5.2 years. This, combined with an increase in cardiovascular events in women and active drug vs. those on placebo that began in the first year and persisted, outweighed the benefits, which included a reduced incidence of colon cancer and hip fractures.
The fear of cancer is one of the most common reasons that women are unwilling to use hormone replacement therapy. Interestingly, actual death rates for breast cancer have not risen at all. This may be because estrogen users have more frequent medical visits and obtain more preventive care including yearly mammograms. The WHI study conitnues to monitor women who are on estrogen alone and do not take progestin (progesterone).
While no one can determine who will eventually develop breast cancer, there are certain risk factors you should be aware of when considering hormone replacement therapy. A family history of breast cancer (sister or mother) is probably the most important risk factor of all. You may also be at an increased risk if: you menstruated before age 12; delayed motherhood until later in life; or have a late menopause (after age 50). Also, the older you are, the higher the risk.
To use or not use hormone replacement therapy is a personal decision to be made by each woman with help from her doctor. Regular breast examinations by a health care professional and self-examination are recommended for women receiving estrogen therapy, as they are for all women.
Best Bet For Detection and Survival
Breast Self Examination – Breast Self Examination (BSE) takes just a few minutes and you only need to do it once a month. If you are menstruating, perform BSE 7 to 10 days after the first day of your period when your breasts are least tender. If you no longer menstruate, choose the same day each month to remind yourself to do BSE.
As you do your examination, keep in mind that your goal is to become acquainted with how your breasts normally look and feel.
A lump or thickening in or near the breast or underarm area
A change in the size or shape of the breast
A puckering, dimpling, or redness of the breast skin
Screening – Regular mammogram screening and breast examinations by a medical professional. More than 20% of breast cancers are diagnosed in women over age 50 after a regular mammogram. Mammograms are recommended annually for women age 50 and older. The age that initial mammogram screening is recommended depends upon personal history and a doctor’s recommendation. Some women start as early as age 30. Most start around age 40.
Tissue sampling – The sampling of a lump by performing a biopsy (removal of a small sample by a very thin needle inserted into the lump) has proven to be a very effective method of determining breast cancer. Over 80% of breast biopsies prove to be benign (non-cancerous). Advancement in technique allows for most procedures to be done in the doctor’s office or as an outpatient procedure.
Early detection is the key to beating breast cancer. Advances in surgery, medications, and radiation therapy have allowed more and more women to leave their breast tissue in tact with little scarring. The 5-year survival rate when the cancer is detected early is more than 97%.
A DIAGNOSIS OF CANCER – LOOK FORWARD WITH HOPE
As we live longer lives, more and more people are likely to get cancer. There are, however, millions of Americans who have been diagnosed and successfully treated for cancer. Today, they are alive and well.
Better, and regular, screening tests have helped detect cancer at its earliest and most treatable stages. Treatment methods have also improved over the years. As a result, many people go into remission and also become long-term survivors. About 60 percent of the 1.2 million people diagnosed with cancer this year will live cancer-free for five years or more. For many cancers, these people have the same life expectancy as people who never had cancer.
The American Institute for Cancer Research strongly believes that being an informed, involved patient is an important factor in overcoming cancer. In this section, we discuss the initial questions and emotions nearly all cancer patients face upon first learning that they may have cancer.
UNDERSTANDING YOUR DIAGNOSIS
It is very important to understand the diagnosis you are receiving from your doctor or health care provider. Powerful emotions are a natural response to even a potential diagnosis of cancer, but getting the facts about your situation will help you make the right decisions in the days ahead.
If you are nervous or don’t think you’ll remember what you are being told, then bring someone with you, ask your doctor to write out the information you need, or take notes yourself. Don’t be afraid to ask questions. Make sure you understand what the doctor is saying. If medical jargon is confusing you, then ask the doctor to explain the answer in a different way.
It’s in your best interest to be an involved and informed patient. So, let your doctor know you want to be an active participant in your health care. Try to build a relationship with your doctor and health care team. A good doctor will not only have exceptional medical knowledge about your condition, but will also offer support, listen to your concerns, and explain medical procedures and options to your satisfaction.
Below are some questions you’ll want answered, to help you take charge of your health and medical care.
QUESTIONS TO ASK YOUR PHYSICIAN AND OTHER HEALTH CARE PROVIDERS ABOUT YOUR DIAGNOSIS
Exactly what type of cancer do I have?
What stage is the cancer in? What does that mean?
How does my stage affect what I am supposed to do?
What other health professionals do I need to speak with? How can they help me?
How was my diagnosis determined?
What tests were taken and what did they show?
Are more tests planned?
What is my prognosis? (You should ask your doctor to give you an honest answer, neither minimizing nor maximizing your chances. How likely are you to survive? How likely are you to have a good quality of life?)
What are the next steps to take? (If your doctor is not an oncologist, or cancer specialist, you should be advised to see one for further tests or for treatment. If your doctor is an oncologist, treatment options will be recommended.)
