Facing Breast Cancer Side By Side
Breast cancer does not have to be a lonely journey. Women say they now enjoy more support and encouragement than ever. And experts say new treatments can help many patients beat the disease, save their breasts and return to normal life.
Last summer, Sue Letsom received great news. Her mother, who struggled with breast cancer for 15 years, finally received an “all clear” from her physician. The chances of cancer returning were low, and her mother was officially released from care. The mood changed just a few months later, when Sue’s annual mammogram at Froedtert &The Medical College of Wisconsin detected a suspicious spot in her right breast. Additional imaging and two biopsies confirmed her fears. At 56, Sue was diagnosed with breast cancer.
The news hit Sue’s mother hard because she felt responsible. But Sue says her mother was also a source of strength. “My sisters and I watched our mother go through breast cancer,” Sue said. “Now she said to me, ‘I will be there for you.’”
Common, But ComplexSue and her mother are just two of millions of women who have been touched by breast disease—and survived. About one in eight women will develop breast cancer in her lifetime.
But while breast cancer is common, it is not a “one size fits all” disease. According to Amanda Kong, MD, Medical College of Wisconsin surgical oncologist, breast cancers differ depending on where in the breast they originate, how far they have spread and even by individual cell characteristics.
“Treatment for breast cancer is constantly changing,” Dr. Kong said. “As we learn more about tumor characteristics and new therapies, we are able to individualize treatment.”
One fact about breast cancer is common across the board. As more women receive regular mammograms, more breast cancers are being caught early. According to Dr. Kong, that translates into a decline in death due to the disease.
“One of the Lucky Ones”Sue Letsom understands the value of finding cancer early. Her mother’s cancer was discovered only when she developed a large lump in her breast. Treatment options were limited, and her mother underwent a mastectomy.
“I was one of the lucky ones,” Sue said. “One of the digital mammography machines at Froedtert & The Medical College was developed for larger breasted women. It’s able to penetrate deeper, and that’s part of the reason they caught my cancer earlier.”
The Froedtert &The Medical College Breast Care Center offers all digital mammography, which is more accurate for some women, including those with dense breasts. Radiologists at the Breast Care Center use several technologies to help diagnose cancer and locate tumors before surgery. They also offer highly sensitive breast MRI to determine the extent of disease in recently diagnosed women.
Sue’s surgery was performed by Alonzo Walker, MD, Medical College of Wisconsin breast surgeon. Dr. Walker is director of the Breast Care Center — and the same surgeon who cared for Sue’s mother. Because Sue’s cancer was discovered so early, Dr. Walker removed only a small amount of tissue from her breast.
An Important Message for WomenFortunately, Sue’s story is becoming more common. Julia White, MD, Medical College of Wisconsin radiation oncologist, explained: “Twenty-five years of data show that for appropriately selected women, lumpectomy with radiation is the same as mastectomy in terms of recurrence and cure,” Dr. White said.
Radiation therapy destroys any cancer cells that remain following surgical removal of a tumor. Until about 10 years ago, Dr.White said, treatment involved giving radiation to the entire breast. Radiation specialists have developed ways to treat just the area of the breast from which the tumor has been removed. That treatment can take place in five days, instead of the standard five to seven weeks.
Dr. White is a principal investigator of a national clinical trial evaluating three methods of partial breast radiation. She is also leading an in-house study of a fourth method that could be even more effective. It uses very precise radiation technology, plus a new technique for positioning patients. The patient lies on her belly on a special table. The breast hangs through a hole in the table, away from the body. Radiation stays out of the chest cavity, avoiding the heart and lungs completely.
According to Dr. Walker, clinical trials are the reason treatments have improved so much in recent decades. “When we talk to patients about taking part in a trial, we tell them they will receive proven care that does not put them at undue risk with respect to outcome,” Dr. Walker said. “In some cases, care may be better than a standard treatment.”
At Froedtert & The Medical College, women like Sue may choose to take part in national clinical trials, as well as studies unique to the hospital. Physicians conduct volumes of research to improve treatment and other issues related to breast cancer. Studies involve new surgical approaches, combination therapies, more effective delivery of radiation, new drug agents and population science research. In a five year study funded by the National Cancer Institute, Tina Yen, MD, MS, a Medical College of Wisconsin surgical oncologist, is investigating lymphedema (arm and hand swelling) and risk factors in older breast cancer patients. Another example is the extensive work of Ann Nattinger, MD, MPH, Medical College of Wisconsin internist and director of the Medical College of Wisconsin Center for Patient Care and Outcomes Research. Funded by the National Institutes of Health and other sources, Dr. Nattinger has studied strategies to increase patients’ use of screening mammography, quality of life factors, treatment effects on cognition, breast cancer outcomes and other issues. J. Frank Wilson, MD, Medical College of Wisconsin radiation oncologist and director of the Adult Cancer Clinical Service Line, is another pioneer in breast cancer research. He is an international authority on radiation therapy for breast cancer and leads research efforts to evaluate and improve the quality of cancer care on a national level.
