Breast cancer treatment in the future will be more specific and less traumatic.
A cure might still be out of reach, but medical advances are making it easier to detect the beginning stages of breast cancer and lessen the rigors of treatment, according to doctors.
Dr. Randy Cooper, a general surgeon at University Hospital who specializes in breast diseases, said much has improved in the past five to eight years.
"The thing that's changed the most is we've gotten away from open biopsies where we put people to sleep, and we've gone to much less invasive techniques," he said. "Most surgeons have mammogram machines right in their offices. We can do a core needle biopsy right in the office, and you can do it without general anesthesia."
A core needle biopsy takes a sample of breast tissue through a hollow needle.
In diagnosing breast cancer, the availability of mammograms is important because they are still the best way to detect a tumor before it can metastasize, spreading to the lymph nodes and other parts of the body. Dr. Cooper said that although the number of cancer cases is increasing - he remembers being told in medical school that 1 in 14 women get breast cancer; now it's 1 in 8 - the chances of mortality are decreasing.
That decrease in mortality rests chiefly on advancements in cancer diagnosis. The National Cancer Institute, a division of the National Institutes of Health, recommends women older than 40 get a mammogram every one or two years.
"Better chemo treatment has helped, too, but the key is screen mammography," Dr. Cooper said.
Because screening is of such paramount importance, local hospitals have updated their facilities to make them more inviting. The newly redesigned mammography area at the Medical College of Georgia Breast Health Services opened in July 2003. Alice Reese, a retired MCG employee who helped with the redesign, recalled the earlier utilitarian feel of the area when she was a patient there 14 years ago.
"I can remember being put in a gown and sent back out these double doors and sitting there with all these people walking by," she said. "I wasn't embarrassed, but I could see that it could be for some people."
The new area is more self-contained and segregated from the rest of the hospital. Mrs. Reese said soft lighting, pleasing colors and murals make it feel more like a living room than a doctor's office.
"The doors close behind you, and you get the feeling it's like a spa," she said. "By having nicer surroundings, it makes it a little easier to deal. I think a women's worst fear is getting diagnosed with breast cancer."
Another development that Dr. Cooper foresees helping breast cancer is magnetic resonance imaging. When a woman is in her 20s and 30s, her breasts are too dense for mammograms to be effective. When MRIs become more affordable, they will be a valuable way to screen women who are at high risk for breast cancer. Currently, the best way for women younger than 40 to detect a tumor is through self-examination.
"The older you are, the gentler, if you will, the disease is. When you're 40, you're not supposed to get this," Dr. Cooper said, indicating that breast cancer is usually more aggressive in younger women.
Dr. Amanda May, an assistant professor of medicine in medical oncology at MCG, agreed that MRIs will be a useful tool but said they are not practical yet.
"It's not just the cost. They aren't fun things to go through. You have to lie on a hard, flat surface and go through and not move," she said. "At least, the way it's done now, it's not the easiest thing."
Dr. Dwight Randle, the director of the award and research grant program at the Susan G. Komen Breast Cancer Foundation in Dallas, said developments in positron emission tomography, or PET, scans, ultrasound and MRI are giving young women more options.
"We also want there to not be a divide between the haves and the have-nots," he said. "That has always been a problem, even with the early stages of mammography. We're interested in making sure all women have access to these emerging technologies."
When it comes to treatment, Dr. Cooper said, there was a time when surgeons would completely remove a woman's lymph nodes if it was thought an invasive cancer might spread to them. In sentinel node biopsy, blue dye and a radioactive tracer are injected into the tumor site during surgery. and the first (or sentinel) lymph node that picks up the tracer is removed. This can cut back on the occurrences of lymphedema, a complication in which excess fluid collects in the arms and legs.
Another new treatment technique is the MammoSite Radiation Therapy System. Two to three weeks after performing a lumpectomy and a sentinel node biopsy, the surgeon makes a small incision on the side of the breast and threads a catheter with a balloon attached to it into the breast and blows up the balloon. After the position has been confirmed with a computerized tomography, or CT, scan, radiation therapy is administered to an area about 1 centimeter around the balloon for five days, rather than the traditional six weeks of daily radiation.
Dr. Cooper said this system cuts down on the amount of travel time for women who live far away from medical facilities.
"It's really exciting," he said. "For most people ,when you tell them you want to radiate them for six weeks, it seems like forever."
Dr. May said she's been most impressed with the expanding number of chemotherapy drugs available, in addition to drugs used in hormone therapy. The female sex hormone estrogen might promote the growth of cancer cells, so drugs are sometimes prescribed to halt its production.
"Basically, five years ago we had Tamoxifen. Now we have a lot more newer hormonal agents that can even augment Tamoxifen," she said. "They've provided significant increases in the quality of life for patients."
Dr. Cheryl Perkins, a senior clinical adviser for the Komen foundation, said targeted therapy, such as the MammoSite system, is encouraging.
"The hope is that targeted therapy will result in less side effects, without radiation burns or fatigue," she said. "Radiation with chemotherapy is believed to be the best way to enable breast-saving surgeries."
Reach Patrick Verel at (706) 823-3332 or firstname.lastname@example.org.
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