One in eight U.S. women are diagnosed with breast cancer. When a woman finds out she is one of those statistics, the news is overwhelming; depression, fear, and anxiety are common. The reality is tough to bear.
The procedure is being used with certain types of low-risk cancers at the Wesley Medical Center in Wichita, Kansas.
What causes breast cancer?
While there are various theories as to the cause of breast cancer, common risk factors are being over age 50, and having a family history of breast or ovarian cancer. Studies have also shown that black women are more likely than white women to develop breast cancer before menopause.
If a woman has a mother, sister, or daughter who’s had breast cancer, she becomes two to three times more likely to develop the disease.
A genetic tendency for breast cancer can be determined by a blood test. Research has shown that women who carry at least one of the mutated genes BRCA1 and BRAC2 are more likely to develop breast cancer.
Although certain types of benign breast conditions may lead to breast cancer, this is not “a given.” Nevertheless, any changes in breast tissue should be followed up by a physician to rule out cancer.
One is fibrocystic breast disease. This is a non-cancerous disorder where the breast tissue feels “lumpy.” This condition seems to be hormone-involved and generally clears up after menopause.
Another common occurrence is the presence of breast cysts which are small lumps that containing fluid.
According to The British Journal of Cancer, tests have shown that “multiple cysts are clinical markers of histological breast proliferation and women who have had multiple breast cysts aspirated have an increased risk of breast cancer.”
A woman whose experienced multiple cysts needs to be closely monitored, and should require that her gynecologist stay in touch with the oncologist.
Diagnosis of breast cancer
To test for any signs of cancer in a cyst, a sample of fluid is drawn up with a fine needle. This procedure is referred to as fine needle aspiration (FNA). The sample is examined under the microscope to determine if any cancer cells are present.
Since the breast FNA procedure is not 100% accurate, it must be weighed along with other findings, to include physical exam, family history, and breast imaging such as an ultrasound or MRI.
Depending on the circumstances, the physician may also recommend a core needle biopsy to collect a small amount of breast tissue by the insertion of a hollow needle into the section of the breast in question. The sample will be observed under the microscope to determine if the cells are cancerous.
Local anesthesia is used for both collection procedures.
Once a woman is given the diagnosis of breast cancer, she is faced with a choice regarding her personal preference. Namely, does she want to just have the cancerous area removed or will she opt for the removal of her whole breast?
It must be noted that treatment options differ depending on the type and stage of cancer. So, keeping the breast may not always be possible. And yet, it isn’t uncommon for an oncologist to order radiation before surgery in an attempt to reduce the size of the tumor so that lumpectomy might become an option. Thus, the breast could be “saved.”
Staging of breast cancer
There is a standard medical model for determining the stage of breast cancer. Staging allows for a more in-depth diagnosis and predicts treatment choices. The stage of the cancer depends on tumor size, status of the lymph nodes under the arm (axilla), and whether or not it has spread outside the breast.
Staging categories range from 0 to 4. For example, Stage 0 means there are non-invasive cells in the lining of a breast milk duct; it hasn’t spread outside that area.
However, with stage 4, the cancer is invasive and has spread to the nearby lymph nodes and to other organs of the body. Stage 4 is also referred to as “advanced” or “metastatic” breast cancer.
What are the lymph nodes and how are they tested?
Lymph nodes are small glands throughout the body. They are part of the lymph vessel system whose purpose is to drain fluid from the tissues and transport it to the nodes. The nodes then clean the fluid of germs, cancer cells, and waste products.
Since the breasts are close to lymph nodes under the arm(axilla), this is where they travel first, if they leave the breast. Therefore, part of the staging process is to check these lymph glands for any presence of cancer.
A sample of the nodes have commonly been removed via surgery for testing. However, there is a new procedure being used where a radio-active or blue dye (or both) is injected near the tumor to locate the node (sentinel node) that was first affected by the cancer. The lymph system travelling from the breast to the nearby nodes of the axilla will carry the material along the same path the cancer most likely took.
The first node to be affected is isolated and removed for biopsy. This procedure (SLNB) is generally done either before or after removal of the tumor. If the sentinel node is negative for cancer cells, no further lymph node surgery is needed.
Current treatment for breast cancer
In some cases, where removal of the whole breast is the best option, radiation before surgery can be used to shrink the tumor enough so that only a lumpectomy is needed.
If a woman chooses-and is able-to keep her breast, the tumor is first removed first by a surgical lumpectomy. This is followed by three to six weeks of outpatient radiation treatment therapy. This process is exhausting for the patient due to numerous trips back and forth from the hospital plus probable side-effects from the radiation. It’s encouraging to hear that current research suggests the number of radiation treatments can be reduced for some women.
Treatment may also include chemotherapy, along with radiation.
Hormonal therapy to treat breast cancer
It has been proven that certain breast cancer cells continue their growth by attaching to estrogen hormones in the bloodstream. Approximately 2/3 of breast cancers are known to be of this type.
To interfere with that process, certain oral medications like Tamoxifen and Fulvestrant stop the estrogen from binding to the cancer cells.
Such medication is also used for at least five years after surgery to help prevent the cancer from returning. It can also be given to treat cancer that comes back after surgery or has spread to other parts of the body.
Recent one-day treatment news
Researchers at the Medical Center have gathered enough data to support the new procedure, intraoperative radiation therapy (IORT).
While not everyone with breast cancer would qualify for the procedure, an appointed time to speak with one of their surgical oncologists would determine eligibility.
The IORT procedure is done in the operating room immediately following a lumpectomy. Using a specific high-tech machine, the radiation oncologist places radio-active material into a surgical tube shaped like a balloon.
The balloon is drained in the bedded-area where the tumor was just removed to deliver a mega dose of radiation to that affected area. The radiation treatment takes about 45 minutes.
Giving the radiation in this targeted manner spares healthy tissues and organs from being compromised. Also, the one-day treatment reduces the cumulative effects of radiation over an extended period and relieves the patient from coming to the hospital five days per week for radiation treatments.
The Wichita Center has published very encouraging outcomes. Their statistics have shown that for most women, the one-time dose was enough to complete their radiation treatment. However, additional out-patient radiation may be necessary for others, once the final tissue study reports are available.
Their research also shows that patients treated with IORT are potential candidates for another lumpectomy followed by radiation if the cancer recurs, or a tumor is found in another area of the breast.
Two large independent studies on the outcomes of IORT therapy suggest the procedure “offers about the same overall survival rates as those receiving routine radiation treatment”. But, that women who received IORT therapy had higher rates of the cancer returning in the same breast than those who had “routine” external radiation. However, the IORT-treated women had fewer incidents of skin irritation than the control group did. Side effects were also deemed to be minimal for this group. (Intraoperative Radiotherapy Versus Whole-Breast External Beam Radiotherapy in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis. Hang L1, Zhou Z, Mei X, Yang Z, Ma J, Chen X, Wang J, Liu G, Yu X, Guo X.)
Despite the ambiguities, research continues into this impressive treatment option. This new approach offers hope for a simplified and more merciful type of intervention for women with breast cancer.