Breast cancer continues to be one of the biggest medical challenges today. Thousands of women each year, as well as men, get diagnosed with some form of breast cancer. More research is needed, and better screening options for women need to be implemented. As a husband and father, I appreciate what Breast Cancer Awareness Month means to me and my family. I decided to have a talk with Dr. Debra Capko, breast surgeon at the Hackensack University Medical Center and The Valley Hospital in New Jersey, about some advancements in treating breast cancer today. Here is what we discussed:
Dr. Manny: What's new to help diagnose breast cancers?
Dr. Debra Capko: Mammography remains the gold standard, and is recommended yearly for women 40 and older. Radiologists will often suggest an ultrasound to help clarify a finding on a mammogram, or when lumps can be palpated. Breast MRIs may be recommended in high-risk women or in newly-diagnosed breast cancers; however, they are not appropriate for general screening. Research continues in the search for other modalities that may find breast cancers missed by mammography. These include thermomammography (identifying “hot” spots in the breast due to new blood vessel growth suggesting a cancer), positive emission mammography (PEM), or using a nuclear medicine (scintimammography). The aim is to ultimately find a test more sensitive and more specific than a mammography.
Dr. Manny: Are breast implants safe? What are the reconstruction options for women who need or choose mastectomy?
Dr. Debra Capko: Breast implants, saline or silicone, have been found to be safe by the FDA. Women with implants must continue getting mammographies, understanding that a properly-performed mammography will not cause an implant to rupture. Implants may limit the ability of a mammography to find a breast cancer; this should be especially considered in high-risk women. Select women having a mastectomy are candidates for immediate skin-sparing mastectomies, and possibly nipple-sparing/skin-sparing mastectomies, which produce excellent cosmetic results.
Dr. Manny: Is radiation therapy absolutely necessary?
Dr. Debra Capko: Radiation therapy is usually recommended for women with breast conservation surgery (lumpectomy). Studies have shown that select women over 70 years old may not derive a significant benefit with the radiation, so it may be avoided. Standard radiation is daily treatment for 6 ½ weeks. Newer techniques (Mammosite) allow physicians to shorten this to one week by placing a balloon in the breast to direct intense radiation to the biopsy site. Research continues in developing methods to deliver a single dose of radiation at the time of surgery.
Dr. Manny: Do all breast cancers get treated with chemotherapy?
Dr. Debra Capko: The trend of giving most women chemotherapy is changing. Much research has been focused on understanding the biology of breast cancer and trying to determine which women will benefit most from chemotherapy. Size matters less and less. The OncotypeDx test looks at a panel of biologic features of an individual's tumor, and calculates a score indicating the likelihood of recurrence. This score can be used by an oncologist to guide decisions regarding chemotherapy. Newer treatments such as Herceptin and Avastin are targeted directly at the breast cancer, with promising results and less effects on the entire body.
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