Treatment options for early breast cancer — cancer at the first point of being diagnosed — have never been more varied and more personalized for each patient.
Breast cancer is the most common cancer affecting women, with more than 1 million women diagnosed worldwide each year. Death rates from breast cancer have decreased since 1990, due to early detection methods, such as screening mammography.
Mammography can detect breast cancer at an early stage, when treatment is more effective and prognosis is better. There is general agreement that screening mammography reduces the rate of death from breast cancer in women 40 years of age or older.
Full field digital mammography allows for a more confident characterization of suspicious lesions and microcalcifications, because the image can be magnified, enhanced and the contrast manipulated to allow highlighting. And computer-aided diagnosis provides a second reading of the mammogram to ensure accuracy.
Mammography is highly accurate but may miss up to 10 percent of breast cancers that physical exams may pick up. Recent studies show that breast MRI is more sensitive than mammography in detecting tumors, especially in women with dense breasts.
When surgery is necessary, options for early breast cancer have become more conservative, with breast preservation and lumpectomy and radiation replacing mastectomy as the preferred breast cancer surgery in 66 percent of women. The surgical technique of lymphatic mapping and sentinel node biopsy provides a less morbid operation with more accurate staging — a win/win for the patient that quickly became the standard of care.
Skin- and nipple-sparing mastectomies are being offered to women with smaller tumors. Cosmetic outcomes and patient satisfaction are greater with this procedure compared to standard mastectomy, since incisions are hidden under the breast, the nipple/areolar complex is intact and the breast mound is reconstructed with an implant.
Mastectomy (complete removal of the breast) is still used in patients meeting certain criteria, including having a genetic predisposition for developing breast cancer due to a positive gene test (BRCA I and II).
In order for women to preserve the breast, after the surgical lumpectomy the remainder of the breast is treated with radiation therapy. Since most of the recurrences of breast cancer occur in the quadrant the original cancer was in, radiation therapy can be limited to just the area of the breast of the primary tumor, which reduces the therapy from six weeks to one week with a technique called partial breast radiation.
And the new world of personalized medicine that uses a patient’s own genes for targeting tumor treatment, as well as total body chemotherapy or hormonal therapy, is showing great promise.
Overall, the last 40 years has seen many advances in surgery for treating early breast cancer. And most of them are more conservative treatments, resulting in better outcomes for women the world over.
Dr. Reintgen is professor of surgery at USF Health Morsani College of Medicine and a surgical oncologist, and he serves as director of Cancer Initiatives at USF.