Breast cancer is the second most common cancer among women in the United States, according to the U.S. Centers for Disease Control.
Between 2012 and 2016, the Nassau County Department of Health estimated 1298.6 annual cases for females; Suffolk County Department of Health estimated 1314.2 cases in females. Although it is rare, breast cancer can also be diagnosed in males. The good news is, experts say the prognosis following a breast cancer diagnosis is not nearly as grim as it was even five years ago. Better screening, diagnosis and treatment are paving the way for a greater quality of life and longevity for individuals diagnosed with breast cancer.
“Decades ago, everyone had the same treatment — some did well, some didn’t — but now we know what each patient’s needs are across the board of surgical treatment, medical oncology treatment, and radiation,” says Dr. Christine Hodyl, director of Mount Sinai South Nassau’s Center for Breast Services. “What I’m seeing with breast cancer management is that we are moving towards personalized care.”
Genetic screening plays a major factor in treatment, Dr. Hodyl adds. For example, BRCA1 and BRCA2 genes are known to increase one’s risk for cancer, according to the National Cancer Institute.
“We have learned over time that [some] women need less, not more,” says Jane Carleton, M.D., associate chief of clinical affairs at the Northwell Health Cancer Institute at Monter Cancer Center, Lake Success. Years ago, mastectomies were common protocol. “We found that not all women need a complete axillary lymph node dissection; we could remove just a sentinel lymph node.”
If a lymph node tests negative, removing more lymph nodes may be unnecessary. This is a critical “discovery,” as a considerable number of patients have subsequently developed lymphedema (swelling of the arms and legs) following a complete lymph node dissection; with a sentinel lymph node removal, the percent of women who develop lymphedema is substantially reduced, Dr. Carleton says.
As more drugs like Herceptin are being developed, the cure rate of early stage HER2-positive breast cancer dramatically improves, says Dr. Carleton.
“It also means that if a woman has metastatic HER2 breast cancer, she might live 10 to 15 years longer because of using targeted agents like Herceptin and the many other drugs that have been developed,” she adds.
“The biggest improvement in prognosis has been found in tumors that are receptive to chemotherapy prior to surgery, otherwise known as neoadjuvant chemotherapy; we have been able to downstage a lot of these cancers and improve prognosis,” says Anastasia Bakoulis, DO, a breast and oncologic surgeon at Stony Brook University Cancer Center. “There have also been several advancements in that a lot of chemotherapy agents are now available to patients who may not have responded as well to a neoadjuvant therapy, too.”
Utilizing immunotherapy for breast cancer is also becoming more encouraging, says Dr. Bakoulis.
“We are trying to figure out how we can manipulate our own immune system to kill off this cancer and there have been some promising pathways,” she says.
Repeat lumpectomy is a treatment option — versus the previous standard of care in which a patient who was diagnosed with cancer and underwent lumpectomy with radiation would require breast removal if the cancer reoccurred, says Dr. Bakoulis.
“Emerging data is saying maybe can get away with another lumpectomy and another round of radiation,” she says. Although studies are still in their infancy, Dr. Bakoulis says, “We are not seeing adverse effects from another round of radiation.”
With vast improvement in reconstructive surgery, patients are much more comfortable, notes Dr. Hodyl. One of the newer techniques involves placing implants on top of the muscle versus underneath.
“We are leaving the anatomy as it is naturally,” she says. The implants are safer, too, she adds.
Advanced screening such as 3D mammography, awareness, and adopting a healthy lifestyle may influence the outcome of a breast cancer diagnosis, experts say. Eating healthy, avoiding processed foods, maintaining a healthy weight, exercising, avoiding smoking and drinking, and managing stress can not only decrease your risk of getting cancer but also improve your chance of being cured if you’re diagnosed with the disease.
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