Six Breast Cancer Breakthoughs

OCTOBER, 2002

Each October, the world turns its attention to a woman's breasts. For 31 days we discuss, we report, we examine the state of breast cancer research, women's health, the latest treatments. And hopefully, we raise awareness of a disease every woman fears. Trouble is, some of the most significant news about breast cancer happens when nobody's looking. Here, six findings you should know about. They may very well save your life or the life of your mother - or daughter.
Breakthrough # 1: A kinder, gentler biopsy
Until recently, most breast cancer surgery involved removing a cluster of lymph nodes - the basic components of the body's drainage system. If the nodes in the armpit held cancer cells, it was a good bet that the disease had spread, which is why doctors considered the procedure essential to determining the best treatment. Trouble is, removing lymph nodes can result in lymphadema - a painful and disfiguring buildup of fluids in the arm that strikes 20% to 30% of patients. Now there's a newer option, sentinel node biopsy, in which only one lymph node is removed; this greatly reduces the risk of postsurgical problems.
How it works: A surgeon injects dye around the tumor and waits for the dye to migrate into the first lymph node that drains that area - the "sentinel node." If that node, when removed, shows no sign of cancer, the odds are good that the disease is confined to the breast. Studies have shown that this kind of biopsy is extremely accurate. The downside? The procedure is tricky to learn, which may explain why many surgeons still don't offer the option to patients.
Breakthrough # 2: State-of-the-art treatment for all patients
Thirty years ago, doctors made all the treatment decisions - and, quite frankly, the options were limited: They performed mastectomies and hoped for the best, admits Joann Schellenbach, spokesperson for the American Cancer Society. But now women have treatment choices. That's a good thing, but it's also confusing. Trying to make the right call can feel overwhelming to a patient still reeling from a cancer diagnosis.
That's why one of the most important breast cancer advances has nothing to do with fancy equipment or ultra-potent drugs - and everything to do with patients getting the best possible care. The American Cancer Society (www.cancer.org ) and the National Comprehensive Cancer Network (an alliance of 19 leading cancer treatment centers) have come out with a revised edition of Breast Cancer Treatment Guidelines for Patients. These guidelines set out the most up-to-date standards, in patient-friendly language, so women and their doctors can make the best choices, no matter where they live.
The revised guidelines couldn't have come at a better time. According to a recent study in the journal Cancer, roughly a quarter of breast cancer patients at eight Rhode Island hospitals received "less than definitive" care, which doubled their risk of death within five years. Specific care guidelines can make a world of difference, says study author Timothy Lash, D.Sc., M.P.H., of the Boston University School of Public Health. Adds Schellenbach: "Our role is to help people make good, informed decisions based on science."
Breakthrough # 3: A more powerful last-ditch drug
For women with advanced breast cancer, there's now hope in the form of a new drug called Herceptin. In about 25% to 30% of breast cancer patients with metastatic illness (meaning the cancer has spread), their tumors overproduce a protein called HER2, which makes the cancer grow very rapidly. Herceptin can temporarily slow down the excess growth, extending patients' lives. And the drug also has less toxic side effects than does traditional chemotherapy.
But the drug's real promise lies in the possibility that it may one day make cancer surgery obsolete. Herceptin is an antibody designed to target a particular protein - "zoning in on [that] and leaving everything else alone," Schellenbach explains. (So, theoretically, the drug could be designed to target just tumors, and leave healthy tissue untouched.) The first cancer therapy of its type to be approved by the Food and Drug Administration (FDA), "Herceptin is a first step in a succession of [nonsurgical] approaches that might work."
Breakthrough # 4: More accurate mammography
Digital mammography, approved this year by the FDA, may help doctors catch cancers as early as possible. While there's no evidence that digital images actually make cancer easier to detect, the medium is easier for experts to work with. Instead of shipping unwieldy mammography film from specialist to specialist, doctors can e-mail a digital image - and get another expert opinion - instantly. Digital mammography also enables technicians to take more pictures without repeatedly exposing patients to X-rays. The drawback: So far, the technology is too costly to be used in place of routine mammograms.
Breakthrough # 5: A breast-saving technique
Another promising new diagnostic tool is ductoscopy, which uses a very thin fiber-optic tube equipped with a tiny camera lens to give doctors a view of the milk ducts inside the breast. The scope, inserted through the nipple, can show surgeons exactly how far a tumor has spread, making it easier to remove all the diseased tissue while sparing as much of the healthy breast as possible. In the future, the scopes may be used to suss out microscopic tumors in women with a family history of breast cancer.
Breakthrough # 6: Genetic testing made easy
Right now, doctors rely on a costly and complicated process known as genetic sequencing to determine whether a woman has inherited BRCA1 and BRCA2, the so-called breast cancer genes. But one scientist has developed a test that may drastically reduce the expense of screening at-risk women. Gabriel Cohn, M.D., chief of clinical and reproductive genetics at Bay State Medical Center in Springfield, Massachusetts, has found that mutations on the breast cancer genes cause slight changes in some of the body's proteins. He has developed an antibody test that looks for these damaged proteins: Using a cotton swab, a doctor simply takes a few cells from a woman's mouth and tests to see whether these proteins are present. The accuracy of the test is still being studied, but Dr. Cohn says he hopes it will be a fast, cheap and painless alternative to targeting women at risk for developing the disease.

Source: Elizabeth Austin for Lifetime

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