Good News for Women with Breast Cancer

Women who have breast cancer are now living longer than they did only five years ago—and not simply due to improved mammography techniques.

Reason: Recent scientific evidence is changing the way physicians can treat the disease—making these treatments much more selective and effective. Key findings breast cancer patients need to know about…

• New thinking on double mastectomy. Many women with breast cancer opt to surgically remove the breast with the malignancy and the healthy breast. Their decision to remove both breasts is driven by the fear that a new breast cancer will develop in the healthy breast. But recent research suggests that double mastectomy for these women may be overused.
  

Recent scientific evidence: Researchers who followed up with 1,525 early-stage breast cancer patients four years after they had received mastectomy, double mastectomy or lumpectomy (a breast-conserving procedure that removes only the malignancy and surrounding tissue) found that women who had both breasts removed would have had a very low risk of developing cancer in the healthy breast.

Who should consider having a double mastectomy? According to the Society of Surgical Oncology, it may be warranted for a woman who is at increased risk for breast cancer because she has two or more immediate family members a mother, sister or daughter) with breast or ovarian cancer...or has tested positive for mutations in the BRCA1 or BRCA2 gene. These criteria apply to women who have early-stage breast cancer as well as those who haven't developed the disease.

Self-defense: If you don't have a family history or genetic predisposition to develop breast cancer, carefully review your reasons for considering a double mastectomy.

• Better results with tamoxifen. Doctors have long advised certain breast cancer patients to use an estrogen-blocking drug (tamoxifen) for about five years to stave off future breast malignancies.
  

Recent scientific evidence: For 15 years, researchers followed 6,846 breast cancer patients who took tamoxifen for an additional five years after five years of initial use while another group stopped the drug at five years.

Result: Those who used the drug for 10 years had a significantly reduced risk for breast cancer recurrence and death.

The benefits of longer-term tamoxifen use apply primarily to premenopausal women. That's because postmenopausal women have the option of taking another class of drugs called aromatase inhibitors, including letrozole (Femara), which are slightly more effective than tamoxifen at preventing future breast cancers but do not for unknown reasons, offer the same benefit to premenopausal women. Research has not yet determined whether postmenopausal women would benefit from taking letrozole for 10 years rather than the standard five-year recommendation.

Self-defense: If you're a premenopausal woman with breast cancer (especially if the tumor was large and/or you had lymph nodes that tested positive for cancer), ask your doctor about the risks and benefits of taking tamoxifen for more than the standard five years. Using the drug increases risk for endometrial cancer and pulmonary embolism.

• Less invasive treatment may improve survival for early-stage breast cancer. Women with early-stage breast cancer perceive mastectomy to be more effective at eliminating their future risk for breast cancer, but research shows that this is probably not true.
  

Recent scientific evidence: In an analysis of more than 112,000 women with stage I or stage II breast cancer who were tracked for an average of 9.2 years, those who received lumpectomy plus radiation had odds of survival that were as good as or better than those who underwent mastectomy.

Self-defense: If you are diagnosed with stage I or stage II breast cancer, ask your doctor about lumpectomy plus radiation.

• More women could benefit from reconstruction. With breast reconstruction, a woman who has received a mastectomy or, in some cases, a lumpectomy) can have her breast shape rebuilt with an implant and/or tissue from another part of her body (typically the abdomen, back or buttocks). When a patient opts for reconstruction, it is ideally performed with the initial breast cancer surgery for the best cosmetic result.
  

Breast reconstruction does not restore the breast's natural sensation or replace the nipple. However, a new "nipple-sparing" mastectomy, a technically difficult procedure in which the surgeon preserves the nipple and areola (the brownish or pink-colored tissue surrounding the nipple), is gaining popularity with women whose malignancy does not interfere with this type of surgery.

Recent scientific evidence: Even though breast reconstruction can offer cosmetic and psychological advantages, not very many women choose to have it. In a study of more than 120,000 women who underwent mastectomy, fewer than one in four of the women with invasive breast cancer opted for reconstruction, while only about one in three of those with early-stage disease got it. Almost all women are candidates for reconstruction, which does not impact survival rates. In some cases, women require one or more subsequent surgeries to fine-tune the reconstruction.

Self-defense: Ask about reconstruction before your treatment begins. If you're a candidate, the breast surgeon can coordinate with a plastic surgeon. Breast reconstruction is often covered by insurance, but some insurers may require a co-pay. (See the following article on breast reconstruction for more information.)

• Targeted therapies save lives. Until 40 years ago, breast cancer was treated almost uniformly with radical mastectomy, radiation and some form of hormone therapy.
  

Recent scientific evidence: Using new genomic DNA-based tests, doctors are now able to customize treatment based on tumor biology. helping them better predict a patient's risk for recurrence and response to particular treatments. This may help thousands of women avoid chemotherapy, including anthracyclines, which are linked to heart damage and leukemia.

Self-defense: Ask your doctor whether you could benefit from genomic testing to help determine which breast cancer therapies would be most effective for you.