If asked to name their greatest fears, most women would put breast cancer at or near the top of the list. And there's good reason: more than 200,000 American women are diagnosed with breast cancer each year and nearly 40,000 die. Breast cancer is the second leading cause of cancer deaths after lung cancer.
On the other hand, as breast cancer survivor and author Elaine Ratner, writes: "In all the talk about breast cancer, you rarely hear the fact that most women who get it deal with it and go on to live out normal, healthy lives."
Sally and David were "stunned and terrified" when the doctor gave them her diagnosis. Seven years later, they are much more relaxed. "There's still danger, there's still treatment," David said. "But the cancer is not the first and only thing on our minds, as it was then."
With early detection, thanks to breast self examination and regular mammography, the mortality risk has been declining steadily over the past decade, and the patient has more and better treatment options.
Surgery: The first step is to remove or destroy the cancer cells from the breast tissue. In the not-so-distant past, the primary option for doing this was radical mastectomy, which involves removal of the breast and the underlying chest muscles plus all or most of the lymph nodes in the arm pit. Today, this procedure is no longer done because less disfiguring options are available.
As used today, mastectomy leaves the chest muscles and sometimes at least some of the lymph nodes undisturbed. Breast-conserving lumpectomy removes only the cancerous tissue, sometimes along with lymph nodes.
A 1985 study found that women with small early-stage breast cancers who underwent lumpectomy followed by radiation did better after five years than those who had mastectomies. A 20-year follow-up in 2002 confirmed the results.
Lumpectomy can be performed for tumors that can be felt as lumps as well as smaller ones detectable only by mammography. The tumor itself plus a margin of normal tissue is removed, usually along with some lymph nodes to determine if the cancer has spread.
In some cases, mastectomy is still necessary, and some women, including Elaine Ratner, choose it. In one study, patients undergoing mastectomy followed by breast reconstruction were even more satisfied with the results than were patients having breast-conserving surgery.
Radiation: Radiation is normally a crucial follow-up for women choosing lumpectomy, and it may also be used after mastectomy in order to kill any microscopic cancer cells that have escaped the scalpel and prevent recurrence.
The treatment is painless and lasts only a few minutes daily for five to seven weeks. It can irritate the skin or cause a burn similar to a bad sunburn.
New techniques of delivering radiation are being explored – such as using higher doses for a shorter treatment period or exposing only part of the breast to the radiation.
Chemotherapy: medication given either intravenously or orally, is used both to treat cancer that has spread to other parts of the body and to reduce the risk of recurrence. It may also be used before surgery to shrink a tumor.
Because of the well-known side effects ��hair loss, nausea, vomiting, fatigue ��chemotherapy is usually delivered in cycles ��a few days or weeks of intensive treatment followed by a few weeks of recovery. Some of these side effects have been reduced with newer medications.
Hormone Therapy: Not all breast cancers need estrogen to grow, but more than half do. For these hormone-sensitive cases, medications are used to deprive cancer cells of estrogen.
Tamoxifen, the major hormonal therapy over the past two decades, has been found to reduce the risk of recurrence by 47 percent. After five years of use, however, it appears to lose its effectiveness, and it increases the risk of endometrial cancer, blood clots and stroke.
A newer class of drugs, aromatase inhibitors, are used either by themselves, after five years of tamoxifen or after two to three years of tamoxifen.
Support: In spite of all the positive signs in terms of early detection and treatment, breast cancer still invokes more than a little fear, anger, anxiety and depression. To deal with such issues, it's important that supportive care be available. Women with advanced cancer participating in support groups, according to one study, lived twice as long as women with the same prognosis … but no support.
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Claudia Andreetta and Ian Smith, "Adjuvant Endocrine Therapy for Early Breast Cancer," Cancer Letters, June 18, 2007.
"Breast Cancer Facts," WebMD Medical Reference from American Cancer Society, edited by Paul O'Neill, M.D., September 1, 2006.
Mary Buechler, M.D., "Breast Cancer Overview," WebMD Medical Reference, reviewed September 20, 2005.
"Breast Cancer – Topic Overview," WebMD Medical Reference, last updated November 17, 2005.
Jane E. Brody, "Coping with Fear: Keeping Breast Cancer in Perspective," New York Times Health, October 12, 1999.
Harold J. Burstein, "Aromatase Inhibitor-Associated Arthralgia Syndrome," The Breast, June, 2007.
Darius Dian, et al, "Aesthetic Result among Breast Cancer Patients Undergoing Autologous Breast Reconstruction versus Breast Conserving Therapy," Archives of Gynecology and Obstetrics, June, 2007.
Katherine Hodgkinson, et al, "Breast Cancer Survivors' Supportive Care Needs 2-10 Years after Diagnosis," Supportive Care in Cancer, May, 2007.
"On Becoming a Breast Cancer Survivor," Harvard Women's Health Watch, October, 2006.
"Quality-of-Life Issues in the Management of Early Breast Cancer: An Expert Interview with Dr. Beth A. Overmoyer," Medscape Hamatology-Oncology, May 18, 2007.