Good News In Breast-Cancer Detection, Care

If you think you've been hearing a lot more positive news about breast cancer care and prevention, you're right. And if you support prevention and research efforts, you're part of the reason.

"Improvements in detection and in treatment of breast-cancer have definitely shown a benefit in the past few years," says Robert A. Smith, Ph.D., spokesperson for cancer screening at the American Cancer Society (ACS).

According to the ACS, breast cancer incidence has decreased by 2.2 percent per year from 1999 to 2006.

Overall, the risk of breast cancer has remained relatively stable over the past 10 years; one in eight women still develops it. A woman's chances for recovery, however, have been looking better. Among those diagnosed today in the early stages (0-I), the five-year survival rate has jumped to 100 percent.

Catching it early

Why are more women surviving breast cancer? "Mostly it's because the disease is being detected earlier," says Dr. Smith. "Breast cancer takes many different forms, and some are more aggressive than others. The fundamental key to a good prognosis is finding it early so you have the greatest range of treatment options."

Mammograms are still the "gold standard of early detection, and the good news is that more women are getting them regularly," says Dr. Smith.

Physicians can also utilize other imaging equipment to evaluate possible areas of concern. For example:

  • Ultrasound uses high-frequency sound waves to help determine whether a mass is a solid tumor or a cyst.

  • MRIs sometimes are used to detect small residual tumors after surgery and to monitor breast implants for leakage.

When a mammogram reveals an abnormality, doctors now can perform minimally invasive core biopsies using a slender, hollow needle to gather several samples from different areas of the tissue.

Women diagnosed with breast cancer also benefit from new drug therapies. Tamoxifen, the best known, reduced the recurrence of breast cancer very effectively during clinical trials. As a result, it has been used by women at high risk of breast cancer to reduce their chances of developing it.

In 2005, experts announced that the drug Herceptin (trastuzumab) seems to reduce the risk of a recurrence of breast cancer in women whose tumors have too much of a protein, called HER-2. HER-2 positive cancers tend to grow faster and are more likely to return after treatment than cancers that don't have too much of the protein.

Making good decisions

In addition, researchers are zeroing in on lifestyle factors that affect breast cancer. "We're feeling more and more confident that we can give women information they can use to make decisions that can reduce their risk," says Dr. Smith.

The following are factors that seem to increase the risk of breast cancer:

  • Alcohol. Drinking more than two drinks a day.

  • Postmenopausal obesity. Though a high-fat diet isn't considered a risk factor, obesity has been associated with a higher risk.

  • Hormone-replacement therapy. Over the long term, it produces a slightly elevated risk of breast cancer, which must be weighed against a decreased incidence of hot flashes and other post-menopausal symptoms

Other factors are associated with lower breast-cancer risk:

  • Lactation. Breast-feeding seems to help protect against breast cancer.

  • Physical activity. In addition to controlling obesity, regular exercise appears to have independent risk-reducing benefits.

By far, however, early detection by regular mammograms is the best way to reduce your risk.

The benefits and limitations of mammography vary based on factors like age and personal risk. Experts have different recommendations for mammography. Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every two years for women ages 50 to 74. The American Cancer Society (ACS) recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them.

What about clinical breast exams? The ACS recommends clinical breast exams (CBEs) at least every three years for all women in their 20s and 30s and annual CBEs for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.

"Right now, there's a good percent survival rate for women with breast cancers that are detected while they are still localized," says Dr. Smith. "Compared with other cancers, breast cancer is one of the more survivable."

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