Fighting Breast Cancer: Early Detection Leads Defense

October Is National Breast Cancer Awareness Month

Breakthrough treatments for breast cancer, such as injecting antibodies that track down and kill aggressive cancer cells, often grab the headlines and the public's attention.

But when it comes to detailing the progress in the war on breast cancer, the real star is early detection.

That is a message that bears repeating in October, which is National Breast Cancer Awareness Month.

"Two thirds of the progress is early detection," says Dr. Robert Smith, director of cancer screening for the American Cancer Society (ACS).

What else has helped to reduce the breast cancer death rates, which have been declining since 1989?

"Women responding to symptoms faster and incremental improvements in treatment," Dr. Smith adds.

Guidelines Continue to Help Women

Nearly 212,000 new cases of breast cancer will be discovered in the US this year, according to ACS estimates, and more than 40,000 women will die of the disease.

"The recommendations for annual mammograms [for women age 40 and older] are very important," Dr. Smith says. "Most doctors' offices have reminder systems. If they don't, ask for them, or find a way to mark the calendar so you'll remember, such as getting it the month of your birthday."

In recent years, debate has flared over the role and value of regular screening mammograms, with some researchers finding that such tests have little or no lifesaving value. But more recent studies have demonstrated their worth.

Authors of more recent studies say the older analyses that claimed the exams had no life-saving value were scientifically flawed.

In its new guidelines, issued earlier this year, the ACS stands firm in its recommendation that women age 40 and older get annual mammograms. Also crucial for breast health, the ACS states, is a clinical breast exam done by a health professional every year for women 40 and older, and about every three years for women in their 20s and 30s.

While previous guidelines recommended monthly breast self-exams, the new guidelines make these optional. The reason is a lack of research showing the exams can reduce deaths from breast cancer. But the ACS is reluctant to discourage the practice, since it can make women more familiar with their breasts and alert to changes.

Prevention Still Needs Study

But even a woman who follows the mammography screening recommendations might not be home free, says Dr. John Glaspy, a professor of medicine at the University of California Los Angeles Jonsson Cancer Center.

"Most of the things that drive a woman's risk [of breast cancer] are out of her control," says Dr. Glaspy, referring to genetic abnormalities such as the BRCA1 or BRCA2 genes that increase breast cancer risk.

"In general, it is not a lifestyle cancer," Dr. Glaspy says.
"The important lesson is, we are not yet at the point where we can make a woman in this country have a risk of breast cancer so trivial that it should not be high on her radar screen as something to be aware of."

Besides following the screening guidelines, a woman can eat a low-fat diet, although Dr. Glaspy says that is not proven to reduce breast cancer risk. "Eat for your heart [a low-fat diet] and that's probably the best you can do at this point for breast health."

Regular physical activity has also been linked with a lower risk of breast cancer.

At midlife, a woman can do one more thing to reduce her risk, Dr. Glaspy suggests - avoid hormone replacement therapy (HRT).

"If a woman is taking estrogen and has the absolute desire to lower her breast cancer risk, she shouldn't be taking estrogen," he says.

If a woman does get breast cancer regardless of close attention to screening, some of the latest treatments may help. For instance, Herceptin®, a monoclonal antibody given intravenously, targets cancer cells that make too much of a protein and can help a woman with metastatic breast cancer survive longer.

The future will bring more of these targeted treatments, Dr. Glaspy predicts. "More targeted therapies are being looked at, particularly in combination with Herceptin®," he says.

Advances in screening are progressing, too, Dr. Smith says. Methods that look promising include digital mammography, in which the image can be manipulated so specific areas of the breast can be examined more carefully.

Always consult your physician for more information.

Online Resources

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American Cancer Society

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Women's Health Information Center 

October 2003

Fighting Breast Cancer: Early Detection Leads Defense

Guidelines Continue to Help Women

Prevention Still Needs Study

Breast Cancers Can Be Different, Approach Should Vary

Online Resources

Breast Cancers Can Be Different, Approach Should Vary

Not all breast cancer tumors are alike, and not all play by the same rules. And that, in turn, may dramatically affect the course of the disease and the choice of treatment.

That is the suggestion of a new study in the medical journal Cancer.

Here, researchers highlight the impact of possible biological differences in the tumors of women whose cancer is linked to the BRCA1 gene mutation - an inherited genetic defect that appears to produce highly aggressive tumors.

"What this finding speaks to is a difference in tumor biology," says study author Dr. William D. Foulkes, director of cancer genetics at McGill University in Montreal.

"And the consequence of that is we may need to apply a different set of rules when investigating, for example, the benefits of screening, early detection, and treatment, in carriers of BRCA1," Dr. Foulkes says.

According to Dr. Foulkes, in the past most breast tumors were believed to be quite predictable, with a common correlation between tumor size, the spread of the cancer cells to the nearby lymph nodes, and the severity of the disease itself.

But contrary to this accepted cancer logic, the new study found that even when tumors are small or the breast cancer does not invade lymph nodes, women with the BRCA1 gene mutation still frequently experience a virulent and aggressive form of this disease.

"Now research shows not all tumors play by the same rules, and that when a genetic mutation is present, as in BRCA1, the rules are different," Dr. Foulkes says.

"And that fact can affect detection, prevention, as well as treatment," he says.

The research group, led by Dr. Foulkes, looked at a total of 1,555 women with invasive breast cancer.

Of the group, 276 women carried the BRCA1 gene, 136 had the BRCA2 gene (a slightly less aggressive gene mutation) and 1,143 women had no known genetic link to breast cancer.

Each patient's disease was categorized according to the size of her tumor. Based on that, the researchers used a mathematical calculation to estimate the chance of lymph node involvement.

When lymph nodes are involved, it generally indicates a more aggressive form of the disease and the need for more dramatic follow-up treatment, including chemotherapy.

Dr. Foulkes' team found a significant correlation between tumor size and lymph node involvement in the women who did not carry any gene mutations, as well as for women who carried the BRCA2 gene.

Specifically, the larger the tumor, the greater the chance the cancer would invade lymph nodes.

But the calculations did not apply to the cancer patients who carried the BRCA1 genetic mutation.

For these women, Dr. Foulkes says, the conventional breast cancer factors - tumor size and lymph node involvement - did not appear to predict the course of disease.

Ultimately, he says, this may indicate an entirely new and different disease progression when gene mutations are a part of the diagnostic picture.

Always consult your physician for more information.