When It Comes To Breast Cancer, Knowledge Trumps Fear

DANBURY — Chances are you have met or know someone personally who has been diagnosed with breast cancer. That is because it is the most common cancer in women, not including skin cancer, and affects one out of every eight females at some time in their lives.

Dr Joseph Gordon, co-director of the Breast Care Program at Danbury Hospital, Danbury Hospital Department of Surgery, Section of General Surgery, and practicing physician at Advanced Specialty Care in Danbury, provided many breast cancer statistics while attempting to put to rest some misconceptions that may trouble women who have recently been diagnosed.

While family history is a major concern in many health care matters, 75 percent of women with breast cancer do not have a family history. The risk can easily double or triple, however, if a mother, sister, or other close female relative contracts breast cancer at an early age.

Some lifestyle factors that can slightly increase risk include: not having children until later in life, recent oral contraceptive use, long-term postmenopausal hormone therapy, not breast feeding, alcohol consumption of more than one drink per night, being overweight or obese, and overall lack of physical activity.

Screening typically begins at age 40 where a woman will have an annual mammogram and clinical breast exam. Women who are identified as being at high risk begin screening at age 30 with the inclusion of MRI testing for those who are more than 20 percent at risk.

The MRI can be the double-edged sword in detecting breast cancer, because while it may detect a malignancy where a mammogram cannot, it tends to have a high false positive rate. Women under age 30 are encouraged to conduct self-administered breast exams. But women that young may not be able to effectively detect a lump or nodule because of denser breast tissue that coincides with their age.

Although ten percent of abnormal mammograms end up in biopsy, only 25 percent of suspicious mammograms result in a breast cancer diagnosis. This diagnosis is usually determined before invasive surgery with a needle biopsy.

Treatment of breast cancer first involves localized treatment with surgery. Breast conservation (lumpectomy), or removal of the entire breast (mastectomy) are options for surgery. Lumpectomy is the excision of the malignancy and some surrounding tissue and is typically followed by radiation.

A mastectomy is the total removal of the all breast tissue. Both have equal survival rates, so the physician has to effectively communicate and discusses which treatment may be best suited for their patient. Depending on the tumor characteristics, women may also need treatment with systemic therapy (chemotherapy treatments and/or hormonal therapy).

“Unfortunately, there is a high risk of cancer regrowth with the surrounding cells,” Dr Gordon said. Proper treatments and medical attention are very strongly recommended after a surgery to address the high-risk cancer susceptibility surrounding local breast tissues.

Whole breast radiation therapy will be given after surgery and lasts for about six weeks. Another type of radiation treatment still under clinical study involves radioactive seeds being implanted inside the breast, a treatment that only lasts for five days.

Dr Marc Rappaport, Section of Hematology/Oncology and practicing oncologist at The Praxair Cancer Center at Danbury Hospital, spoke about the latest genetic testing available in identifying breast cancer linked to gene mutation, as well as identifying breast cancers that may be need to be treated with chemotherapy.

Genetic testing involves not only having a blood test drawn for assessment of BRCA1 and BRCA2 genes, but should also include genetic counseling by a qualified genetic counselor.

Oncotype Dx is a test performed on tumor tissue that helps predict the likelihood of recurrence of in newly diagnosed, early stage invasive breast cancer. It classifies the patient into low, medium+ and high-risk categories. High is ranked with a 30 percent risk and requires chemotherapy. Low falls below a 30 percent risk and typically does not require chemotherapy.

The intermediate middle section is the gray area, which is hard to determine if an individual requires chemotherapy treatment. The goal for this testing is to eventually minimize the middle risk section and define more clearly which individuals require chemotherapy. Ongoing trials are still being done to help address this question.  

“I think identifying who needs chemotherapy is one of the most important topics surrounding breast cancer,” Dr Rappaport said. Since the three years Oncotype Dx has been available, it is considered the biggest medical breakthrough since chemotherapy.

For more information about Danbury Hospital Medical Town Meetings and community health and wellness outreach programs, visit the hospital’s website at www.danburyhospital.org.