Breast Cancer, Much Good News but Controversies Remain

Dr. David Lipschitz
Wed, 21 Jan 2015 21:00:00 -0800
Lifestyle

Breast cancer is the second-leading cause of cancer deaths in women (after lung cancer). In 2014, 232,000 cases of breast cancer were diagnosed. After five years, 89.5 percent will be alive; the majority being cured. As the population at risk for breast cancer increases, results must be expressed per 100,000 women. In 2005 a total of 211,000 women ware diagnosed with breast cancer (141 per 100,000 women) compared to 232,00 (124/100,00) in 2014. Although the numbers of deaths have stayed about the same, corrected for the increased population, there has been a 34 percent reduction in those who die from the disease.

The decrease in incidence and better survival of breast cancer between 2005 and today is thought to be related to less use of hormone replacement therapy, increased screening and early detection as well as better therapy.

The vast majority of cancers diagnosed is early stage, very small in size and has not spread to the lymph nodes. These cancers are usually treated by removing the breast lump followed by either radiotherapy or relatively nontoxic therapy with medications such as Tamoxifen that the reduce risk of recurrence.
Updated: Thu Jan 22, 2015

Breast cancer is the second-leading cause of cancer deaths in women (after lung cancer). In 2014, 232,000 cases of breast cancer were diagnosed. After five years, 89.5 percent will be alive; the majority being cured. As the population at risk for breast cancer increases, results must be expressed per 100,000 women. In 2005 a total of 211,000 women ware diagnosed with breast cancer (141 per 100,000 women) compared to 232,00 (124/100,00) in 2014. Although the numbers of deaths have stayed about the same, corrected for the increased population, there has been a 34 percent reduction in those who die from the disease.

The decrease in incidence and better survival of breast cancer between 2005 and today is thought to be related to less use of hormone replacement therapy, increased screening and early detection as well as better therapy.

The vast majority of cancers diagnosed is early stage, very small in size and has not spread to the lymph nodes. These cancers are usually treated by removing the breast lump followed by either radiotherapy or relatively nontoxic therapy with medications such as Tamoxifen that the reduce risk of recurrence.

As awareness of breast cancer has increased, more physicians and their patients are electing to have one or both breasts removed in the hope of increasing the chance of a cure. The number of women having a mastectomy for the earliest stage breast cancer increased by 34 percent between 2003 and 2011. And for the so-called "in situ" cancer that has a 100-percent cure rate, mastectomy increased by 200 percent during the same timeframe. Bilateral mastectomy rates for tiny breast cancers increased from 5.4 percent in 1998 to 29.7 percent in 2011. And reconstructive surgery rates increased from 11.6 percent to 34.6 percent in 2011. Many believe that remarkable improvements in breast reconstruction that include nipple sparing procedures account for the trend toward more mastectomies.

A study published in the Journal of the American Medical Association by researchers from California followed 189,000 newly diagnosed breast cancer patients over at least seven years and found that single or double mastectomy in patients with early-stage breast cancer did not improve survival compared to those who merely had a lumpectomy.

There are certain high-risk patients with strong family history and genetic abnormalities associated with breast cancer in which bilateral mastectomy is warranted. But all others should be aware of the lack of benefit, the added cost and the potential of side effects before electing to undergo this major surgical procedure.

With improvements in lumpectomy, radiation, chemotherapy and medications that help reduce recurrence, breast cancer survival is improving and even those with widespread disease are living much longer. When mammograms were first introduced and therapy was less effective, appropriate screening and early detection was a true-life saver. But in recent years, and thanks to better therapy, the value of mammography is diminishing.

There is still much controversy about mammograms. The United States Preventative Health Service Task Force recommends screening mammograms every two years from age 50 to age 70 unless a woman is at high risk of cancer. Most European countries favor every three years. Many breast cancer specialists and the American Cancer Society favor annual mammograms from age 40 and as long as an older person remains healthy.

Now comes a study from Canadian researchers who followed 90,000 women ages 40 to 59 for 25 years from 1980 onwards. Half the women had screening mammograms annually for five years, and the other half did not. Over the entire period of study, 3250 cancers were diagnosed in the mammography group compared to 3133 in those who did not have mammograms. Over the 25-year period, mortality from breast cancer was identical in both groups. This provides more proof that frequent screening mammograms with their associated risk of more procedures and biopsies may indeed cause much harm.

Much remains controversial about how breast cancer should be diagnosed and managed. This emphasizes the importance of every woman receiving fair and balanced information about the pros and cons of screening and treatment. Equipped with this knowledge, a patient will have the necessary tools to have an educated discussion with their doctor about how to approach breast cancer screening and treatment.