Breast Health

By Carrie Smoot

“Lack of a family history does not protect anyone from breast cancer. Seventy percent of those diagnosed have no previously known risk factors,” says Tammy Wagner, vice president, American Breast Cancer Foundation (www.abcf.org), in Baltimore, MD. “Diagnosis is not a death sentence,” she says. “With early detection and treatment, a woman’s chances for survival are nearly 98 percent.”

ABCF provides breast health and breast cancer education and research grants and encourages women to conduct monthly breast self-exams. Funding assistance for mammograms and clinical breast exams is available through ABCF’s Key to Life Breast Cancer Screening Assistance Program at 877-Key-2-Life (877-539-2543). “Schedule mammograms around annual physicals or other regular medical appointments,” Wagner says. “Be aware of changes in your breasts at any given time. [What is the] look and feel? If you see scaling, discharge, lumps, bulges, puckering or sudden swelling, … see the doctor, even though previous mammograms [were] clear. [In] monthly breast self-exams, check not only around the breast area, but the underarms and collarbone for anything that doesn’t seem normal. Even though recent research shows that self-exams [don’t] always lead to the discovery of more tumors than screening tools, it’s advisable to continue self-exams, especially if they have worked in the past. Ideally, women should [have learned] self-exams during adolescence,” she says.

“Those few minutes spent having a mammogram and clinical breast exam can save your life,” Wagner says. “Mammograms shouldn’t be painful. If they are, tell your technicians.”

Who’s At Risk?

Breast cancer affects all women and a small percentage of men. With more than five types of breast cancer tumors, treatments and surgery decisions are different for every woman. According to Breast Fitness: An Optimal Exercise and Health Plan for Reducing Your Risk of Breast Cancer (St. Martin’s Press, 2000), a breast cancer tumor is discovered every three minutes, and every 12 minutes in the U.S., a woman dies from breast cancer. Caucasian women are at slightly higher risk, and African-American women face higher mortality rates from the disease. Women who had a first period before the age of 12, had children later or never had children are at increased risk. Those with a strong family history of breast cancer or the BRCA1 and BRCA2 genes are also at risk.

“We have some idea about [breast cancer’s] multiple contributing factors,” says Dalliah Black, M.D., breast surgeon at The Hoffberger Breast Center at Mercy Medical Center in Baltimore, MD. “There’s a link between obesity, a high-fat diet with lots of meat and sweets and breast cancer incidence. Fat cells make natural estrogen, and that may contribute to the disease. I’ve had patients who are thin, fit and vegetarian, and they have been diagnosed with breast cancer. Keep weight down for many health reasons.

“Women from all backgrounds still have basic questions about benign problems, such as cysts, mammography, cancer, what it means to be high-risk and related topics,” she says. “In the U.S., 75 percent of women over the age of 40 get their annual mammograms. That should be 95 percent or better.”

Testing & Treatment Options

“Most breast cancers can’t be detected with a breast self-exam alone, but [mammography] is not a perfect test,” Black says. “In addition to traditional analog mammography, digital mammography may take a clearer picture in certain women but also can lead to more benign biopsies. If a woman has a breast problem … get the abnormality checked out. Most problems that women see a breast specialist for are benign. However, breast cancer is common. Early detection is key for breast cancer treatment success and outcomes. Breast MRI and breast ultrasound are options for high-risk patients, like those with a 20 to 25 percent lifetime risk of getting breast cancer. Treatment options are now tailored to the cancer and individual patient and may include a lumpectomy or mastectomy, radiation, chemotherapy or hormonal therapy. After treatment, mammogram follow-up of that breast is six months after surgery or radiation. Possibly another mammogram [is taken] on that side in another six months, or [it is] back to yearly screening. Breast MRI or ultrasound may be used in certain situations,” Black says.

“I have new patients write down questions. People are understandably very nervous,” says Katherine Alley, M.D., medical director of the Breast Cancer Program of Suburban Hospital in Bethesda, MD. “Bring a friend or family member with you,” Alley says. Her medical team includes radiologists, medical oncologists and radiation therapists. If breast conservation surgery isn’t an option and the patient needs a mastectomy, plastic surgeons may be involved. Alley says 85 percent of her patients are good candidates for breast conservation because tumors were caught early. Alley encourages patients to continue some exercise such as walking or riding a bike during treatment and afterward. She refers patients to physical therapists to discuss lymphedema prevention, arm exercises and follow-up fitness strategies.

“More than 80 percent of women diagnosed with breast cancer live and thrive more than five years after diagnosis. This is a dramatic increase in survivorship directly attributable to treatment advances and effective screenings such as mammograms, which help us find cancers earlier when they’re most treatable. New treatment options are developed all the time. It’s these two factors that are bringing mortality rates down,” says Claudine Isaacs, M.D., director of the Clinical Breast Cancer Program at Georgetown University Hospital’s Lombardi Comprehensive Cancer Center.

She says Austrian researchers this past year found that adding the osteoporosis drug Zometa to hormonal treatment in premenopausal women with early stage breast cancer reduced the risk of recurrence by 35 percent, compared to women who took only hormonal therapy. “We still need to find out exactly how these drugs interact and work,” she says. Isaacs says Lombardi has ongoing research with Zometa-like drugs called “bisphosphonates.”

