16 octobre, 2007 08:40

The victories are incremental: Doctors working to detect and treat breast cancer report no miracle cure on the horizon. But they are enthusiastic about a wide range of new ways to detect and treat the disease.

"We have a much better understanding now that breast cancer is not one-size-fits-all," said Dr. Pamela Munster, scientific director of the breast cancer program at the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida in Tampa.

"We now better understand what makes cancer cells grow," she said. "Once we understand that, we can target the driving source more effectively."

Surgeries used to remove breast tumors are less disfiguring than in the past, Munster said, with total loss of a breast much less common than just a few years ago.

Also, surgical techniques to reconstruct breasts have improved in recent years and include better ways to reattach blood vessels to keep tissue healthy.

"Some of these reconstructions are so amazing, you would hardly know the woman had breast cancer," Munster said.

Among new treatments:

Aromatase inhibitors: About 65 percent of breast cancers are fueled by the female hormone estrogen. New drugs fight the growth of these tumors by either reducing the amount of estrogen in the body or blocking the cancer cell’s ability to use estrogen.

Nanotechnology: Experiments are underway using microscopic beads that enter cancer cells and directly deliver cancer-fight drugs. These make higher doses possible without increasing toxicity.

Vaccines: Unlike preventative vaccines, these would be given to a patient after she develops breast cancer. The aim is to stimulate the body’s immune system to recognize cancer cells and destroy them. These are still being tested; Munster said clinical trials of a breast cancer vaccine are set to begin at Moffitt in January.

Fertility insurance: Chemotherapy can damage a pre-menopausal woman’s fertility. Eggs are harvested and preserved for younger patients who wish to have children after chemotherapy. And today’s chemotherapy regimens are milder and less likely to produce sterility.

Early detection remains the best weapon against breast cancer and advances in diagnostic imaging are available throughout the Treasure Coast.

Mammography, using X-rays to show breast tissue, has been improved through the use of digital technology. It provides clearer and more detailed images.

But when X-rays and ultrasound images leave doubt, doctors are using magnetic resonance imaging, or MRI,[Jim: add: ] specially set up to image breast tumors.[Jim: end add: ] One such machine is at Vero Radiology Associates in Vero Beach.

"If an MRI is totally normal, I can give the patient greater than 95 percent peace of mind that they aren’t dealing with invasive cancer for up to two years," said Dr. Heather Nagel, director of the Women’s Imaging Center at Vero Radiology.

That doesn’t mean all women should seek breast MRIs, Nagel said. They are expensive, not always covered by health insurance and cannot be given to women with heart pacemakers.

However, Nagel said MRIs are useful in finding tumors in women with breast implants or scarring from prior breast surgeries that muddle standard mammograms; looking for residual disease after lumpectomies; and diagnosing breast lumps that can be felt, but do not show on mammograms.

An MRI also is recommended for women with newly diagnosed invasive breast cancer because other tumors sometimes go undetected on their mammograms, Nagel said.

Shirley Ball, a breast cancer survivor from Vero Beach, recently got a breast MRI after being told to repeat a mammogram sooner than usual.

"I didn’t want to wait six months," Ball said. "I would have been thinking about it every day, wondering if there was something growing in me."

The MRI cane back negative and "gave me terrific peace of mind," Ball said.

Port St. Lucie breast surgeon Dr. Reatha Williams works through quarter-inch incisions with a special tool to gather tissue samples of suspected tumors in her office. She said definite test results arrive in about one week, compared to several weeks it would take using a standard surgical biopsy.

"Probably 80 percent of the biopsies that we do are not cancerous," Williams said. "I think imaging is getting better and biopsies will decrease."

The tool Williams uses to sample tissue is guided by ultrasound images. It also leaves behind a tiny titanium marker that helps locate the rest of the tumor if surgery is needed.

Cancers that have spread outside the breast often are treated with chemotherapy drugs. Williams said recent improvements have made these treatments easier to endure.

"The difference in side effects is amazing," she said. "It is not nearly as toxic as the chemotherapy that they did years ago."

Tumors confined to breast tissue often are treated with radiation. Here, too, improvements are locally available.

One such device uses a small saline-filled balloon that surgeons leave behind in the cavity created when the tumor is removed. Surgical breast oncologist Dr. Denise Ortega Sanderson of Stuart works with colleagues at Martin Memorial Medical Center to apply cancer-killing radiation from the inside out.

The system threads a radioactive bead through a catheter and into the balloon, directly treating cells that surrounded the tumor.

"We can give 5,000 units of radiation within five days instead of five weeks, because we are not worried about burning the skin," Sanderson said.

The treatment can be used on selected patients, usually women 50 or older, whose tumors are small, low-grade and without lymph nodes involved.

"They are patients who are going to do well no matter what you do," Sanderson said.

Both Sanderson and Williams noted a disturbing trend: Fewer woman are getting mammograms as often as they should.

"That worries me," Williams said. "The sooner it’s detected, the better." �

October is National Breast Cancer Awareness Month, when Americans reflect on progress in treating a disease that is the second leading cause of cancer deaths in women, after lung cancer.

About 200,000 women in the U.S. will be diagnosed with breast cancer this year and about 40,500 will die of the disease.

Overall rates of deaths from breast cancer have decreased about 2 percent a year since 1990, due mostly to advances in early detection and treatment.

Fewer women older than 50 are suffering breast cancer, a drop sometimes attributed to less use of combination hormone therapies to ease symptoms of menopause following a 2002 study that linked their prolonged use to increased risk of breast cancer and heart disease. The incidence of breast cancer in women younger than 50 has remained the same since 1986.

Most breast lumps are benign. They do not spread outside the breast and are not life-threatening.

Men have some breast tissue with cells that can undergo cancerous change. But breast cancer is 100-times more frequent in women.

It is a malignant tumor that starts in the cells of the breast, most in the lobular cells of glands that make breast milk or the cells lining ducts that carry it to the nipple.

Non-invasive: Cancer is only in the ducts or glands of the breast and has not spread to the tissue of the breast. Nearly all women with cancer at this stage can be cured.

Invasive: Cancer has spread to surrounding breast tissue. Cancer cells can enter the lymphatic system and begin to grow in underarm lymph nodes. Once cancer reaches these nodes, it is more likely spread to other organs of the body. Inflammatory: An uncommon type of invasive cancer. Usually there is no single lump or tumor. Instead, it makes the skin of the breast look red and feel warm.

The chance of a woman having invasive breast cancer sometime during her life is about one in eight; The chance of dying from breast cancer is about one in 35.

The best prevention against breast cancer is early detection. Women 40 and older should have an annual mammogram. If a mother, sister or daughter has had breast cancer, mammograms should begin sooner. Consult your physician. �

�The American Cancer Society (www.cancer.org); The National Cancer Institute ,http:// www.cancer.gov