Massachusetts Medical Society's Physician Focus

September 2015

Breast Cancer:
Risks, Screening, Prevention

PROGRAM HIGHLIGHTS:

  • Next to skin cancer, breast cancer is the most common cancer among American women. More than 230,000 new cases will be diagnosed this year.
  • About 1 in 8 women in the U.S., or 12 percent of females, will develop invasive breast cancer in their lifetime, and three out of four will develop it after age 50.
  • Death rates from breast cancer have been declining due to better treatment, and today there are nearly three million breast cancer survivors in the U.S.

A common theme in discussing breast cancer is ‘one in eight’ – indicating that the disease will strike one in eight women in the United States. But what does ‘one in eight’ actually mean?

“One in eight does not mean death from breast cancer,” says Nadine Tung, M.D., Director of the Cancer Genetics and Prevention Program of The Cancer Center at Beth Israel Deaconess Medical Center in Boston.

While one in eight women may develop the disease in their lifetime, Dr. Tung offers a positive approach, saying that “breast cancer is one of those cancers that our expectation for the vast majority is cure.”

Her BIDMC colleague Gerburg Wulf, M.D., a medical oncologist and researcher, adds perspective: “Early stage breast cancer is frequently much more curable than hypertension or diabetes. It’s a condition that can be diagnosed, be dealt with, and the woman can move on and live a healthy life in the majority of cases.”

As guests on the September edition of Physician Focus with the Massachusetts Medical Society, Dr. Tung and Dr. Wulf discuss a wide range of topics about breast cancer: risk factors, screenings and treatments, mammography, mastectomy, and preventive steps that women can take to reduce their risk. Hosting this program is Dale Magee, M.D., a past president of the Massachusetts Medical Society. What follows are excerpts from the conversation.

Breast cancer may be a common disease, but the physicians point out that it’s not a single disease. Some cancers are more aggressive, some less so, and many tools are available to understand how much of a risk the patient faces with breast cancer.

“Treatment starts with the mammogram,” says Dr. Wulf. “For most women the treatment is surgery, to have the cancer removed. After the surgery, we know what kind of tumor it was, how large it was, and if the cancer has spread to the lymph nodes.” That information, she says, helps the physician make decisions about additional medical treatments, such as radiation, chemotherapy, or medication, which will minimize the risk of the cancer returning.

Mammography has been the standard of preventive care for years, but differing opinions among health professionals about its effectiveness have raised some concern and confusion. Despite its limitations, Dr. Tung says it remains the only screening tool that has been proven to decrease death from breast cancer.

Mastectomy is another option for women to consider as part of treatment, but “should be the exception” says Dr. Tung. “Allowing a woman to keep her breast is really the goal. Studies involving thousands of women who have participated in research have demonstrated that the survival rates [comparing those who have mastectomies versus those who don’t] are the same.”

One message that consistently comes through in the physicians’ discussion is that much progress has occurred in recent years in the diagnosis and treatment of breast cancer – and that has led to better outcomes.

“We used to rely on just how it looked under the microscope,” says Dr. Tung. “Now physicians can take a piece of the tumor and analyze its structure, and that directs how physicians can treat the patient with personalized medicine. Special treatments and personalized medicine have improved the treatments and cure rates for breast cancer,” she says.

Adds Dr. Wulf: “It is an obstacle than can be overcome. The prognosis is overwhelmingly good for the vast majority of women who are getting diagnosed with early stage breast cancer.”

Watch the above video for the complete discussion, including conversation on the controversy over mammograms and their effectiveness; the differences between mammograms and MRIs as screening tools; who should undergo genetic testing; who should consider preventive mastectomies; the relationship between breast cancer, birth control pills, and hormone replacement therapy; and three key lifestyle issues that can reduce a woman’s risk of breast cancer.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
American Cancer Society

BreastCancer.org

National Cancer Institute

Beth Israel Deaconess Medical Center Cancer Center

"Breast Cancer" PSA


From left, Dale Magee, M.D., Gerburg Wulf, M.D., Nadine Tung, M.D.
hi-res photo
promo slide