Understanding a breast cancer diagnosis can be complex – here’s what you should know.
A funny thing happens after a breast cancer diagnosis: you become an expert on the subject. The girls, those beautiful bumps you could hardly wait to grow, are now trying to kill you. Knowledge is power, but there’s an overwhelming amount to learn.
Since my own diagnosis of Triple Negative Breast Cancer, I’ve shared what I learned with others. Now I’m going bigger. In conjunction with National Breast Cancer Awareness Month, I’ve sought knowledge and expertise from two talented researchers, both Lynn Sage Foundation Scholars (a partnership with the Robert H. Lurie Comprehensive Cancer Center of Northwestern University).
Sarika Jain, MD, is a medical oncologist and assistant professor in Medicine-Hematology/Oncology at Feinberg School of Medicine. Joining her here is Jacqueline S. Jeruss, MD, PhD, a breast surgeon and assistant professor in the Department of Surgery.
We know about mammograms and self-exams to screen for breast cancer. What else are doctors telling patients to be vigilant about? Dr. Jain: Half of all new breast cancer diagnoses can be explained by known risk factors. Those include women age 40-59 [the common age at diagnosis], women who experienced late menopause, a family history of breast cancer, obesity and alcohol consumption. Exercise provides moderate protection; conversely, the more alcohol one consumes, the higher the risk. Four glasses or less per week, on average, should be the limit.
Dr. Jeruss: I’d add that cancer is thought of as a disease of Western society, as evidenced by the behaviors Dr. Jain mentions. In addition, prolonged exposure to estrogen and never having children, or having them past the age of 37 increase the risk of breast cancer. In addition to monitoring alcohol, monitoring stress is also important.
Most people don’t realize there are myriad types of breast cancer. Can you give us a quick breakdown? Dr. Jain: There are three main subtypes. Luminal A is estrogen and/or progesterone positive and HER2 neu negative (a protein that appears on the surface of some breast cancer cells). This subtype has the best prognosis for treatment. Luminal B is estrogen and/or progesterone and HER2 neu negative or positive. In addition to surgery, radiation and chemotherapy, both those types are also treated with targeted, anti-estrogen drugs over a period of time. Triple Negative (estrogen, progesterone and HER2 neu negative), is a more aggressive cancer, with a slightly worse prognosis and no targeted therapies beyond chemotherapy.
Dr. Jeruss: Additionally there’s a fourth subtype that’s estrogen, progesterone and HER2 neu positive. There are currently new drugs in the pipeline, which will allow us to treat that form more effectively. The last type to mention is Inflammatory Breast Cancer, which tends to have a very poor prognosis.
But prognosis is more than just the group in which one falls. We consider other factors such as tumor size and lymph node involvement. A doctor can’t ever look at a patient and know her story. Nor should the patient ever feel so categorized that her story has been told. It will be told according to the life you live.
America loves buzzwords and there are many related to breast cancer, including prophylactic mastectomies and dense breast tissue. Could you address those? Dr. Jeruss: Dr. Kelly Hunt [of the University of Texas MD Anderson Cancer Center] presented a report on prophylactic mastectomies in 2007. It showed astounding increases in the number of these surgeries in the previous decade, but it’s an intensely personal choice. For some patients, even the lowest risk is too much. Patients with the BRCA genes are a different story. With their genetic predisposition, I recommend they consider prophylactic surgery, after they feel sufficiently educated on the subject.
Dr. Jain: Agreed. Genetic counselors are well-equipped to discuss statistics, given the patient’s age, family history, and other factors. On the issue of dense breast tissue, we must first accept that mammography is one of the best grading tools we have for patients who are post-menopausal. Studies involving dense tissue are inconclusive, but it is important to inform patients if they have denser breasts. It’s a real issue for which we don’t have a good answer.
Dr. Jeruss: Women with dense tissue have a four to five times greater risk of breast cancer compared to women of similar age with less dense tissue. But tissue density is not associated with mortality or a higher risk of dying.
Medicine is striving to cure cancer as well as to find new and improved treatments. What most excites you? Dr. Jeruss: We’re now investigating immunologic therapies for breast cancer and they may really have great promise. As a part of a larger international study, there is a vaccine trial occurring right here at Northwestern, under the auspices of MD Anderson in Texas.
Additionally, I find the whole field of oncofertility, spearheaded by Northwestern’s Dr. Teresa Woodruff, so wonderful. The advances in that field remove some of the difficult decisions younger women must make between breast cancer treatment and plans for a family.
Dr. Jain: I’m heading up the breast cancer portion of the clinical trials Dr. Jeruss spoke about at Northwestern’s new Developmental Therapeutic Institute. It’s very exciting as preventing recurrence is one of the biggest issues for breast cancer patients. Research is looking for markers that will tell them who is more at risk. And we’re working on a more translational model, where researchers and clinicians work together to increase the pace of moving drugs from lab to clinic.
I’m also interested in finding targeted therapies for Triple Negative Breast Cancer. One particular drug I was involved with, tetrathiomolybdate, reduced copper levels in breast cancer patients and was shown to delay or even prevent a recurrence in women with a high risk of recurrence. We found the best results in those with triple negative disease. It’s exciting, but we need more studies to confirm this.
So here’s my two cents: As a two-year survivor, my advice is be vigilant without being obsessive. Be wise in your lifestyle, but treat yourself in moderation. The bottom line: be good to the girls, and they’ll be good to you.
Editor’s Note: The Lynn Sage Foundation was founded by sisters Laura and Halee Sage upon losing their mother to breast cancer.