By Kristin Campbell
From the July 2013 issue of Columbus CEO
Each year, more than 230,000 people are diagnosed with breast cancer in the United States alone, according to the National Cancer Institute. Researchers, physicians and the general public are working hard to lower those numbers and to make sure more patients make it successfully to the other side of their cancer battles.
Experts say awareness and early detection remain the best weapons in beating breast cancer—for both men and women. Although men can undergo mammograms, the test is not recommended as a screening tool since only 2,000 male cases are diagnosed annually. For women, however, an annual mammogram or other imaging test starting at age 40 is de rigeur. By the time a mass is detectable purely by touch, the odds of survival have dropped significantly.
According to the National Cancer Institute, the overall five-year relative survival rate for breast cancer is 89.2 percent. Depending on what stage the cancer is in, survival rates range from 98.6 ercent to 24.3 percent.
“Screening mammography plays a major role in detecting abnormalities when they are small,” says Dr. Lauren Miller, an OhioHealth breast imaging radiologist. If anything shows up, the patient called back for another set of mammograms and possibly a ultrasound, depending on the type of abnormality, Miller says.
Sometimes a biopsy is warranted—often a needle biopsy, in which ultrasound or stereotactic imaging visually guides the radiologist to the mass.“Many of these biopsies will be benign, but those that are cancerous or pre-cancerous will be determined by this needle biopsy,” Miller says.
Breast MRI is another tool that may be used in certain situations, particularly for patients who are at high risk of developing breast cancer. That may include women with genetic mutations and those who have a family or personal history of the disease. MRI and ultrasound can also be used to measure progress when larger cancers have been treated with chemotherapy to shrink them prior to surgery.
Miller says several new developments are improving the detection and treatment of breast cancer.“Breast tomosynthesis is a 3-D mammography technique that we have at OhioHealth,” she says. “It is used in conjunction with regular 2D mammograms and breast ultrasound to further localize or characterize an abnormality or show that something is just normal, overlapping breast tissue.”
Elastography is a new ultrasound tool that allows radiologists to assess the breast more accurately by measuring the stiffness of tissue; normal cells and benign tumors are typically softer than malignancies. Doctors have long debated whether the negative psychological impact of excessive tests and procedures outweighs the good they do. Elastography could potentially prevent unnecessary biopsies.
“Additionally, the biopsy techniques continue to become more and more precise and minimally invasive,” Miller says.
Health on the Road
Despite physicians’ admonitions, many women still forego routine mammograms. Some may neglect their own health while lavishing attention on their families and giving countless hours to their careers and volunteer activities. Other may fear a cancer diagnosis. Whatever the reason, health-care providers are working to eliminate excuses mak mammograms more accessible.
The OhioHealth Mobile Mammography Unit serves women throughout Central and Southern Ohio by providing on-site health screenings at businesses and community organizations.
Kay Holland, manager of medical imaging for OhioHealth Neighborhood Care, says the mobile unit is typically on the road five to six days a week. Trained technologists and breast health educators staff the unit, providing not only mammograms but also bone density testing and the most important tool of all: information. There is no cost to the organizations that host the unit, and patients’ health insurance covers the procedures. The convenience can be a huge advantage for women who find themselvesdelaying a mammogram.
“The OhioHealth Mobile Mammography Unit brings mammography and bone density screenings to the patient,” Holland says. “Typically, this means a woman can step out of her workplace, onto the unit and have her mammogram complete in just 30 minutes.”
Dr. Jeanna Knoble, a medical oncologist and hematologist with the Zangmeister Center and Mount Carmel Health System, says that in cases where a mass is detected, a biopsy can rule out cancer or help doctors assess the behavior and stage of the malignancyWhen cancer is diagnosed, surgery—either a lumpectomy or mastectomy—is typically (though not always) the next step, Knoble says.
However, chemotherapy may be done first for several reasons. The goal of surgery is to remove all of the cancer plus a small margin of healthy tissue around the tumor, in order to ensure all malignant cells have been removed. That becomes more complicated if the cancer is advanced, so chemo may be used to shrink the tumor. In cases where a patient opt for breast conservation measures, if ’s sizereduced prior to surgery, doctors may be able to save more breast tissue.
“Chemotherapy works systemically against any cancer cells in the body, but it’s not really discriminatory against healthy cells,” Knoble says. Still, despite its potential side effects (including hair loss and nausea), chemo remains a valued tool in the treatment of cancer.
Radiation is also a common part of the treatment plan, and it may come before or after surgery and chemotherapy. It typically lasts five days a week for six weeks and is designed to eradicate any remaining cancer cells. The course of action varies for each patient depending on the characteristics, aggressiveness and stage of the cancer, Knoble says.
Often, the last step in the treatment process is endocrine therapy, also called hormontherapy, which helps to prevent recurrence. Patients typically take pills (such as tamoxifen) for five years, but Knoble says new data indicates that continuing drug therapy for 10 years is even more successful.
After the Fact
Breast cancer takes a huge psychological toll. Once the cancer is beaten, mastectomy patients face the additional hurdle of having their bodieslookdifferent than before. Reconstructive surgery can solve that problem by repairing even improving the physical appearance of the survivor.
Dr. Michael Miller, chairman of the Department of Plastic Surgery at the Ohio tate University Wexner Medical Center, works with many breast cancer patients. While men typically don’t opt for reconstructive surgery for purely aesthetic reasons, women often do.
Miller works closely with a patient’s surgical oncologist and often performs reconstructive procedures at the same time as the mastectomy. “Most often, the skin can be saved, because the skin and the breast are different structures,” Miller says.
The surgeon may use a gel implant for a relatively natural look and feel, or may use tissue from another part of the patient’s body and employ a more complex procedure. The extra tissue may be taken from the lower abdomen, the buttocks, the inner thigh or the back. The tissue is transplanted, microsurgery is employed to reattach blood vessels, and the skin is shored up in something akin to a tummy tuck.
Some women find it appealing to have breasts made of their own natural tissue, while someone who doesn’t have much tissue to spare may not want such an elaborate reconstruction. “It all depends on the patient, that person’s interests and the tissue available on the body,” Miller says.
Following reconstruction, it takes about a month to feel completely normal. Miller says patients spend four days in the hospital and then need to take easy for several weeks. The biggest issue most patients deal with is not pain, but fatigue. “It takes energy to heal,” Miller says. “It’s like running 10 miles a day. You’re going to need some time to rest.”
Miller says working with people who have been through cancer is one of the most rewarding parts of his profession.“These people are the most grateful and loyal patients,” he says. “We go for the best-looking result we can possibly get, and for them, it’s a huge part of getting over the cancer.”
Kristin Campbell is a freelance writer.