21st Century Breast Cancer Management

October 2007 - An online survey commissioned by AstraZeneca and conducted by Harris Interactive found that most breast cancer survivors considered themselves stronger after having the disease but their level of knowledge about steps they could take to reduce the likelihood of recurrence was "surprisingly low".

The report explains that breast cancer is the most frequently diagnosed cancer in women in the United States and is second only to lung cancer in leading causes of cancer deaths in women.

It is estimated that 40 460 women will die of the disease in 2007. The focus on early detection (for example, through annual mammography screening for women over 40) and improved treatment has significantly improved chances of long-term survival. After increasing for over 20 years, the incidence of breast cancer levelled off from 2001 to 2003. Mortality rates have steadily declined since 1990, with an annual decrease of 3.3 per cent in women less than 50 and 2.0 per cent in those over 50. There are currently more than 2.3 million breast cancer survivors in the United States.

The current study was based on interviews with 543 American women who had been diagnosed with breast cancer. The vast majority (92 per cent) reported a positive change in their lifestyles since diagnosis and 63 per cent reported being optimistic about the future. Similarly, 87 per cent said that having breast cancer had made them a stronger person and 83 per cent felt they were better able to put their lives in perspective. Breast cancer survivors were found to be more likely to strongly identify with other women who have had the disease (66 per cent) than with people of the same ethnic/racial background (41 per cent) or religious beliefs (40 per cent).

The survey also found that the majority (78 per cent) were concerned about recurrence but 30 per cent "don't believe" and 23 per cent "aren't sure" there is anything they can do reduce the likelihood and only 55 per cent have raised the issue with their doctor. The survey found that more breast cancer survivors (72 per cent) said they relied heavily on their doctors or health professionals in the process of recovery than on friends (67 per cent) or spouse (52 per cent). The majority (89 per cent) reported being only "somewhat involved" or "not involved" in a survivor community, therefore possibly lacking support and access to information. Researchers suggest that more education is needed about topics such as healthier eating, reducing stress and taking hormonal therapy.

Jean A. Sachs, executive director of Living Beyond Breast Cancer said:

"For most women, a diagnosis of breast cancer has a significant impact on their lifestyle and the way they monitor their health. We want to support all women who have had breast cancer in getting the best information available to help them remain disease-free for as long as possible. We strongly encourage women who have had breast cancer and their loved ones to speak with their health care professionals to obtain the facts."

Cancer Research

Earlier this year, a review by Dr S. Eva Singletary, a surgeon from the University of Texas M. D. Anderson Cancer Center in Houston and published in the online edition of CANCER concluded that current research may lead to dramatic advances in breast cancer management. New developments in breast cancer imaging, timing of chemotherapy, and vaccine research may offer innovative non-surgical interventions resulting in significant changes to current screening and treatment practice and improvements in patient care.

Dr Singletary summarises changes in breast cancer management since Dr William Halsted first performed radical mastectomies nearly 100 years ago. Advances in genetics, immunology, and cell biology have demonstrated that breast cancer is a complex family of diseases that requires individualized treatment. The current multidisciplinary approach incorporating surgery, radiotherapy, chemotherapy, hormonal therapy, and targeted therapy will continue to evolve as knowledge increases.

Eva Singletary commented:

"As we progress into the 21st century, new treatment schema and devices outside of the surgical arena may significantly alter current practices".

The review concludes that current research in the fields of radiology, drug therapeutics, and vaccine development has great potential to change breast cancer management. Refinements in techniques such as 3-dimensional digital mammography, color doppler ultrasonography, and magnetic resonance imaging (MRI), will increase the accuracy with which size and location of tumors are identified, and benign and malignant lesions distinguished. Use of nanotechnology may provide safer imaging capitalizing on increasing identification of specific genes associated with cancer.

The review identifies adjustments in the timing of systemic drug treatments to maximize cell death, "short-circuit" tumor growth, and minimize toxicity. There have been encouraging results from animal testing of vaccines designed to stimulate the immune system to attack developing tumors. Early clinical trials in breast cancer patients have also shown promising responses but the review stresses that much remains to be done in this complex area of research.

Eva Singletary said:

"During the lifetime of most surgeons practicing today we have seen breast cancer management evolve dramatically from a paradigm centered on radical surgery to one that involves the synergistic combination of multidisciplinary approaches. It will be important for surgeons to stay aware of all developments that may improve the care of their patients, and to be true surgical oncologists rather than merely surgical technicians."

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