Over 200,000 women are diagnosed with breast cancer each year, and this number is expected to increase significantly over the next decade as more women will be living in the age-at-risk group. One out of eight women will be diagnosed in their lifetime, and at least 40,000 will die of the disease each year. Most women who get breast cancer will survive the disease, and the number of women dying per year is expected to decrease. For many reasons, this encouraging trend is expected to continue.
As advances in imaging techniques, treatment, and prevention continue to be made, women can expect their chances of surviving breast cancer to improve. The actual cause of most breast cancers is not known. However, many risk factors have been identified that include female gender, family history, early menarche, late menopause, increasing age, some forms of benign breast disease, prolonged exposure to exogenous estrogen, and recently identified mutations in the genes BRCA 1 and 2. The majority of women being diagnosed with breast cancer, however, do not have these risk factors, with the exception of increasing age and female gender.
Detecting breast cancer (“screening”) involves selfexamination, evaluation by a physician, and imaging. The relative importance and ability of each of these mechanisms to detect breast cancer (sensitivity) continues to be debated; a combination of the three will always be important in early detection of breast cancer. Early detection remains the best way to survive breast cancer.
Screening for breast cancer should be applied based on a woman’s individual risk of getting breast cancer. A woman is considered at increased risk if she has a strong family history or genetic predisposition, has previously received therapeutic radiation to the chest for another condition, has a 5-year calculated risk (by special computer techniques) of 1.7%, or has had a breast biopsy showing atypical hyperplasia or lobular carcinoma in situ. These women should also have an annual physical examination. This group of women should have annual mammography (perhaps at an earlier age), and more frequent exams by a health care professional. Some women in this group may be candidates for chemoprevention, a newer treatment that involves taking a medication (tamoxifen) prophylactically, which is ordinarily given to women who have diagnosed breast cancers. Women at normal risk between the ages of 20 and 39 should be encouraged to do breast self-examination, and have an examination by a physician every 1-3 years. Women aged 40 and above should have an annual mammography and continue with breast self-exam.
Exciting new imaging techniques are being developed to diagnose early breast cancers, at smaller sizes than were previously detectable. Modalities for the treatment of breast cancers continue to evolve at a rapid rate. In the future, early breast cancer treatment may not actually involve surgery as we know it. Even the standard techniques of surgery are now dramatically less invasive, so that most women with breast cancer today are treated in the outpatient setting.
When a diagnosis of breast cancer is made, it is imperative that a thorough, nonhurried discussion occur with a surgeon who will present all treatment options. Most women will be deciding between two equally safe options. Breast cancers are typically slower growing tumors, which implies that a decision regarding the type of surgery need not be reached immediately, but rather after a woman understands fully the choices available to her. After sufficient consultation, which may involve seeking a second opinion, a woman can make an informed choice.
The two options that are available today are breastconserving surgery (lumpectomy or wide excision/radiation) or mastectomy with or without reconstruction. Both offer equally good survival rates. A minimally invasive technique that accurately evaluates the axillary lymph nodes (sentinel node dissection) is part of either of the primary surgical procedures.
Once the surgical treatment is completed and the stage (size of tumor and status of the nodes) is determined, then a decision can be made regarding the need for chemotherapy. This involves a discussion with a medical oncologist, understanding that the recommendation for chemotherapy is not based on the surgery chosen, but the stage of the tumor. Most women with breast cancer today are treated by a multidisciplinary team comprised of several specialties.
As mentioned above, advances are being made daily in the diagnosis and treatment of breast cancer. Women should be encouraged that management of early-detected breast cancer involves increasingly less invasive approaches and will be addressed through the interaction of a team of dedicated specialists. New techniques in the fields of genetics, radiologic imaging, medical oncology, pathology, and surgery empower a woman to be actively involved in the management of her disease. Most women with breast cancer are surviving the disease, and can look forward to a future where prevention may actually be a reality.