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New Ways to Fight Breast Cancer

Posted on Oct 15, 2013 in Cancer | 0 comments

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In honor of Breast Cancer Awareness Month, throughout October we’ll be posting a series of stories about breast cancer prevention, treatment and survivors.

Angelina Jolie surprised the world when she had a preventative double mastectomy. Yet she had strong reasons to do so. She inherited the rare BRCA1 gene, which her doctors estimated gave her an 87 percent chance of developing breast cancer. By having surgery, she minimized her risk of developing the disease.

While this course of action is relatively new in the fight against breast cancer, it’s not the only one changing the way experts treat and prevent the disease. Doctors at Sutter Health affiliates Mills-Peninsula Health Services and the Palo Alto Medical Foundation say four key developments in recent years are reshaping the course of treatment for women who have breast cancer, or who are at risk for breast cancer.

Harriet Borofsky, M.D.

Harriet Borofsky, M.D.

“The whole way in which we manage, treat and take care of breast cancer patients today is hugely different,” says Harriet Borofsky, M.D., medical director of the Mills-Peninsula Women’s Center. Here are the latest advances in breast cancer care.

Shorter Radiation Treatments

For some women – typically those with early stage breast cancer that hasn’t spread – high-dose, short-term radiation can shorten the course of therapy.

  • Hypofractionated radiation therapy gives higher doses every day for three to four weeks, instead of lower doses over six weeks.
  • Brachytherapy inserts radioactive seeds in a woman’s breast, changing them twice a day for five days. It takes just 10 treatments.
  • Intraoperative radiation therapy (IORT) radiates breast tissue at the time of surgery. After a lumpectomy, radiation is inserted into the cavity during surgery, completing all the treatment at once.

While these advances in radiation therapy sound like improvements, PAMF radiologist Pauling Chang, M.D., warns that doctors need long-term data before they are sure these new radiation therapies work as well as standard, lower-dose external beam radiation.

“We still need large-scale, randomized studies with long-term follow-up,” he says. But some day, he hopes, “this will become the standard of care for women with breast cancer, so treatment times can be much shorter, with fewer side effects.”

Genomic Testing of Early Stage Breast Tumors

Two tests – Oncotype DX and MammaPrint – can examine a breast tumor’s genetic structure to help determine if chemotherapy will work well, and whether the cancer will likely come back after treatment. The tests can spare some women from having to undergo difficult chemotherapy that wouldn’t benefit them.

Today, genomic tests help women with very early and limited forms of breast cancer: estrogen-positive tumors that have not spread to lymph nodes, and DCIS (ductal carcinoma in situ), which is the earliest, noninvasive form of breast cancer.

But the field of personalized medicine – treatment based on your own genetic profile – is growing rapidly. Eventually, genomic tests may help shape the best treatment for many women with breast cancer.

Chemoprevention for Women at Risk

About 35 years ago, the drug tamoxifen was approved to treat women with the type of breast cancer fueled by the female hormone estrogen. Today, women who are at high risk of developing estrogen-positive breast cancer can take tamoxifen or a similar drug, raloxifene, to help prevent disease.

Both of these drugs block estrogen’s effect in the breast and in other tissue. Other drugs are being studied for chemoprevention.

“As we better understand the role of genetics and family history, it’s important to offer women at risk a way to lower their risk,” Dr. Borofsky says.

Still, about 80 percent of women who are diagnosed with breast cancer have no family history of the disease, she says. So the best protection for women remains early detection.

Oncoplastic Surgery

With oncoplastic surgery, a plastic surgeon often works side by side with the breast cancer surgeon. When possible, a woman’s skin and nipples are preserved. Then, an implant is inserted or fat is taken from another part of the woman’s body and used to rebuild her breast. Sometimes reconstruction starts at the same time as the mastectomy. Sometimes it’s done a few months later, after radiation.

“When you save the skin and nipple, and then put an implant or tissue behind it, it’s a breast,” Dr. Borofsky says. “And it looks just like your breast.”

Early Detection Is Still the Key

Today, about 90 percent of women who discover breast cancer on mammograms catch it so early that the cancer has not spread to lymph nodes, Dr. Borofsky says. She credits that to digital mammography, which is getting better and better.

In January, the Mills-Peninsula Women’s Health Center will install five machines with the newest advance in mammography: digital breast tomosynthesis, or 3-D mammography. These machines are better able to find tumors in overlapping tissue, the weakness of traditional mammograms.

“It’s going to have a very positive impact on early detection,” she says. “And with early detection comes better treatment options and outcomes.”

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