The content below is provided by Virginia Oncology Associates, a sponsor of H4TG’s A Calendar to Live By/Guide to Caring for Yourself.
Every breast cancer patient’s journey begins with a flood of questions about the best plan for treatment and follow-up care.
As therapeutic options and scientific knowledge continue to expand at a rapid pace, the answers can change based on new clinical findings.
While many women assume that a bilateral mastectomy will always offer the greatest odds of survival without recurrence or further surgery, in most cases a lumpectomy followed by radiation can provide an equally effective outcome with a much shorter recovery period.
The best lumpectomy candidates have small <2cm tumors that are localized and don’t impact the nipple or central breast area. Patients with multiple disease sites and/or a genetic predisposition to cancer, on the other hand, typically will need mastectomy.
Another recent change is that the traditional surgery-before-chemotherapy progression has shifted for patients with certain breast cancer types with locally advanced disease.
Women with triple-negative or HER2-positive cancers, both of which tend to be more aggressive, may benefit from intravenous chemotherapy with/without immunotherapy or a targeted agent prior to surgery.
Doing chemotherapy first can be beneficial for a variety of reasons. It can help downstage a tumor so that the surgery is not as extensive, thereby minimizing side effects and decreasing recovery time. It can also help with treatment decisions as we can alter the treatment after surgery if the patient was not fully responsive to initial therapy.
Throughout treatment, multi-disciplinary teams of medical, surgical and radiation oncologists meet on a regular basis to make individualized decisions based on disease stage, location, pathology, and a patient’s overall health.
Additionally, genetic testing is currently recommended for all patients diagnosed before age 45 and/or with triple-negative breast cancer or a particularly strong family history of breast or ovarian cancer.
Women found to have mutations in their BRCA1 or BRCA2 genes, which normally produce proteins to help repair damaged DNA, can lower their cancer recurrence risk by up to 90 percent with a bilateral mastectomy.
Those patients also tend to respond better to platinum-based chemotherapy, which acts directly on the DNA of cancer cells. And they may qualify for a PARP inhibitor, a targeted medication to repair the damaged DNA that allows cancer cells to reproduce.
For patients with hormone receptor-positive invasive cancer, meanwhile, hormone therapy can significantly reduce the risk of future recurrence. The goal is to decrease estrogen levels by blocking estrogen production and stopping tumor growth in cells throughout the body.
Overall, anti-estrogen therapies are very well tolerated. Less than 1 percent of patients on the commonly prescribed medication tamoxifen, for example, develop blood clots or uterine cancer; annual gynecologic screenings provide further protection.
Similarly, older women who take an aromatase inhibitor can offset a slightly increased risk of osteoporosis through frequent bone density scans and the addition of a daily calcium and vitamin D supplement.
In all cases, a healthy diet, regular exercise, weight management, smoking cessation and limited alcohol intake will help patients protect themselves over time.