In the U.S., the average risk of a woman developing breast cancer is about 1 in 8. On the other hand, death rates have been falling steadily.
In the United States, the average risk of a woman developing breast cancer in a lifetime is about 1 in 8. On the other hand, breast cancer death rates have been falling steadily since 1989, declining by 43 percent through 2020, according to the American Cancer Society.
Dr. Allison A. Aggon, Fox Chase Cancer Center – Chestnut Hill surgical oncologist, sees reason for hope. Dr. Aggon credits earlier and better detection and enhanced treatment methods as cause for optimism.
“I think the advances we’re seeing are primarily in the medicine realm and also the radiation realm,” she says. “With surgery, we’re tending to try and decrease side effects and morbidity,” she says. “But really the survival gains are with the different medicines that are being trialed and offered over the last 10 years. It’s a pretty exciting time from the medical oncology standpoint to see how these options are benefiting patients.”
Still, there’s a long way to go. Consider these American Cancer Society statistics:
Narrowing the odds begins with early detection. The mammogram remains the standard of care.
The guidelines that Fox Chase follows recommend starting mammography at the age of 40 and repeating it annually, Aggon explained. At Fox Chase, 3D mammography (breast tomosynthesis) is used for exams, combining multiple X-ray views to provide a three-dimensional, and thus more detailed, view of the breast from a variety of angles. The 3D mammograms are believed to be an improvement over 2D imaging, which was the standard for decades, because they catch more cancers, and earlier.
But now, there are more options to further narrow the diagnosis, including MRIs, ultrasounds and even molecular breast imaging, which uses a radioactive tracer and a specialized camera to detect cancer cells.
Whether a woman receives additional imaging is largely up to her. “Additional imaging might be recommended if there’s a question raised by the mammogram,” Aggon said. “If we see something that warrants further investigation, sometimes those additional imaging modalities can be utilized. And then some women may potentially benefit from additional imaging just for routine screening. If they have extremely dense breast tissue or if they have a strong family history of breast cancer, we recommend women discuss it with their care team to determine if they’re being adequately screened by mammogram alone or if they may benefit from additional imaging. There should be a conversation with the patient about the pros and cons of any additional imaging before it’s ordered.”
If it comes time for treatment, the standard options remain surgery, radiation and chemotherapy, but there are new and exciting advances that improve breast cancer survival rates.
As a surgeon, Aggon says the field has made great strides over the past couple of decades.
“They’d been doing mastectomies (surgical removal of the breast) for years and years, and the advent of doing a lumpectomy (removing only the cancerous portion of the breast), where you can conserve the majority of the breast was kind of a radical idea initially, but it’s been proven,” she said.
“We have 20-plus years of data showing that breast conservation — a lumpectomy plus radiation in appropriate patients — results in the same overall survival as a woman who undergoes a mastectomy for their early breast cancer,” Aggon continued. “We used to automatically remove all the lymph nodes from a woman’s armpit if they had a cancer diagnosis. And now for appropriately selected patients, we can just take a few lymph nodes with sentinel node biopsy. We’re able to gain the information that we need and reduce the risk of local recurrence by doing smaller surgeries in selected patients as opposed to offering a bigger surgery automatically to everybody. We’re able to offer a more personalized approach.”
In addition to enhanced surgeries, more targeted chemotherapy and several enhanced radiation therapies, there are new, game-changing tests and medications that also increase breast cancer survival rates, including hormone therapies and immunotherapy.
Hormone therapy blocks the body’s ability to produce hormones in hormone-sensitive tumors. Immunotherapy uses the patient’s own immune system to fight cancer, employing monoclonal antibodies to deliver drugs straight to the cancer cells.
“At least in terms of medications for breast cancer, we’re treating more and more based on the individual biology of the cancer as opposed to just size and location,” Aggon explained. “It was always what’s the size of the lump and did it go to the lymph nodes. Those were the criteria for medications. Now there’s a lot more that goes into the decisions of medications. There’s just a plethora of additional tumor testing that gets done so patients are offered the kinds of medications that are tailored to their specific type of cancer and ultimately result in better outcomes because you want to give the medications that those tumors are going to specifically respond to.”
All in all, it's an exciting time in the field of breast cancer treatment. As for Aggon, whose mother and grandmother had breast cancer, this battle is personal. And like so many others, she lives for the day when we’re all looking at breast cancer in the rearview mirror.
“I tell my patients all the time,” Aggon said. “As much as I love operating, I will cheer with everyone else when my job is no longer needed. That’s not a problem. I’ll find something else. I’ll be excited to teach the history of breast cancer.”