Only lung cancer kills more women each year in the United States than breast cancer does. The American Cancer Society (ACS) estimates that over184,000 new cases of breast cancer were diagnosed in women in 1996 (ACS Breast). Although these statistics are alarming, there are a number of treatment optionsavailable for those that are diagnosed with breast cancer.
The best way to treat any disease is to prevent it. Since little isknown about breast cancer, there are no established rules for prevention. TheACS 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 isconflicting data on when and how often women should have mammograms.
What isknown is that mammography is the best way to determine if a palpable lump isactually cancerous or not. Treatment methods for breast cancer can be lumped in two majorcategories; local or systemic. Local treatments are used to destroy or controlthe cancer cells in a specific area of the body. Surgery and radiation therapyare considered local treatments.
Systemic treatments are used to destroy orcontrol cancer cells anywhere in the body. Chemotherapy and hormonal therapyare considered systemic treatments. Surgery is the most common treatment for breast cancer. Although thereare many different types of breast cancer surgery, they all fit into a few basiccategories. An operation that aims to remove most or all of the breast iscalled a mastectomy.
If at all possible, doctors shy away from mastectomies dueto the side effects which include loss of strength in the closest arm, swellingof the arm, and limitation of shoulder movement. If a mastectomy must beperformed, the physician will often suggest post surgical reconstruction of thebreast (Kushner 37). Another type of breast cancer surgery is called breast-sparing surgery. This category would include lumpectomies and segmental mastectomies. In thissituation, doctors remove only the tumor and make an attempt at sparing the restof the breast tissue. These procedures are often followed by radiation therapyto destroy any cancer cells that may remain in the area.
In most cases, thesurgeon also removes lymph nodes under the arm to help determine whether cancercells 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 andretard further growth. The radiation may come from a radioactive source outsidethe 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 externalradiation.
For external radiation, patients must visit the hospital or cliniceach day. When this regimen follows breast-sparing surgery, the treatments aregiven five days a week for five to six weeks. At the end of that time, an extraboost of radiation is often given to the place where the tumor was removed. Hospital stays are required for implant radiation. Some common side effects ofradiation therapy include swelling of the breast and dry skin at the radiationsite.
Chemotherapy is one of the systemic therapies doctors use to fightbreast cancer. Chemotherapy uses drugs to kill cancer cells, and it usuallyinvolves a combination of those drugs. Traditional chemotherapy is administeredin cycles; a treatment period followed by a recovery period, then anothertreatment, and so on (NIH 23). Like radiation therapy, chemotherapy can beadministered on an outpatient basis.
Although chemotherapy works to kill cancercells, some of the side effects almost make treatment unbearable. Common sideeffects include nausea, decrease of appetite, hair loss, vaginal sores,infertility, and fatigue (ACS For Women 32). Most of these effects, exceptinfertility, cease when the treatment is over. There are many other possible treatments for breast cancer that arecurrently under study. One of the biggest clinical trials involves hormonetherapy.
This treatment uses medication to prevent the tumors from getting thehormones, such as estrogen, that they need to thrive. Removal of the ovariesand other hormone producing glands may also be prescribed. Another treatmentoption being studied is bone marrow transplantation. The bone marrow can betaken 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 seempromising. Because there are so many varied treatment options, treatment decisionsare complex. These decisions are often affected by the judgment of the doctorsinvolved and the desires of the patient. A patient’s treatment options dependon a number of factors.
These factors include age, menopausal status, generalhealth, 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 togrow, are also considered. The most important factor in determining treatmentis the stage of the disease. Stages are based on the size of the tumor andwhether 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 thetumor is no more than an inch in diameter. Stage II means that the cancer hasspread to underarm lymph nodes and/or the tumor in the breast is one to twoinches in diameter. Women with early stage breast cancer may have breast-sparing surgeryfollowed by radiation as their primary local treatment, or they may have amastectomy. These approaches are equally effective in treating early stagecancers. The choice of breast-sparing surgery or mastectomy depends mostly onthe size and location of the tumor, the size of the patient’s breast, certainfeatures of the mammogram, and how the patient feels about preserving her breast.
With either approach, lymph nodes under the arm generally are removed. Somepatients with stage I and most with stage II breast cancer have chemotherapyand/or hormonal therapy. This added treatment is called adjuvant therapy, andis given to prevent the cancer from recurring (LaTour 131). Stage III is known as locally advanced cancer. The tumor in thissituation measures more than two inches in diameter and has invaded othertissues near the breast (131).
Patients with stage III breast cancer usuallyhave both local treatment to destroy the tumor and systemic treatment to keepthe cancer from spreading further. Systemic treatment can consist ofchemotherapy, hormonal therapy, or both. Stage IV is called metastatic cancer, which implies the cancer hasspread to other organs in the body (ACS Breast). Patients who have stage IVbreast cancer receive chemotherapy and hormonal therapy to shrink the tumor, andradiation to control the spread of the cancer throughout the body.
Clinicaltrials are also underway to determine if bone marrow transplants are effectivein treating stage IV patients. Contrary to the negative press commonly attributed to breast cancer,there are viable treatment options for those diagnosed with this terribleaffliction. The push for increased research in breast cancer is even comingfrom the White House. President Bill Clinton mentioned his support forincreased funding for research and prevention in his recent State of the UnionAddress, and he urged insurance companies to pay for more mammograms.
Hopefully,with the support from the White House, new treatments can be found for breastcancer, and maybe with a little luck we will have a cure by the turn of thecentury. Works CitedAmerican 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: RoseKushner Breast Cancer Advisory Center, 1994. LaTour, Kathy. The Breast Cancer Companion. New York: William Morrow andCompany,Inc. , 1993. National Institutes of Health.
National Cancer Institute. What You Need toKnow About Breast Cancer. Revised August 1995.
