Breast Cancer Treatment And Research
There are many treatment options for women with breast cancer. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the breast, and other factors.
Treatment and Research - Planning Treatment
If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes.
People with cancer often are treated by a team of specialists. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others.
Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.
Some breast cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is both safe and effective.
Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Women with breast cancer who are interested in taking part in a clinical trial should talk to their doctor.
The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to see a list of the current clinical trials on breast cancer. A separate window will open. Click the "x" in the upper right hand corner of the "Clinical Trials" window to return here.
Treatment and Research - What is Staging?
Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment.
Staging will let the doctor know
the size of the tumor and exactly where it is in the breast
if the cancer has spread within the breast
if cancer is present in the lymph nodes under the arm
if cancer is present in other parts of the body
Here are the stages of breast cancer
Stage 0 — This is very early breast cancer that has not spread within or outside the breast. Doctors often refer to this type of cancer as in situ or non-invasive cancer.
Stage I and stage II also are early stages of breast cancer. Stage I means that the tumor has not spread beyond the breast. In stage II, the tumor may be larger and may have spread to the lymph nodes.
Stage III is called locally advanced cancer. Here the tumor has spread beyond the breast to lymph nodes or to other tissues near the breast.
Stage IV is metastatic cancer. In this stage the cancer has spread beyond the breast and the underarm lymph nodes to other parts of the body, most often the bones, lungs, liver, or brain.
The choice of treatment is based on many factors. For stage I, II or III cancers, the main goals are to treat the cancer and reduce the chance it will come back, either at the place where the tumor first occurred or elsewhere in the body. For stage IV cancer, the goal is to improve symptoms and prolong survival.
Treatment and Research - Standard Treatments
There are a number of treatments for breast cancer, but the ones women choose most often — alone or in combination — are surgery, radiation therapy, chemotherapy, and hormone therapy.
Here is what the standard cancer treatments are designed to do:
Surgery takes out the cancer.
Hormone therapy keeps cancer cells from getting the hormones they need to survive and grow.
Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors.
Chemotherapy uses anti-cancer drugs to kill cancer cells.
Treatment for breast cancer may involve local or whole body therapy. Doctors use local therapies, such as surgery or radiation, to remove or destroy breast cancer in a specific area. Whole body, or systemic, treatments like chemotherapy, hormonal, or biological therapies are used to destroy or control cancer throughout the body. Some patients have both kinds of treatment.
If you have early-stage breast cancer, one common treatment available to you is a lumpectomy combined with radiation therapy. A lumpectomy is surgery that preserves a woman's breast.
In a lumpectomy, the surgeon removes only the tumor and a small amount of the surrounding tissue. The survival rate for a woman who has this therapy plus radiation is similar to that for a woman who chooses a radical mastectomy, which is complete removal of a breast.
If you have breast cancer that has spread locally — just to other parts of the breast — your treatment may involve a combination of chemotherapy and surgery. Doctors first shrink the tumor with chemotherapy and then remove it through surgery. Shrinking the tumor before surgery may allow a woman to avoid a mastectomy and keep her breast.
In the past, doctors would remove a lot of lymph nodes near breast tumors to see if the cancer had spread. Some doctors are also using a method called sentinel node biopsy. Using a dye or radioactive tracer, surgeons locate the first or "sentinel" lymph node closest to the tumor, and remove only that node to see if the cancer has spread.
If the breast cancer has spread to other parts of the body, such as the lung or bone, you might receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Radiation therapy may also be useful to control tumors in other parts of the body.
Treatment and Research - Latest Research
Several new technologies offer hope for making future treatment easier for women with breast cancer. Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. In the future, doctors may use this tool to deliver treatment.
Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter — a tube with a balloon tip — doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days.
New drug therapies also are on the horizon. Findings from several clinical trials show that the chemotherapy drug paclitaxel combined with the drugs cyclophosphamide and doxorubicin can help women with tumors that have spread to other parts of the body.
This mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery.
New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence.
Also, other new research found a test that can predict both the risk of breast cancer recurrence and who is most likely to benefit from chemotherapy such as letrozole. Herceptin® is another drug commonly used to treat women who have a certain type of breast cancer. This drug slows or stops the growth of cancer cells by blocking Her-2, a protein found on the surface of some types of breast cancer cells.
Approximately 20 percent of breast cancers produce too much Her-2. These "Her-2 positive" tumors tend to grow faster and are generally more likely to return than tumors that do not overproduce Her-2.
Cancer treatments like chemotherapy can be systemic, meaning they affect whole tissues, organs, or the entire body. Herceptin®, however, is the first drug used to target only a specific molecule involved in breast cancer.
Results from two recent clinical trials show that those patients with early-stage Her-2 positive breast cancer who received Herceptin® in combination with chemotherapy had a 52 percent decrease in risk in the cancer returning compared with patients who received chemotherapy treatment alone.
In an attempt to further specialize breast cancer treatment, The Trial Assigning Individualized Options for Treatment, or TAILORx, was recently initiated by NCI. This study will enroll 10,000 women to examine whether appropriate treatment can be assigned based on genes that are frequently associated with risk of recurrence of breast cancer.
The goal of TAILORx is important because the majority of women with early-stage breast cancer are advised to receive chemotherapy in addition to radiation and hormonal therapy, yet research has not demonstrated that chemotherapy benefits all of them equally.
TAILORx seeks to examine many of a woman's genes simultaneously and use this information in choosing a treatment course, thus sparing women unnecessary treatment if chemotherapy is not likely to be of substantial benefit to them.
Several methods show promise in reducing the risk of breast cancer. In October 1998, the U.S. Food and Drug Administration, or FDA, approved the drug tamoxifen to lower the chance of cancer in high-risk women.
The approval of tamoxifen followed a clinical trial sponsored by the National Cancer Institute that included more than 13,000 pre-menopausal and post-menopausal women. All of the women were considered at high risk for breast cancer.
One group of women took the drug tamoxifen and another took a placebo — an inactive pill that looked like tamoxifen. The results of the study showed a 49 percent decrease in breast cancer among women who took tamoxifen.
Tamoxifen does have side effects. The most serious in some women are an increased risk of endometrial cancer, uterine sarcoma, and an increased risk of blood clots. Women at high risk for breast cancer may want to consult their doctor to see if tamoxifen may help them.
The Study of Tamoxifen and Raloxifene (STAR) is a more recent clinical trial sponsored by the National Cancer Institute. STAR enlisted nearly 20,000 women to compare tamoxifen to the drug raloxifene for effectiveness in reducing of breast cancer risk.
Raloxifene, marketed as Evista®, has been approved for use to lower the risk of and treat osteoporosis.
Initial results of the STAR trial show that raloxifene works as well as tamoxifen in reducing breast cancer risk for postmenopausal women at increased risk of the disease. Both drugs decrease risk by about 50 percent.
In addition, women enrolled in STAR who were assigned to take raloxifene had fewer uterine cancers, blood clots, and cataracts than those taking tamoxifen.
However, taking raloxifene raised the risk of blood clots and fatal strokes in women already at risk.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.
Copyright Information: Public domain information with acknowledgement given to the U.S. National Library of Medicine.