Current Breast Cancer Protocols And Modalities
Breast cancer is the most common cancer among American women and is the second leading cause of cancer death in women, exceeded only by lung cancer. About 1 in 8 (12%) women in the US will develop invasive breast cancer during their lifetime. In 2014, it is estimated that among U.S. women there will be 300,000 new cases of breast cancer with an estimated 40,000 breast cancer deaths.
What are current guidelines for breast cancer screening?
- According to current American Cancer Society guidelines, women age 40 (up to the age at which they cannot tolerate treatment) need to be screened
- Screenings should occur annually
Do these protocols change based on family history?
- Yes. We recommend that female patients with a strong family history of breast cancer, particularly primary relatives, be screened 10 years earlier than the affected relative
- For women who are known to be genetic mutation carriers, we typically recommend high risk screening begin at least by age 25. MRI alternating with mammograms every six months
Do you recommend genetic counseling and when?
- I recommend genetic counseling for patients under 50 who have cancers, and for those who have primary relatives with a history of cancer (particularly those under the age of 50)
- See recent editorial [JAMA. 2014;312(11):1091-1092] recommending population-based screening
What are the current modalities in diagnosing and treating breast cancer?
- Diagnoses typically begins with a mammogram; a biopsy is performed if there’s a suspicious lesion on the mammogram
- If there is a palpable mass despite a negative mammogram, then an image-guided biopsy should be performed
- Ultrasound-guided or stereotactic biopsies are preferable to excisional biopsies
What are future treatments that PCPs should become aware of now?
- The benefits of a multidisciplinary team approach, including surgeons, medical oncology, radiation oncology, pathology, and radiology
- Predictive algorithms such as Oncotype Dx to assess the need for chemotherapy and radiation
- The move toward personalized treatments based on the genetic mutations
Can a clinical trial make a difference with breast cancer patients?
- We’ve made tremendous strides in diagnosing and treating breast cancer as a result of increased clinical research
- Breast cancer mortality has decreased dramatically due to efforts of clinical trial with improvement in treatment, screening, and early detection
- OHC has ongoing clinical trials for breast cancer: 12 clinical trials are now open and 4 are pending.
What should PCPs focus on during their patients’ yearly check-up?
- Perform a clinical breast exam and talk to your patient about any changes in their breasts; asymmetry, changes in size, nipple discharge or discoloration. Any change should prompt further investigation
- Remember to take family history into account
- Reinforce their need for a mammogram as protocols dictate
What lifestyle changes can help prevent breast cancer?
- Exercise and maintaining appropriate BMI is becoming a hot topic in prevention
- Even low to moderate exercise (just 30 minutes, five days a week) has been shown to contribute significantly to the prevention of breast cancer and breast cancer relapse
- Obesity is associated with increased risk of breast cancer
- Alcohol has been shown to be associated with breast cancer (though not tobacco)