What Tumor Cells Tell UsSome of the biggest improvements research has yielded have come in the area of drug therapy. At the center of these developments are “tumor markers” — substances found in higher amounts in people with cancer.
“Looking at cancer cell markers helps us predict how they will behave,” said Christopher Chitambar, MD, Medical College of Wisconsin medical oncologist. “We use molecular information about the genes of a breast tumor to select a treatment strategy.” Hormone markers are one important signpost. “If tumor cells have estrogen or progesterone receptors, the cancer requires those hormones for growth,” Dr. Chitambar said.
For these patients, various hormone-blocking drugs are used along with traditional chemotherapy to inhibit tumor growth. For very early breast cancers, hormonal therapy may be all a patient needs. How do you know if hormone blockers are enough? Again, molecular profiling can provide an answer.
A test calledOncotypeDX® uses genetic profiling of the cancer cells to identify patients for whom hormone therapy is adequate and those who could benefit from additional drugs.
Another key tumor marker is a protein called HER2. “If HER2 is present, the tumor behaves more aggressively,” Dr. Chitambar said. In these cases, a biological drug called Herceptin can interrupt the action of HER2.
Herceptin has been used for several years to treat breast cancers that have spread to other parts of the body. Recently, physicians have begun testing the drug as a way to fight cancers that are still confined to the breast.
A Sense of WholenessComplete care also includes breast reconstruction. “Data show breast reconstruction improves a woman’s self-esteem and sense of wholeness,” said John Hijjawi, MD, Medical College of Wisconsin plastic surgeon.
Surgeons in the Breast Cancer Program commonly perform mastectomy procedures that leave the skin of the breast and sometimes even the nipple intact. Plastic surgeons then construct a new breast using tissue from the patient’s abdomen. “With older techniques, abdominal muscle was sacrificed to create a new breast,” Dr. Hijjawi said. “Now, a new procedure called a “DIEP flap” allows surgeons to construct a natural-seeming breast with just abdominal skin and fat.”
“Another approach, called oncoplastic surgery, incorporates cosmetic surgery principles into treatment. The breast surgeon removes the tumor, the plastic surgeon arranges remaining tissue in an aesthetically pleasing way, and radiation therapy is scheduled several weeks after surgery, depending on the individual’s needs,” Dr. Hijjawi said.
Complete, Fully Coordinated CareThe entire breast cancer team meets weekly to discuss patients and plan optimal treatment strategies. That team includes pathologists who focus on breast cancer, as well as Breast Care Center nurses who are certified by the Oncology Nursing Society. Oncology certified nurses (OCNs) have met rigorous national standards for oncology expertise.
In addition to the treatment team, a full range of services is available, including psychological, social and nutritional counseling. Genetic counseling is also available—important for women like Sue, whose cancer may have a hereditary component. Experienced Genetics Program counselors assess possible hereditary factors through genetic testing, and help patients and family members understand their personal risk.
“Women feel they are receiving the most optimal care when they work with an integrated team of breast cancer experts,” Dr. Walker said.
“What Made Me Brave”According to Sue Letsom, support makes all the difference. “Fifteen years ago, breast cancer seemed like such a lonely disease,” she said. “Today, with so many women getting diagnosed, it has become a sisterhood.”
Some of her most important support came from caregivers at Froedtert &The Medical College. “From the people who transport you, to the technologists, to every physician and nurse, they are so kind, gentle and thoughtful,” she said.
Sue’s own family continues to be a source of strength. She and her husband have two daughters, and recently welcomed two grandchildren. Of course, Sue spends a lot of time with her mother. The pair keep up a running competition in her mother’s favorite pastime, Scrabble.
Sue says she now sees her mother with new eyes. “When I remember how frightened I was, I view my mom with such admiration,” she said. “Her disease was much more serious than mine. What made me brave was her going through it first.”
Source: Froedtert Today
Date: May 2009