The treatment options for breast cancer are expanding rapidly. At the Payson Regional Medical Center’s Pink Panel discussion on breast cancer, experts walked the audience through surprising changes, an impressive array of choices and a future bathed in hope’s bright light.
Speaking at the Oct. 10 event at the PRMC Senior Circle building were Dr. Cynthia Booth, Preferred Women’s Care, Payson; Renee Harrigan, PRMC Outpatient Imaging Center; Dr. Ihor Zakaluzny, Payson Surgery Associates; Dr. Heather Cunliffe, Translation Genomics Research Institute (TGen), Phoenix; and Shirley Grady, volunteer coordinator of Look Good, Feel Better.
Booth stressed the importance of starting self-exams early and explained changes in how to conduct the exams. Assisted by a male model, Booth demonstrated the up-and-down movement doctors now recommend to replace the old circular movement to detect abnormalities in the breast.
“Use the pads of your fingers, not your fingertips,” she said. Abnormalities to bring to the attention of your doctor will have the consistency of an un-popped kernel of corn or an eraser head that seems to be stuck to the skin.
Booth said women should conduct self-exams every month. In addition to self-exams, women should examine their breasts for any change in appearance. She said doctors should also conduct both sorts of exams during a well-woman exam.
Mammograms should be done every year once a woman turns 40, she said. Younger women with family members within the first degree (mother, sister, etc.) should also have a mammogram.
However, the U.S. Preventive Services Task Force in 2009 concluded that women without strong risk factors could safely postpone the start of one-every-two-year mammograms until they turn 50. The recommendation was based on a large number of studies, but proved controversial with many doctors and breast cancer advocacy groups.
When an abnormality occurs
When a self-exam and/or physician breast exam reveals an abnormality, the first step is a mammogram or possibly an ultrasound.
PRMC is now providing digital imaging for mammograms. Harrigan said the process results in images that are clearer and easier to read. The imaging center also uses a MammoPad® with each exam. This is a foam pad only about 3/8-inch thick that considerably reduces the discomfort of a mammogram.
Harrigan said the digital imaging also makes the process much faster, in most cases the exam is done within five minutes. “It takes less time than filling out the paperwork,” she said.
Zakaluzny discussed the numerous options now available for a closer examination of a lump in the breast.
He said until the early 1970s the only treatment available for breast cancer was a radical mastectomy. Initially developed in 1882, the surgery involved removing all the breast tissue, lymph nodes and supporting muscles, essentially mutilating the patient.
Since the early 1970s, doctors have refined treatment by relying on a variety of biopsies, from the simple use of a needle for extraction to surgical extraction. Should the biopsy show the need for further treatment, the next step is usually surgery, Zakaluzny said. The extent of surgery now includes the removal of the lump and some normal surrounding tissue, which is known as a lumpectomy or partial mastectomy to remove the breast or a radical mastectomy to remove additional tissue when the test results suggest possible spread.
He said surgeons might also remove lymph glands in the armpit as part of the surgical treatment. This helps determine what additional treatments might be needed. Zakaluzny said a less invasive method to sample the lymph nodes is a sentinel node biopsy.
The next step in treatment, if it is called for, is radiation, often given at the time of surgery. Additional treatments include chemotherapy and/or hormone therapy.
Zakaluzny said many surgeons and oncologists now recommend administering chemotherapy or radiation before the surgery, in hopes of shrinking the tumor and reducing the extent of the surgery.
“Surgical treatment for breast cancer has become less and less,” he said, moving from radical mastectomies as recently as the early 1970s to lumpectomies and chemical and radiation treatments.
He added that doctors and researchers continue to make big strides in using chemotherapy and hormonal therapy.
Even bigger strides
Cunliffe, head of TGen’s Breast & Ovarian Cancer Research Unit, said she hopes her colleagues at TGen might take that next great leap forward when it comes to chemotherapy and hormonal therapy.
Although researchers discovered the genetic blueprint coded in coils of DNA in the 1950s, they didn’t finish mapping the human genome until 2003. Since then, scientists have used gene studies to pinpoint the specific abnormalities in cells that become cancers.
Cunliffe is studying the genetics of breast and ovarian cancers.
“There are 23,000 genes that go haywire,” she said.
Her work involves discovering which existing drugs might serve as “smart bombs” to attack the individual types of cancer at the molecular level without harming healthy cells.
The participants in TGen’s clinical study for Inflammatory Breast Cancer have reported remarkable success, she said. Normally, this cancer spreads rapidly and does not respond well to traditional treatments.
Cunliffe’s work and similar efforts have hit the clinical trial stages. She said a “smart bomb” approach to dealing with breast cancer would perhaps be available for general use in four to six years.
In the meantime
Women already in treatment for breast cancer can enroll in a variety of programs the American Cancer Society has made available through the PRMC Senior Circle, said Grady. The Cancer Closet provides women with wigs, hats and scarves. The quarterly Look Good, Feel Better program provides aestheticians to show women how to use special moisturizers and makeup to minimize the effects of cancer treatment on their complexions.
The cancer society also offers grant money to provide transportation to treatment programs elsewhere.
Another program is Reach to Recovery, which provides one-on-one support from cancer survivors.
Anyone can visit the PRMC Senior Circle at 215 N. Beeline Highway in Payson to find out more about the various ACS programs available in the area.
A raffle of baked goods is planned from 11:30 a.m. to 1:30 p.m., Friday, Oct. 26 at the PRMC Cafeteria. Come bid on baked goods to help raise money for the Cancer Closet, which provides materials to help those battling breast cancer through their treatment and recovery.
A PRMC 5k Fun Run/Walk for Breast Cancer Awareness will start at 9 a.m., Saturday, Oct. 27 at Green Valley Park. Come out and walk to show support for local women battling and recovering from breast cancer. Registration is $10 per person and all ages are welcome. For registration forms and waivers, please call (928) 472-1275.