Breast Cancer: The Facts
About 200,000 women develop breast cancer annually. The disease claims about 39,000 lives each year, making it the most common cancer to affect women. But promising screening techniques and drug therapies are stirring new optimism.
Big Advance: Cutting Back on Menopausal Hormone Therapy
Tens of millions of women stopped using menopausal hormone therapy (also known as hormone replacement therapy or HRT) after a 2002 study linked therapies that combined estrogen and progesterone with breast cancer. Since then, Rowan Chlebowski, MD, a professor at UCLA’s David Geffen School of Medicine, estimates that as many as 150,000 new cases have actually been prevented by this change alone. “I don’t think one can point to anything else that has resulted in a greater reduction of breast cancer incidence in the past decade,” says Dr. Chlebowski, whose research uncovered the relationship.
While combination hormone therapies are still prescribed, the FDA has changed labeling to recommend lower doses and shorten the duration of treatment for women who still take hormone pills.
Big Advance: More Comfortable and Accurate Mammograms
A new computed tomography (CT) scanner, custom designed for breasts, eliminates the need to compress breast tissue and produces a 3D image in as little as 10 seconds. To be screened in this device, a patient simply bends over and places her breasts into two adjustable cups. No pinch. No pain.
These CT scans can also detect tumors as small as three millimeters, which are difficult to see on a traditional mammogram, says Belinda Seto, PhD, deputy director of the National Institute of Biomedical Imaging and Bio-Engineering (NIBIBE).
The test can even detect whether a nodule is cancerous or benign during the screening (potentially eliminating the need for a follow-up biopsy) if the patient is injected with a radio-isotope before the screening. The add-on technique is called positron emission tomography, or PET. The radio-isotope lights up on the scan, highlighting metabolic activity in cancerous tumors.
“It’s nerve-wracking waiting for those results after an abnormal test,” says Dr. Seto. “So, imagine if your doctor had all the information in one scan to know whether or not you have a cancerous tumor. This is what this new combination of CT and PET can show.”
The cost of the CT scanning machine (in the high six-figures) may limit its use to women who are at high risk of developing breast cancer. Right now, the technology is in advanced clinical trials at the University of California, Davis, Cancer Center in Sacramento, but may be more widely available in a matter of years.
Small Wonder: A Pillow Made With Love
Ask a mastectomy patient what got her through those painful post-op weeks, and she’s likely to bare her heart — her heart pillow, that is. These small, mostly homemade heart-shaped cushions are handed out in hospitals to ease the pain of mastectomy and lymph node surgery.
“What hurt me most during the post-op period was putting my arm down by my side,” says Janet Kramer-Mai, an oncology nurse in Chattanooga, Tenn., who was diagnosed with breast cancer in 2001. “My great aunts in Indiana sent me this pillow and I thought, ‘My gosh, all my patients have got to have one’. You place the center of the heart in your armpit, and it eases the pain of swelling and irritation at the exit site of the post-operative drain tubes.”
Now a cancer counselor at the Erlanger Cancer Resource Center in Chattanooga, Kramer-Mai distributes pillows made by teams of local volunteers to all the breast cancer patients at the hospital. The same grass-roots system is in place around the country, and the world. “It makes you feel even better that someone gave up her time to make something that brings so much comfort,” she says.
Small Wonder: Reducing Chemo-Related Hair Loss
A new scalp-cooling cap worn during chemotherapy may prevent breast cancer patients from losing their hair as a side effect of treatment. Researchers at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., are testing the cap, which was developed in Sweden and has been proven safe and effective in several international trials.
The Dignicap, as it’s called, consists of a silicone head cover that looks a bit like a swim cap with tubes that connect it to a cooling unit. A second neoprene insulating cap is fitted over the top. While the patient receives chemotherapy, a coolant circulates through the silicone layer, lowering the temperature of the scalp and constricting the blood vessels around the hair follicles. That, in turn, reduces the amount of the chemotherapy drug that is absorbed into the hair roots, lessening hair loss.
“One of the first questions my breast cancer patients ask is whether they will lose their hair,” says Susan Melin, MD, the principal investigator for the study. “This solution could really relieve a lot of psychological and emotional distress.”
Stay Tuned for: Better Breast Cancer Drug Therapies
A new combination of drugs may actually reverse tumor growth in some of the most aggressive breast cancer cases. Since 1998, the drug Herceptin (traztusumab) has been used to attack the HER-2 protein, which is over-expressed by about 25 percent of breast cancer tumors, causing rapid progression and recurrence.
A study presented at the San Antonio Breast Cancer Symposium in in December 2010 found that combining Herceptin with an oral drug called Tykerb (lapatinib) that also attacks HER-2, in addition to standard chemotherapy, eradicated tumors in 46 percent of patients, which is 50 percent more than by using just Herceptin with regular chemotherapy.
Other combinations of Herceptin with new drugs are also showing promise and could be available within the next two or three years, says UCLA’s Chlebowski. “We are moving toward a cure for patients with this particular sub-type of breast cancer, and that’s very exciting,” he says. “We’re not there yet, but you can talk about it without sounding like a crazy person.”