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Considering breast cancer treatment options

What woman has not shuddered at the thought of discovering a lump in her breast? With more than 184,000 women facing a breast-cancer diagnosis each year, that thought is not far from the mind and heart of every woman.

Fortunately, a diagnosis of breast cancer does not automatically mean the loss of one’s breast. The type and extent of the tumor has a significant effect on the number of treatment options available. And recent advances in treatment can mean less radical treatments for some breast cancers.

Early detection ideal

With the exact cause of breast cancer still open to question, one fact remains indisputable—early detection offers the best chance of successful treatment and recovery. Mammograms and clinical breast exams are powerful tools in the fight against breast cancer. And, if you choose to perform monthly breast self-exams, reporting any changes to your healthcare provider is also a good line of defense.

Magnetic resonance imaging (MRI) is recommended as a screening test for women at very high risk for breast cancer. MRI is also useful for finding tumors in the opposite (contralateral) breast of women newly diagnosed with the disease.

Treatment considerations

When breast cancer is diagnosed, treatment depends on many factors: the stage of the cancer, where in the breast it is located, whether it is confined to the breast or has spread, the size of the tumor, the type of tumor and the characteristics of the tumor’s cells. Age, general health and where a woman is in relation to menopause also are factors in determining treatment.

Surgical options

Once, radical mastectomy (removal of the breast, lymph nodes and underlying chest muscle) was a standard treatment for all breast cancers. But that has changed, and the choice of surgical treatments has greatly expanded. These days, radical mastectomies are performed infrequently.

Instead, doctors commonly rely on two surgical options: the modified radical mastectomy, in which the breast and the lymph nodes are removed but the chest muscle is left intact, and the lumpectomy, in which the tumor and some breast tissue is removed, but the lymph nodes and chest muscle are left in place. With the modified radical mastectomy, breast reconstruction is relatively easy and serious side effects are uncommon. Some patients are candidates for a new procedure, called sentinel lymph node biopsy, which removes only the one lymph node most likely to contain cancer cells. If that node is cancer-free, further lymph node surgery can be avoided, reducing the risk of complications.

For most women with early-stage breast cancers, breast conservation can be the best option. But it is important to emphasize that for this treatment to have a good chance of success, the tumor must be a solitary lesion with no involvement of the surrounding tissue. Breast-sparing treatment includes a lumpectomy, possible removal of lymph nodes or sentinel node biopsy and radiation.

It’s important to note that younger women who choose lumpectomy and radiation may experience long-term complications from radiation exposure that may not surface until some years later. These include radiation-induced tumors and changes in the appearance and consistency of breast tissue.

Preventing recurrence

After surgery, chemotherapy and radiation can help prevent cancer recurrence. But because recurrence is unpredictable, many healthcare providers recommend drug therapy even to women with early-stage breast cancer.

Before menopause, a number of drugs can help delay or prevent recurrence and improve a woman’s overall survival. After menopause, tamoxifen, a drug that has an antiestrogen effect on breast tissue, may be more useful. And if breast cancer has spread to the lymph nodes, tamoxifen can help reduce the risk of recurrence by as much as one third. Tamoxifen works by blocking the stimulating effect of internal estrogen on breast cancer cells. It is given for a period of five years following surgery. Though it is less toxic than most anticancer drugs, tamoxifen is not without risk. It can slightly increase the chance of developing endometrial cancer. But for a woman who already has breast cancer, the benefits of tamoxifen outweigh the risks.

Another group of drugs, called aromatase inhibitors, are effective in preventing breast-cancer recurrence in postmenopausal women who have completed a course of tamoxifen. And a recent study shows adding the drug Herceptin to standard chemotherapy for some women reduces recurrence and increases survival rates.

If you or a loved one is coping with a breast-cancer diagnosis, try to take a calm, measured approach to decision making. Remember that every treatment option has pros and cons. And only you, with the guidance of your healthcare provider, can decide which makes the most sense for you.