More Choices in Breast Cancer Treatment

It's now about patient involvement, experts say

SATURDAY, Oct. 19, 2002 (HealthDayNews) -- Nearly 200,000 women and about 1,000 men are diagnosed with breast cancer each year in the United States.

Unlike the past, when a biopsy was often followed by immediate surgical removal of the affected breast, most of today's newly diagnosed patients have a range of treatment options to weigh, as well as a greater voice in when these treatments are used.

Shelly Blechman, vice president of the Women's Information Network Against Breast Cancer (WIN ABC), says these options fall into three broad categories:

  • Surgical procedures such as biopsies, lumpectomies and mastectomies to establish the diagnosis, remove the local disease in the breast, and estimate the extent of the disease.
  • Radiation therapy to control local disease in the breast or other sites where the cancer has spread.
  • Chemotherapy or hormone therapy to treat the breast cancer, reduce the likelihood of recurrence, and treat the known spread of the cancer to other parts of the body.

"There have been significant improvements in the past decade in the treatment of breast cancer," Blechman says. "Not only are biopsies less invasive, but there are a range of skin-sparing surgeries that can preserve most of a breast, if the woman wants to do so, as well as advances like sentinel node biopsies to identify whether cancer has spread."

"The availability of these newer procedures provide women with a much greater voice in the treatment process than they've ever had before," she adds.

While 39,600 American women will die from the disease this year, breast cancer death rates declined significantly from 1992 to 1996, with the largest decrease in younger women -- both white and black. This decline is probably the result of earlier detection and improved treatment, the American Cancer Society says.

Breast cancer patients' participation in treatment decisions has been enhanced by advances in breast cancer detection. In fact, the two go hand-in-hand, according to most experts.

"The majority of women diagnosed with breast cancer these days are in an early stage of the disease," explains Dr. Jennifer Eng-Wong, a Cancer Prevention Fellow at the National Cancer Institute.

"The emphasis on annual screening means we are finding these cancers when they are growing relatively slowly, and the prognosis is good. When cancer is in Stage 0, I or II, the patient still feels well," she explains.

"Emergency or next-day surgery is not necessary," she adds. "And there's time for them to take part with their surgeon, oncologist, radiologist and others on their treatment team in reaching a thoughtful, reasoned decision about how they want their cancer treated."

Eng-Wong says it's not uncommon for women with early stage breast cancer to take up to six weeks to decide how to proceed with treatment, with no adverse effect on their health or treatment outcomes.

"Most women seek all the information they can get during this period," she says. "Many secure second or even third opinions about whether a lumpectomy, mastectomy, radiation or chemotherapy is best for them. And most take the time to prepare themselves and their family members emotionally for the treatment processes and its aftermath."

Although it's still common for effective breast cancer therapy to involve more than one form of treatment, how these treatments are combined and timed is more and more often a matter for the medical team and the patient to determine collaboratively.

Some patients try a course of chemotherapy or radiation before surgery. Others have a lumpectomy or mastectomy first, followed by radiation, chemotherapy or both, Eng-Wong says.

She notes that women with later stage breast cancer -- Stage III or IV -- typically don't have as much time to gather information, make a decision and prepare themselves for the treatment and its common side effects.

"When breast cancer has reached Stage III or IV, there is definitely more of an urgency to get the treatment under way," she says. "A delay of a week or two between diagnosis and treatment is more common. Fortunately, more and more American women are securing screening mammograms and clinical breast exams on a regular basis. This helps to ensure that when breast cancer does develop, it is detected promptly."

October is Breast Cancer Awareness Month.

All month long, free and low-cost mammograms are available around the country. Contact your local chapter of the American Cancer Society or WIN ABC (toll free 1-866-294-6222) for information about breast cancer screening in your community.

What To Do

Learn more about breast cancer and its treatment from the National Cancer Institute or the Women's Information Network Against Breast Cancer.

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