Throughout the course of his career, Kenneth D. Miller, MD, assistant
professor of medicine at Yale University, has watched the evolution of breast
cancer diagnosis and treatment. He remembers a time when many women received
diagnoses of advanced stages of breast cancer, accompanied by much worse
prognoses, during routine physical exams.
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| Kenneth D. Miller |
Times have changed, and have brought significantly improved screening,
diagnoses and outcomes.
“There still are, however, approximately 213,000 women diagnosed
with breast cancer each year and it still is the number one type of cancer in
women,” Miller said.
The rate of 5-year survival after a diagnosis of breast cancer has risen
steadily over the past 40 years, from 75% in the 1970s, to about 78% in the
1980s, to 88% between 1995 and 2000.
“Today, in 2010, it’s over 90%,” he said. “That
relates to the fact that we’re finding it earlier and we have better
treatments.”
He listed several factors that contribute to this improvement:
breast-conserving surgery now is as effective as mastectomy; the decision to
remove the sentinel node often has the same result as removing many nodes;
oncologists have improved their ability to distinguish whether patients require
chemotherapy or hormonal therapy after surgery; and new targets have been
identified that aid the treatment process.
Most important is that researchers and oncologists better understand the
genetic syndromes involved, as well as other predisposing factors like family
history that contribute to a person’s likelihood to develop the disease.
With a firm grasp on the characteristics that place someone at a high risk of
developing breast cancer, the medical community continues to develop a strategy
for preventive screening — including mammography and breast MRI — and
for reducing those risk factors.
Other prevention strategies also have improved.
“Giving high-risk women tamoxifen, which is a breast cancer drug,
can reduce the risk of breast cancer by half,” he said.
Another drug, raloxifene (Evista, Eli Lilly), has shown promise for
prevention. Other new drugs, such as trastuzumab (Herceptin, Genentech), are
used for targeted treatment after surgery. Unlike chemotherapy, which attacks
all of the body’s cells, trastuzumab hones in on certain breast cancer
cells that express a protein called HER2/neu, without damaging other cells,
Miller told O&P Business News.
“It’s like shooting an arrow at a bull’s-eye — you
know just what to go after,” he said.
This treatment avoids the approach more commonly used in the past, where
“when all you have is a hammer, everything looks like a nail.”
Instead, Miller explained that only those patients who need that hammer for
more aggressive therapy receive it.
To decide on the best course of treatment, oncologists first must
determine the option that gives the woman the best chance of a cure. In
situations where there are several valid choices, patient preference becomes
the most important factor.
“You can tell someone mastectomy gives her the best chance, and the
woman might say she won’t do that, or vice versa,” Miller said.
“In general, women know what they want, but it’s not always the same
thing as the next woman.”
Either way, experience has proved that lumpectomy with radiation is just
as effective as mastectomy for treatment in most breast cancer cases, which
provides good news for patients. Another bright spot lies in post-mastectomy
and post-lumpectomy care. Patients may benefit from undergoing reconstructive
surgery or being fit for breast prostheses — either to completely
reconstruct the breast or to restore symmetry — and improvements in these
areas continue to provide additional options.
Miller said he sees a hopeful future for breast cancer patients,
including earlier diagnosis, smarter treatment and more targeted therapy.
“Many women are cured of breast cancer already,” he said.
“Will there be a global cure? That’s probably going to take a long
time. I think within my career, but I’m not sure.” — by
Stephanie Z. Pavlou
