Breast Cancer Treatment
Only lung cancer kills more women each year in the United States than breast cancer does. The American Cancer Society (ACS) estimates that over 184,000 new cases of breast cancer were diagnosed in women in 1996 (ACS Breast). Although these statistics are alarming, there are a number of treatment options available for those that are diagnosed with breast cancer.
The best way to treat any disease is to prevent it. Since little is known about breast cancer, there are no established rules for prevention. The ACS recommends that women age twenty and older perform monthly breast self-exams, and it also suggests clinical examinations every three years (ACS Breast). Mammography is also a wonderful tool for detecting tumors; however, there is conflicting data on when and how often women should have mammograms. What is known is that mammography is the best way to determine if a palpable lump is actually cancerous or not.
Treatment methods for breast cancer can be lumped in two major categories; local or systemic. Local treatments are used to destroy or control the cancer cells in a specific area of the body. Surgery and radiation therapy are considered local treatments. Systemic treatments are used to destroy or control cancer cells anywhere in the body. Chemotherapy and hormonal therapy are considered systemic treatments.
Surgery is the most common treatment for breast cancer. Although there are many different types of breast cancer surgery, they all fit into a few basic categories. An operation that aims to remove most or all of the breast is called a mastectomy. If at all possible, doctors shy away from mastectomies due to the side effects which include loss of strength in the closest arm, swelling of the arm, and limitation of shoulder movement. If a mastectomy must be performed, the physician will often suggest post surgical reconstruction of the breast (Kushner 37).
Another type of breast cancer surgery is called breast-sparing surgery. This category would include lumpectomies and segmental mastectomies. In this situation, doctors remove only the tumor and make an attempt at sparing the rest of the breast tissue. These procedures are often followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.
Radiation therapy is another common treatment for breast cancer. Radiation involves the use of high-energy x-rays to damage cancer cells and retard further growth. The radiation may come from a radioactive source outside the body, or it can come from radioactive pellets placed directly in the breasts. It is not uncommon for a patient to receive both internal and external radiation. For external radiation, patients must visit the hospital or clinic each day. When this regimen follows breast-sparing surgery, the treatments are given five days a week for five to six weeks. At the end of that time, an extra "boost" of radiation is often given to the place where the tumor was removed. Hospital stays are required for implant radiation. Some common side effects of radiation therapy include swelling of the breast and dry skin at the radiation site.
Chemotherapy is one of the systemic therapies doctors use to fight breast cancer. Chemotherapy uses drugs to kill cancer cells, and it usually involves a combination of those drugs. Traditional chemotherapy is administered in cycles; a treatment period followed by a recovery period, then another treatment, and so on (NIH 23). Like radiation therapy, chemotherapy can be administered on an outpatient basis. Although chemotherapy works to kill cancer cells, some of the side effects almost make treatment unbearable. Common side effects include nausea, decrease of appetite, hair loss, vaginal sores, infertility, and fatigue (ACS For Women 32). Most of these effects, except infertility, cease when the treatment is over.
There are many other possible treatments for breast cancer that are currently under study. One of the biggest clinical trials involves hormone therapy. This treatment uses medication to prevent the tumors from getting the hormones, such as estrogen, that they need to thrive. Removal of the ovaries and other hormone producing glands may also be prescribed. Another treatment option being studied is bone marrow transplantation. The bone marrow can be taken from healthy parts of the patient's own body or from other donors. Although this treatment idea is still in its early stages, the results seem promising.
Because there are so many varied treatment options, treatment decisions are complex. These decisions are often affected by the judgment of the doctors involved and the desires of the patient. A patient's treatment options depend on a number of factors. These factors include age, menopausal status, general health, the location of the tumor, and the size of the breasts (ACS Breast). Certain features of the tumor cells, such as whether they depend on hormones to grow, are also considered. The most important factor in determining treatment is the stage of the disease. Stages are based on the size of the tumor and whether it has spread to other tissues.
Stage I and stage II are considered the early stages of breast cancer. Stage I implies that cancer cells have not spread beyond the breast and the tumor is no more than an inch in diameter. Stage II means that the cancer has spread to underarm lymph nodes and/or the tumor in the breast is one to two inches in diameter.
Women with early stage breast cancer may have breast-sparing surgery followed by radiation as their primary local treatment, or they may have a mastectomy. These approaches are equally effective in treating early stage cancers. The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the patient's breast, certain features of the mammogram, and how the patient feels about preserving her breast. With either approach, lymph nodes under the arm generally are removed. Some patients with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy. This added treatment is called adjuvant therapy, and is given to prevent the cancer from recurring (LaTour 131).
Stage III is known as locally advanced cancer. The tumor in this situation measures more than two inches in diameter and has invaded other tissues near the breast (131). Patients with stage III breast cancer usually have both local treatment to destroy the tumor and systemic treatment to keep the cancer from spreading further. Systemic treatment can consist of chemotherapy, hormonal therapy, or both.
Stage IV is called metastatic cancer, which implies the cancer has spread to other organs in the body (ACS Breast). Patients who have stage IV breast cancer receive chemotherapy and hormonal therapy to shrink the tumor, and radiation to control the spread of the cancer throughout the body. Clinical trials are also underway to determine if bone marrow transplants are effective in treating stage IV patients.
Contrary to the negative press commonly attributed to breast cancer, there are viable treatment options for those diagnosed with this terrible affliction. The push for increased research in breast cancer is even coming from the White House. President Bill Clinton mentioned his support for increased funding for research and prevention in his recent State of the Union Address, and he urged insurance companies to pay for more mammograms. Hopefully, with the support from the White House, new treatments can be found for breast cancer, and maybe with a little luck we will have a cure by the turn of the century.
American Cancer Society. Breast Cancer. Document 004070.
American Cancer Society. For Women Facing Breast Cancer. 1995.
Kushner, Rose. If You've Thought About Breast Cancer. Kensington, MD: Rose Kushner Breast Cancer Advisory Center, 1994.
LaTour, Kathy. The Breast Cancer Companion. New York: William Morrow and Company, Inc., 1993.
National Institutes of Health. National Cancer Institute. What You Need to Know About Breast Cancer. Revised August 1995.