Over the years, the medical community has learned a lot more about how we can prevent breast cancer. As a breast-dedicated surgeon, I would be happy to just help prevent breast cancer and never have to perform another surgery. By learning more about risk factors, you choose a screening routine and take preventative therapies to reduce risk and enable early detection of breast cancer.
Are there any medications that reduce breast cancer risk?
Certain medications can be administered before breast cancer is ever diagnosed to prevent breast cancer. Tamoxifen has been used for years to treat breast cancer, but more recently it has been prescribed to prevent breast cancer in women at high risk. In some women, Tamoxifen can reduce risk for breast cancer by as much as 50 percent. Similarly, aromatase inhibitors has been shown to be effective as a preventative therapy.
How do genetics affect breast cancer risk?
Many individuals are aware that mutations to the genes BRCA1 and BRCA2 increase risk for breast cancer. However, what many people are unaware of is that there are numerous other genes linked to increased risk for breast cancer. In a study conducted at three Breastlink locations, we determined that BRCA1 and BRCA2 accounted for approximately one-half of hereditary breast cancer.
The other one-half of hereditary breast cancer risk were attributable to other genes. The most common genes detected in our study were PALB2, CHEK2 and ATM. Technology now allows us to test up to 3 genes associated with breast cancer. It is highly possible that we will discover dozens more breast cancer-related genes within the next five years.
What does breast density have to do with breast cancer?
There is a possibility that dense breast tissue increases risk for breast cancer. Breasts are mostly composed of fatty tissue and fibrous connective tissue, or dense breast tissue. One study determined that women with a high ratio of dense breast tissue to fatty tissue were up to five times more likely to develop breast cancer.
The jury is still out to what degree the dense tissue increases breast cancer risk or to what degree it interferes with a diagnosis. Women with dense breast tissue may want to consider adding breast MRI to mammography in their screening routine if they qualify. Ultrasound can also be used to supplement mammogram in women who do not qualify for MRI. 3D mammography is an emerging technology that could be an appropriate option for women with dense breast tissue.
Breast Cancer Treatments
Are all breast cancers treated with chemotherapy?
Breast cancer is not a single disease. When deciding on a course of treatment, we need to look at the ‘personality’ or biology of a cancer. There are some tests available, such as MammaPrint, that help to identify which patients can benefit from chemotherapy. We’re entering an era where we can and should more selectively decide who requires chemotherapy.
How is radiation therapy delivered?
The standard of care for radiation therapy in breast cancer treatment is whole breast radiation. This method delivers radiation via an external machine. Radiation affects cancerous tissue, as well as healthy tissue and the ribs, lungs and heart. Women generally receive whole breast radiation treatment every day for approximately six weeks.
Partial radiation therapy has a couple of benefits over whole breast radiation therapy. It spares damage to healthy tissue and takes significantly less time than whole breast radiation therapy. Partial radiation therapy is appropriate for women with smaller tumors and cancer that has not spread to the lymph nodes.
During partial radiation therapy, radiation is delivered via a catheter temporarily implanted in the breast. Women receiving partial radiation therapy generally receive two treatments per day for five days. Partial radiation therapy is appropriate for women with smaller tumors and node negative breast cancers.
Intraoperative radiation therapy is a relatively new way to deliver radiation and is still under investigation. Intraoperative radiation therapy is performed at the same time as surgery. Once a tumor is surgically removed, a single dose of radiation is delivered via catheter to the breast tissue surrounding the cancerous area. There are some downsides to intraoperative radiation therapy. If we later determine that cancer is still present or has spread to the lymph nodes, the patient will require additional treatment.
These are just some of the questions about breast cancer that we addressed during a recent lecture in the Susan G. Komen® Orange County educational series. If you are a breast cancer patient or a woman curious about breast cancer risk, please contact one of our offices if you have any additional questions. A member of our staff will be happy to speak with you.
On a final note, I would like to thank my patients and my colleagues at Breastlink. Speaking with them on a daily basis affords me an opportunity to continue learning about this complex disease we call breast cancer every day. I would also like to thank our dedicated support staff who make these events possible.