Breast Cancer: Better
Treatments Save More Lives
By Carol Lewis
Star Community Newspapers – August 27, 2003
Two different women.
The same deadly disease. One thought she couldn’t get it. The other
was told she didn’t have it. Both opinions were wrong. In 1994,
one week before turning 35, Cathy Young received the devastating
news. ”I thought you had to be in their 50s to get cancer,” the
Oak Grove Mo., resident says “And then it happened to me.”
Linda Hunter, 42, recalls
that in 1995, her mammogram results came back normal. But skin changes
in one of her breasts compelled her to seek a second, third and
fourth opinion – all of which supported the initial mammogram findings.
Her tenacity paid off when the fifth doctor she visited detected
a rare form of the disease.
Every three minutes,
a woman in the United States learns she has breast cancer. It is
the most common cancer among women, next to skin cancers, and is
second only to lung cancer in deaths in women. Only 5 to 10 percent
of breast cancers occur in women with a clearly defined genetic
predisposition for the disease! The overall risk for developing
breast cancer increases as a woman gets older.
is initially successful for many women, The American Cancer Society
(ACS) says that breast cancer will return in about 50% of these
"It’s hard to say that
things are back to normal when one survives breast cancer,” says
Young, “because a survivor always has the fear that one day the
cancer will return.”
New drugs, new treatment
regimens and better diagnostic techniques have improved the outlook
for many, and are responsible, according to the ACS, for breast
cancer death rates going down.
Women have greater
options in breast treatment compared to a decade ago,” says Harman
Eyre, M.D., chief medical officer at the ACS. New drugs and procedures
open up a whole new era of effective treatment.”
Breast cancer can be
treated with surgery, radiation, and drugs (chemotherapy and hormonal
therapy). Doctors may use one of these or a combination, depending
on factors such as the type and location of the cancer, whether
the disease has spread, and the patient’s overall health.
Most women with cancer
will have some kind of surgery, depending on the stage of the breast
cancer. The least invasive, lumpectomy (breast conserving surgery),
removes only the cancerous tissue and a surrounding margin of normal
tissue. Removal of the entire breast is called a mastectomy. A modified
radical mastectomy includes the entire breast and some of the underarm
lymph nodes. The very disfiguring radical mastectomy, in which the
breast, lymph nodes, and chest wall muscles under the breast
are removed, is rarely performed today because doctors believe that
a modified radical mastectomy is just as effective.
While removing underarm
lymph nodes after surgery is important in order to determine if
the cancer has spread, this procedure may add chronic arm swelling
and restricted shoulder motion to the discomfort of the overall
treatment. But a new method, sentinel node biopsy, allows physicians
to pinpoint the first lymph node into which the tumor drains ( the
sentinel node), and remove the only nodes most likely to contain
To locate the sentinel
node, the physician injects a radioactive tracer in the area around
the tumor before the mastectomy. The tracer travels the same path
to the lymph nodes that the cancer cells would take, making it possible
for the surgeon to determine the one or two nodes most likely to
test positive. The surgeon will then remove the one or two nodes
most likely to be cancerous.
Radiation therapy is
treatment with high-energy rays or particles given to destroy cancer.
In almost all cases, lumpectomy is followed by six or seven weeks
of radiation, an integral part of breast-conserving treatment. Although
radiation therapy damages both normal and cancerous cells, most
of the normal cells are able to repair themselves and function properly.
Radiation therapy can
cause side effects such as swelling and heaviness in the breast,
sunburn-like skin changes in the treated area, and lymphodema (swelling
of the arm due to fluid buildup) if the underarm lymph nodes were
treated after a node dissection.
Drug Options Expanded
Drugs are used to reach
cancer cells that have spread beyond the breast -- in many cases
even if no cancer is detected in the lymph nodes after surgery.