Isaacs says recent research showed that women who had normal levels of vitamin D at the time of breast cancer diagnosis were less likely to have a recurrence than those who were vitamin D-deficient. “Does that mean women diagnosed with breast cancer who have low levels of vitamin D can change the outcome from their breast cancer by taking supplements, getting more sun and so on? We just don’t know all the answers yet.”

Isaacs’ other role is medical director of the Cancer Assessment and Risk Evaluation program (CARE) at Lombardi. CARE patients have a strong personal or family cancer history that increases their risk of developing breast or ovarian cancer. Options for women with a hereditary predisposition to breast cancer include tailored and more frequent screening, medicines to help reduce the risk of developing cancer and, in some cases, surgery to remove the breast and ovaries. CARE conducts ongoing clinical trials to discover relationships between hereditary breast and ovarian cancers and other cancers.

Lombardi researcher Leena Hilakivi-Clarke, Ph.D. explores how diet and exercise impact breast cancer development. “There’s some indication that consumption of a high-fat diet during these periods contributes to breast cancer risk,” says Hilakivi-Clarke. “Some evidence indicates that eating soy one to four times per week during childhood reduces later breast cancer risk up to 50 percent. We need to understand these [protective] mechanisms. Traditional Asian foods, like soybeans, tofu and soy milk, not processed products, are best. A balanced diet including fish, fruits and vegetables is important, too,” she says, noting that being active during childhood reduces breast cancer risk later in life. Her studies suggest this may be gene activation protecting the breast from cancer initiation.

Minetta C. Liu, M.D., investigates utility of circulating tumor cells in metastatic breast cancer patients. She’s a medical oncologist who directs translational breast center research at Lombardi. “Several potentially effective medications are available for treatment of advanced breast cancer,” she says. “Unfortunately, there is no set algorithm for cancer treatment. We need to refine the ability to find the most effective therapy for an individual patient.”
Liu is conducting a two-year clinical trial utilizing the FDA-approved CellSearch™ technology (Veridex, LLC). “It usually takes several weeks or months to determine with standard radiology studies, like CT scans, if a particular cancer treatment is working. This new, widely available blood test provides a tool that may allow oncologists to more reliably—and more quickly—assess treatment efficacy. If we can stop ineffective therapies sooner and identify effective therapies promptly, we should make more significant improvements in breast cancer survival.”

Oncologist Nicholas Robert, M.D., is affiliated with Inova Fairfax Hospital in Virginia. Robert encourages genetic testing if patients qualify. “Female relatives on the father’s side are also important when looking at family history,” he says. Robert says most of his patients are good candidates for lumpectomy and radiation, rather than mastectomy, although the final decision is up to the woman.

For women with metastatic breast cancer, Robert says, new therapies are available to control disease, help women live longer and have a better quality of life, but they aren’t cures. More than 100 genes are involved in breast cancer, and [there are] at least 20 different cancer drugs. “We spend a lot of time looking at tumors, which are heterogenous and affect people differently. We want to alter the tumor’s blood supply.

“Recently approved by the FDA, Avastin is an antibody that helps kill the tumor’s cells when given with chemotherapy. Herceptin is another antibody that binds to a special protein on breast cancer cells that also kills tumor cells. Herceptin-based treatments have been beneficial in both metastatic breast cancer and early breast cancer. Another advancement is aromatase inhibitors, medications that are useful in the care of postmenopausal women with breast cancers that are estrogen-receptor positive and are also effective in metastatic and early breast cancer settings,” he says.

October is Breast Cancer Awareness Month. Take the time to learn about the importance of breast cancer prevention and treatment.

“Four thousand Maryland women are diagnosed with breast cancer annually. The disease affects the entire family, not just the person diagnosed,” says Jan Wilson, executive director of The Red Devils (www.the-red-devils.org), a nonprofit, Baltimore organization providing non-medical, patient-specific and free support to Maryland breast cancer patients and families.

Wilson says the group will expand into Montgomery County and Prince George’s County next year, adding six more to the current network of 28 partner hospitals. Assistance includes housecleaning, meal preparation, transportation to medical appointments and child care. The Red Devils work with contractors to provide services and pay bills. “[They] are tremendous gifts to yourself and your family,” she says.

Breast Cancer Network of Strength, formerly Y-ME National Breast Cancer Organization, began in 1978. “Then, no one talked about breast cancer,” says Mid-Atlantic Affiliate executive director Traci Richards. “Now you see pink ribbons everywhere. We provide workshops teaching self-breast examination, clinical breast examination and mammography,” Richards says. Visit www.networkofstrength.org for more information.

Trained peer counselors who are breast cancer survivors staff the Breast Cancer Network of Strength’s YourShoes™ 24/7 Breast Cancer Support Center, with interpreters in more than 150 languages. Call 1-800-221-2141. “No one should have to face breast cancer alone,” Richards says.

Carrie Smoot is a Northern Virginia freelance writer.