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FIVE WINS AND ONE DILEMMA IN THE RACE TO A CURE FOR BREAST CANCER

10-02-19 | Posted by Denise Mann

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Each October, the world ostensibly turns pink for National Breast Cancer Awareness Month, and by and large, these efforts—and the money and attention they generate—are making a difference.  We know so much more about breast cancer risks, prevention and treatment today than we did in 1993 when Evelyn Lauder, Senior Corporate Vice President of the Estée Lauder Companies first started Breast Cancer Awareness month.

Here are some highlights:

Win No. 1: Mammograms Save Lives: There’s Proof!

In 2019, about 268,600 new cases of invasive breast cancer will be diagnosed in women in the US and about 41,760 women will die from this cancer, according to the American Cancer Society. These numbers don’t tell the whole story.  Hundreds of thousands of women’s lives have been saved by mammography and improvements in breast cancer treatment, according to a study in Cancer.

To estimate the number of breast cancer deaths averted since 1989 due to screening mammography and improved treatments, R. Edward Hendrick, PhD, of the University of Colorado School of Medicine, Jay Baker, MD, of Duke University Medical Center, and Mark Helvie, MD, of the University of Michigan Health System, analyzed breast cancer mortality data and female population data for U.S. women aged 40 to 84 years over the past three decades.

They found that cumulative breast cancer deaths averted from 1990 to 2015 ranged from more than 305,000 women to more than 483,000. When extrapolating results to 2018, cumulative breast cancer deaths averted since 1989 ranged from 384,000 to 614,500. When considering 2018 alone, an estimated 27,083 to 45,726 breast cancer deaths were averted. The investigators calculated that mammography and improved treatment decreased the expected mortality rate of breast cancer in 2018 by 45.3 to 58.3 percent.

Win No. 2: Density Matters

 Breast density and risk for breast cancer has gotten a lot of attention in recent years. Dense breasts have less fatty tissue (and more non-fatty tissue) than non-dense breasts which makes it harder for mammograms to spot breast cancer. Now women with dense breasts are advised about additional or more frequent screening so that cancers aren’t missed.

Win No. 3: Genes Aren’t Destiny Anymore

You may not know who Mary-Claire King, PhD is, but you should. Dr. King, a University of Washington professor of genome sciences and medicine, discovered the “breast cancer gene” or BRCA1, and this led to the discovery of BRCA2.

And knowledge is power, says Heather Hampel, Associate Director, Division of Human Genetics at The Ohio State University Comprehensive Cancer Center in Columbus. New recommendations from the U.S. Preventive Services Task Force suggest that a woman see a genetic counselor and possibly be tested for the BRCA mutations if she has a personal or family history of cancer in the breast, ovaries, fallopian tubes or the tissue lining the abdomen. Women with an ancestry linked to BRCA mutations, such as those of Ashkenazi Jewish descent, should also have a risk assessment, the guidelines state. “If you test positive for BRCA, your breast cancer risk is elevated and you can decide on enhanced surveillance or prevention surgery,” she says. “We also now know that BRCA mutations are common in ovarian, prostate and pancreatic cancer.”

Win No. 4: A New Approach to Spreading Breast Cancer

If breast cancer has spread to the lymph nodes, starting chemotherapy to downstage the cancer may eliminate the need for invasive lymph node removal surgery.“Downstaging the axilla-armpit lymph nodes with chemotherapy and then not doing a formal dissection, which every patient who had disease in the axilla used to get, is a huge advance,” says Sarah P. Cate, MD, an assistant professor of surgery at the Icahn School of Medicine at Mount Sinai and the director of the Special Surveillance and Breast Program at Mount Sinai Chelsea Downtown in New York City. Axillary lymph node dissection raises the risk of lymphedema or swelling of the arm.  Women with lymphedema must wear a compression sleeve and glove during their waking hours. “We now are following a trial called Z1071, where if they have 1-3 lymph nodes with cancer in them, they get chemotherapy, and then we try to take out only three nodes in the surgery for the breast cancer.”

Win No. 5: A Focus on What a Woman Wants

Andrea Pusic, MD, Chief of Plastic and Reconstructive Surgery at Brigham Health in Boston, says that one of the biggest changes in the breast reconstrcyion landscape has been a focus on what women really want and what is important to them after surgery.“In the old way of looking at outcomes in breast reconstruction, we might look at photos or clinician reports, but now we are looking at what women feel and experience.” For example, women want sensation returned to their breast after reconstruction using their own tissue to rebuild the breast. “We are researching the best ways to accomplish this,” she says. In addition, women don’t always like the way their implants shift when they move in certain ways, a complication known as automation deformity. “Over time we will be able to solve these problems. Stay tuned.”

Dilemma: Breast Implant-Associated Lymphoma and Reconstruction

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) isn’t breast cancer. It is a type of non-Hodgkin’s lymphoma that has been identified in women with certain textured breast implants.Deciding whether to undergo breast reconstruction is a big decision, says New York City plastic surgeon Alan Matarraso, MD, immediate past president of the American Society of Plastic Surgeons (ASPS). Some women may opt for reconstruction using their own tissues while others choose implants.There are pros and cons to each procedure, he says.“It’s a very individualized decision and one to make after a conversation it your plastic surgeon.”

There are choices of implants if a woman moves ahead with implant-based breast reconstruction.Textured breast implants were thought to confer certain advantages over smooth implants, he says. They are less likely to move around inside the breast pocket, are firmer and were believed to reduce risk of capsular contracture which occurs when the scar tissue forms a tight or constricting capsule around a breast implant,

Not all textured breast implants are created equal so not all increase your risk for BIA-ALCL. (Only Allergan’s BIOCELL Textured Breast Implants have been voluntarily recalled.) The textured implants still on the market are considered safe. ASPS just published a new FAQ to help guide women.