Doctors once believed that the spread of breast cancer could be
controlled with extensive surgery. Now, they believe that cancer
cell may break away from he primary tumor and spread hrough the
bloodstream, even in the earliest stages of the disease. These cells
cannot be felt by examination or seen on x-rays or other imaging
methods, and they cause no symptoms. But they can establish new
tumors in other organs or bones. The goal of drug treatment , even
if there's no detectable cancer after surgery, is to kill these
cells. This treatment, known as adjuvant therapy, is not needed
by every patient. Doctors will make recommendations regarding specific
types of therapy based on he stage of the breast cancer.
The Food and Drug Administration
has approved several new drugs and new uses of older drugs in recent
years that improve the chances of successfully treating breast cancer.
These drugs include Herceptin (trastuzumab), which binds to HER2
and kills the excess cancer cells, theoretically leaving the healthy
cells alone, Novadex (temoxifen citrate), used for breast cancer
risk reduction in high-risk women, Xeloda (capectabine), for the
treatment of breast cancer that has spread to other parts of the
body (metastasized) in its resistance to both paclitaxel and an
anthracycline-containing regimen and Taxotere (docetaxel) to treat
patients whos locally advanced or metastasized breast cancer has
progressed despite treatment with other drugs.
In addition to these
drugs, combinations of the anti-cancer drugs Cytoxan (cyclophosphamide)
and Adriamycin (doxoribicin), with or without Adrucil (fluorouacil)
, may be used to treat breast cancer.
Treatment) is given in cycles, with each period of treatment followed
by a recovery period. The total course of chemotherapy can last
3 to 6 months, depending on the drugs and how far the cancer has
Kelly Munsell of Tuscon,
Ariz., took the combination Adriamycin and Cytoxan in six cycles,
spaced 3 weeks apart, after doctors diagnosed her breast cancer
in 1996 at age 27.
"Chemo for me was torture,"
Munsell recalls, describing profuse vomiting and severe weight
gain as two serious side effects. But despite the discomfort, Munsell,
whose mother and grandmother died of breast cancer, is glad she
underwent the grueling treatment two years ago. "My recent battery
of tests came back negative for cancer," she says.
In addition to the
drugs, actually battling the disease, there also is help for patients
in severe pain from cancer. FDA approved Actic (oral transmucosal
fentanyl citrate) in November 1998 as a treatment specifically for
cancer patients with severe pain that breaks through their regular
narcotic therapy. A narcotic more potent than morphine, Actic is
in the form of a flavored lozenge that dissolves slowly in the mouth.
It is important for every woman to consider herself at risk
for breast cancer, the ACS says, simply because she is female. At
the same time, however, studies continue to uncover lifestyle factors
and habits that can alter the risk, and many new chemotherapy drugs
and combinations continue to be developed and tested in clinical
trials. Drugs and procedures currently under investigation include
bisphosphonates (a group of drugs routinely used to treat osteoporosis),
monoclonal antibodies (similar to Herseptin), and angiogenesis inhibitors
(drugs that block the development of blood vessels that nourish
cancer cells). "While death rates for breast cancer are falling,
and while there are a number of new strategies being developed,"
says Dr. Michael A. Friedman, a former FDA deputy commissioner and
cancer research specialist, "we recognize that a great deal more
needs to be done."
Mammography: A Lifesaving Step
The ACS says that the best strategy for successfully beating breast
cancer is to follow guidelines for early detection. Currently, the
most effective technique for early detection is screening mammography,
an x-ray procedure that can detect small tumors and breast abnormalities
up to two years before they can be felt and they are most treatable.
(See "FDA Sets Higher Standards For Mammography" in the January-February
1999 FDA Consume.)
Studies show regular
screening mammograms can help decrease the chance of dying of breast
cancer. Finding a breast tumor early may mean that a woman can choose
breast saving surgery. Furthermore, she may not have to undergo
To find a certified
mammography facility near you, go to
on FDA's Website, or call the National Cancer Institute at 1-800-4-CANCER
Carol Lewis is a staff
writer for FDA Consumer.