Hope on the Horizon for Breast Cancer

Except for non-melanoma skin cancer, breast cancer remains the most frequently diagnosed cancer in women. Cancer experts say there is reason to feel encouraged by the current breakthroughs in detection and treatment.

In recent years, researchers have discovered new and better ways to detect and treat breast cancer— and to keep it from coming back, the American Cancer Society (ACS) says. These new developments stem from a vast body of research. Recent advances, along with greater public awareness of the importance of breast exams, have caused a decline in breast cancer deaths in women since 1990.

Here’s a roundup of what’s on the horizon in the areas of mammography, surgery, and hormonal therapy. Keep in mind that all these advances are not yet widely available and many may not be appropriate for everyone. Any treatment decisions must be made by a woman and her doctor, based on her particular cancer, her medical and physical history, and her doctor’s clinical judgment.

Improved mammography

There’s no doubt about it: Finding breast cancer early increases treatment options and saves lives. Study after study has shown that regular mammograms play a vital role in early cancer detection.

Thanks to advances in digital technology, mammography may become an even more valuable tool in the future. Currently, standard mammography captures images on film. But research centers around the country are now testing digital mammography, which generates images without film much the way a digital camera does.

Both digital and standard mammography use X-rays to take a picture of your breast, but in digital mammography, the image is recorded and stored on a computer, the ACS says. The radiologist can manipulate the digital image, adjusting the size, brightness, or contrast to see it more clearly. Digital mammography is more expensive than standard mammography.

“Right now, it appears that film and digital mammography are equivalent,” says Kevin S. Hughes, M.D., a Boston breast cancer specialist. “While I think we’re close to our limits as to what we can do with film, we still have a lot of potential to enhance what digital mammography can do.”

In the years to come, digital mammography may make it easier to diagnose cancer by using special computer programs that recognize cancerlike patterns in breast images.

Another way to find cancer

An alternative to using X-rays is magnetic resonance imaging (MRI), which uses radio waves and strong magnets to view body tissue, the ACS says. Although MRIs are common in helping to diagnose other diseases, they must be specially adapted to scan the breast. They can be used as a follow-up after mammography has found cancer in the breast, or to screen women at high risk for breast cancer. More research is needed, however, to find out if MRIs are any better than mammography at finding small breast cancers.

Advances in biopsies

Before an abnormality on a mammogram is diagnosed as cancer, doctors typically order a biopsy. This is a procedure in which a doctor removes a small tissue sample from the breast and examines it under a microscope. This is the only way to tell if cancer is really present. The sample may be removed using a needle or open surgery. When using a needle to perform the biopsy, the doctor usually guides it into the area by feeling the lump. If a lump is too small to be felt, doctors have used ultrasound or a computer to help guide the needle.

The newest biopsy technique being studied uses magnetic resonance imaging to help doctors get a clearer picture of the tissue being sampled, the ACS says. In this type of biopsy, a doctor can take many tissue samples through one small incision. Researchers say this procedure is being studied in women with a personal or family history of breast cancer, those who have already had breast surgery, and those with dense breast tissue.

Breast reconstruction surgery

Once breast cancer has been diagnosed, most women have some type of surgery to treat it. A lumpectomy removes only the breast lump with a small amount of tissue around it, while a mastectomy removes a larger part of the breast tissue and/or the whole breast.

For women who undergo a mastectomy, a procedure called skin-sparing mastectomy (SSM) is becoming more popular, the ACS says. In a traditional mastectomy, the skin of the breast is removed along with other tissue. In SSM, however, the cancer surgeon removes the breast tissue, but leaves the skin that covers the breast in place. A plastic surgeon can then use this skin when reconstructing the breast, which gives it a more natural appearance.

Several studies have compared the safety of SSM with traditional mastectomy. “There has been no difference at all in terms of local recurrence of cancer,” says researcher Anees Chagpar, M.D., a breast cancer specialist in Louisville, Ky.

Detecting the spread of cancer

During a lumpectomy or mastectomy, lymph nodes under the arm may be removed to check whether the cancer has spread. In the past, several lymph nodes had to be removed, which sometimes led to uncomfortable side effects such as numbness or swelling of the arm. Today, however, a less extensive procedure known as sentinel node biopsy may be another option, the ACS says. Research suggests that it may be just as effective at indicating whether cancer has spread.

In a sentinel node biopsy, a special dye or radioactive substance is injected near the tumor and carried by the lymph system to the first, or sentinel, node to which the tumor drains. Once this node has been identified, it can be removed and checked for cancer. If none is found, it may not be necessary to remove more nodes.

“To me, this has been the single most important advance in surgery because it has limited the number of side effects women have afterward,” says Lisa Jablon, M.D., a breast surgeon in Philadelphia.

Additional treatments

After surgery, many women receive additional treatment to destroy any remaining cancer cells. Radiation therapy uses high-energy rays to destroy cancer cells or to slow their growth. It can be used to target any cancer cells that may remain in the breast or in nearby tissues. Systemic therapy, on the other hand, targets cancer cells that may have spread beyond the breast area. The two main types of systemic therapy are chemotherapy and hormonal therapy, Dr. Jablon says.

Chemotherapy involves powerful anticancer drugs that are either injected into a vein or swallowed as a pill. Doctors are now studying new dosage regimens and drug combinations to find the ones that are most effective for women in specific situations. One treatment option that is being explored is the use of monoclonal antibodies. 

“We’re also getting better at treating the side effects of these drugs and supporting women throughout their treatment,” says Dr. Jablon.

Hormonal therapy

Hormonal therapy refers to treatments that affect hormone levels in the body. Estrogen, a female hormone, causes some breast cancers to grow. For women with such cancers, various methods may be used to block the effects of estrogen or to lower estrogen levels. The most widely used estrogen-blocking drug is tamoxifen. Recently, however, a new class of drugs called aromatase inhibitors has become available. New aromatase inhibitors include letrozole, anastrozole, and exemestane. These drugs, which stop the body from making estrogen, only work for women past menopause. For this age group, they seem to be very promising.

In a large, five-year study published in 2005, British researchers compared an aromatase inhibitor called anastrozole with tamoxifen in postmenopausal women with early-stage breast cancer. The researchers found that anastrozole appeared to do a much better job of preventing cancer from reappearing. If the cancer did return, it took longer to show up in the women who took anastrozole.  

Today, the five-year survival rate for women whose breast cancer is caught before it has spread outside the breast is 98 percent. As detection and treatment methods continue to improve, this percentage should increase.