We’ve made a lot of progress in the last decade or so,” Dr. Leona Downey said Wednesday at the sixth of seven monthly cancer lectures held at the West Center.
A medical oncologist at the Arizona Cancer Center and Associate Professor of Clinical Medicine at the University of Arizona, Downey said molecular profiling allows for the best individualization of treatment for breast cancer.
Though progress continues, breast cancer remains the most common life-threatening cancer in women. In 2005, there were 200,000 cases diagnosed and 40,000 deaths.
Most women diagnosed with breast cancer are post-menopausal. The average age at time of diagnosis is 61.
Between 2001 and 2004, studies show there was a drop in breast cancer diagnoses. Downey said this can be correlated to a drop in the number of women not taking, or no longer taking, hormone-replacement therapy. Nutrition and obesity are also factors.
“There is no good data on when to discontinue screening for women over 75,” Downey told the audience of about 60 women. However, starting at age 40, she recommends a clinical breast exam and annual mammography.
For women ages 20 to 39, she recommends imaging only if a woman has symptoms.
For women at high risk who have a genetic predisposition such as a mother or sister who was diagnosed with breast cancer by age 45, she recommends mammography at five to ten years earlier than the age when the relative was diagnosed.
Though there was controversy in fall 2009 over annual mammograms, Downey still suggests annual mammograms for women ages 40 to 49. For women ages 50 to 74, she suggests biennial mammograms.
Last year, the U.S. Preventive Services Task Force, which issues recommendations for preventive health care, said routine breast cancer screening for women under 50 weren’t necessary.
Diagnosis and staging
Once a diagnosis of breast cancer has been made, two types of surgery are most common — lumpectomy or mastectomy.
Lumpectomy is a breast-conserving therapy and is followed by radiation, a high-energy beam that is aimed at the target area and causes molecular changes and cell death. Its purpose is to destroy any microscopic cells that may be present after surgery.
Mastectomy is suggested for large or multifocal tumors or for women who want to avoid radiation. It is usually followed by systemic chemotherapy.
Downey said “staging” is the most prognostic factor and relates to the early or advanced stage at which the cancer is first diagnosed.
For those diagnosed when the cancer is at Stage I there is a 99 percent survival rate at five years. At Stage II, there is an 86 percent survival rate, at Stage III the survival rate is 60 percent and for cancer diagnosed at Stage IV survival at five years is 20 percent.
New advances in radiation allow a woman to receive radiation in five days vs. the traditional six-week period.
“We’ve learned that breast cancer biology is widely variable… individualization of treatment vs. everyone getting the same therapy is one of the advances,” Downey said.
Oncotype DX is a 16-gene assay that does a better job of predicting outcomes and allows oncologists to individualize treatment better.
“Some have been receiving chemotherapy with no benefit, but some clearly do benefit from chemotherapy.
“Different regimens depend on underlying biology… it depends on the characteristics of the cancer,” Downey said in closing.
“We have a better understanding of why cancers happen. It’s a very exciting time to be involved in breast cancer research.”
Contact Green Valley freelance reporter Ellen Sussman at firstname.lastname@example.org.