THE EMOTIONAL IMPACT OF A CANCER DIAGNOSIS
YOUR PERSONAL REACTIONS
Powerful feelings, both positive and negative, are part of living with cancer. For many people, the most intense emotional upheaval comes right after diagnosis. Feelings change rapidly in the first few days and weeks, and may include such emotions as denial, anger, fear, stress, loneliness and depression. Family members and friends may also go through similar feelings. Or, they may try to hide their sadness and worry, and “distance” themselves emotionally.
All these emotions are natural reactions to a diagnosis of cancer. Most are temporary. Cancer experts recommend confronting these feelings directly, although methods and timetables will differ from person to person.
At first, denial can help soften the impact of the diagnosis and give you time to process the information. Denial can be a problem, however, if it keeps you from getting treatment. Most cancer patients are able to work through these feelings before they begin treatment.
Once you accept the diagnosis, anger may set in. You might ask yourself, “Why me?” Being angry at the disease or at healthy people you know could be a way of expressing other feelings, like fear or helplessness. Letting your feelings be known can help you accept the diagnosis.
A cancer diagnosis frightens many people. It may be the fear of pain or dying, the physical effects and costs of treatment, or the burden it could place on your family. Not knowing what to expect can cause more fear than the facts. Learning as much as you can about your diagnosis and treatment may make you feel less afraid and more in control of the situation. Read through CancerResource for helpful information.
The stress that comes from learning of your diagnosis can cause a variety of physical symptoms, including a faster heart rate, headaches, trembling, loss of appetite and sleeping problems. Stress may also affect your immune system and how well your body fights disease. To help reduce stress and anxiety, try to exercise, listen to relaxing music, talk about your feelings, and keep involved in activities you enjoy. Counseling or joining a support group may also help.
Cancer patients may feel isolated when they don’t feel like socializing or if friends stay away because of the diagnosis. If you are lonely or feel like no one you know understands what you’re going through, try to get in touch with other cancer patients or a support group of people who are facing issues similar to yours. Ask your health care team for referrals or look through the AICR brochure “Cancer Information—Where to Find Help” for information on finding an appropriate support group.
You may feel depressed about a cancer diagnosis. If symptoms become more serious, like strong feelings of sadness and despair, helplessness, and loss of interest or ability to do activities that were a normal part of your life, then let your doctor know, so you can get appropriate help or treatment.
Once the shock of a cancer diagnosis passes, most people are able to look forward with a feeling of hope. Since each cancer case is unique, it is not possible to exactly predict the outcome of your cancer. However, improved treatment methods and knowing that so many cancer survivors are leading full, productive lives may help you and your family feel more optimistic about the future.
Often, people living with cancer find that support groups can help them cope with some of the emotions described above. If you are interested in joining a support group, check with your hospital or treatment center for information about groups in the community. You may also be interested in joining AICR’s “Pen Pals Cancer Support Network.” The program gives cancer patients and survivors the opportunity to share support through letter writing. Call AICR toll-free at 1-800-843-8114 for more information.
HANDLING FAMILY ISSUES
“I’m so concerned about how my family will handle this cancer diagnosis.”
A diagnosis of cancer can present new challenges and stresses for many families. Adjusting to new roles and responsibilities can cause upheavals in the way family members interact. Children may need special attention and guidance at times of disruption in their routine. They need to know that nothing they said or thought caused you to get cancer and that their help and support means so much to you and the family. Sharing your feelings and needs with your spouse or partner is also very important.
If family members are unable to help each other or are having difficulty adjusting to the diagnosis, check with your physician, hospital social services department or library for referrals to local support and service organizations that can help you cope with the emotional stresses of the disease.
FINDING EMOTIONAL SUPPORT
“My friends and family were just so helpful.”
People with cancer and their families often find a great deal of help and support by making contact with others who are in similar circumstances. Cancer support groups can be a wonderful source of strength, hope and practical ideas for everyday life. Attending a support group can give needed structure and focus to your week, as well as emotional support from individuals who can empathize with you.
Some patients find that the support of the medical social worker in a local hospital, local mental health or health care facility is invaluable. For others, it might be a member of the doctor’s staff, a relative who has experienced cancer therapy or a neighbor who can run a few errands if you’re feeling tired.
The AICR brochure “Cancer Information—-Where to Find Help” contains resources that can connect you with other cancer patients and provide you with additional forms of emotional support. To order this brochure, call AICR toll-free at 1-800-843-8114.
AICR – American Institute for Cancer Research
The American Institute for Cancer Research is the nation’s third largest cancer charity and focuses exclusively on the link between diet and cancer. The Institute provides a wide range of consumer education programs that have helped millions of Americans learn to make dietary changes for lower cancer risk. AICR also supports innovative research in cancer prevention and treatment at universities, hospitals and research centers across the U.S. The Institute has provided over $50 million in funding for research in diet, nutrition and cancer. Visit the Institute online at www.aicr.org
American Institute for Cancer Research
1759 R Street NW
Washington, DC 20009