By Eirish Sison
According to the National Cancer Institute, 1 in 8 women will get breast cancer in their lifetime. Despite the prevalence of the disease, death rates from breast cancer have been steadily decreasing since 1990, likely due to earlier detection, increased awareness and treatment advances. If you've been diagnosed with breast cancer, you'll be talking to your doctor about your various treatment options, so it's good to have some background information on hand. Here's a rundown of the standard treatments being used for breast cancer today.
Most breast cancer patients undergo surgery as part of their treatment plan. In this procedure, doctors cut out the cancer. Surgery is often supplemented with other types of cancer treatments to decrease the chance of recurrence.
There are different types of breast cancer surgery. One major type is breast-conserving surgery, in which a surgeon removes the part of the breast that has cancer, but spares most of the healthy breast tissue. Lumpectomy falls under this type of surgery. This procedure takes out the least amount of tissue, as it involves removing only the tumor (lump), and some of the normal tissue around it. Partial mastectomy, on the other hand, removes the part of the breast that contains the cancer and some normal tissue around it, not just the lump. Patients who undergo breast-conserving surgery may also undergo lymph node dissection during or after surgery to determine if the cancer has spread to the lymph nodes.
The other type of breast cancer surgery is a mastectomy. A simple mastectomy involves removing the entire breast that has cancer. A modified radical mastectomy may also include removing some lymph nodes under the arm, the lining over the chest muscles and perhaps some of the chest muscles under the breast. The last type of mastectomy is a radical mastectomy (rarely used today) when the breast that has cancer, the chest wall muscles under the breast and all of the lymph nodes under the arm are removed.
Patients who have a mastectomy can consider undergoing breast reconstruction to restore the breasts' shape. This procedure will lengthen recovery time when done together with surgical removal of cancer, but for many women it is the preferred option.
Chemotherapy is probably the treatment most commonly associated with cancer. When patients undergo chemotherapy, they ingest or get injected with medicines that will either kill cancer cells or prevent them from dividing and spreading.
Chemotherapy may either be systemic, where the chemotherapy drugs are spread throughout the body, or regional, where the drugs only affect the localized area that contains the cancer. The type of chemotherapy used will depend on the type and stage of the cancer being treated. Systemic therapy is often used on patients with advanced stage breast cancer, when the cancer cells have metastasized (spread from the breast to other parts of the body).
Chemotherapy can also affect healthy cells that behave similarly to cancer cells, so most patients experience side effects from chemotherapy treatment. Most of these side effects will disappear shortly after treatment is finished. Though each person reacts differently to their particular chemotherapy regimen, some common side effects include nausea, vomiting, pain, anemia, hair loss, sexual and fertility changes and fatigue.
For early stage breast cancer, surgical treatment of cancer may be combined with chemotherapy to destroy any cancer cells that may be remaining, and to possibly prevent the cancer from coming back. Some patients may undergo chemotherapy before surgery to reduce the size of the cancer that needs to be removed.
In radiation therapy, targeted high-energy beams of x-rays or other kinds of radiation destroy cancer cells. The radiation may be delivered externally by a machine, or internally with a radioactive substance sealed in needles, seeds, pellets or wires that are placed directly in or near a cancer site.
According to Breastcancer.org, radiation therapy after surgery can reduce the risk of breast cancer recurrence by around 70 percent.
Because it is effective and relatively safe, radiation may be used to treat all stages of breast cancer. It is often recommended to patients who have a lumpectomy in order to kill any cancer cells that may have been left behind after the tumor is removed.
If a patient's breast cancer is found to be hormone-receptor-positive — that is, it contains a lot of sites where hormones (such as estrogen) can bind and fuel the cancer's growth — then it may be treated with hormone therapy. This treatment stops the cancer from growing by either reducing the production of estrogen in the body or by blocking the action of the hormone on breast cancer cells. Hormone therapy is usually administered with medicines that lower estrogen levels or prevent them from working on the cancer cells, but in some cases it is done by surgical removal of the ovaries (where most estrogen in the female body is produced) and the fallopian tubes.
Hormonal therapy, like chemotherapy and radiation therapy, helps reduce the risk of cancer recurrence after surgery. For advanced stages of hormone-receptor-positive breast cancer, hormone therapy may be used to shrink or slow the growth and spread of the cancer.
Tamoxifen is a breast cancer treatment drug that is usually given to those with early-stage breast cancer, or metastatic breast cancer. It works by blocking the effects of estrogen in the breast. It is also used for breast cancer prevention in patients who have abnormal cells in the ducts of the breast, and those who are at high risk of breast cancer.
Hormone therapy with aromatase inhibitors (such as Arimidex, Aromasin and Femara) decreases the body's estrogen levels by preventing the enzyme aromatase from converting androgen to estrogen. This type of hormone therapy is often recommended for women who have hormone-dependent breast cancer and who have undergone menopause.
One of the downsides of therapies like radiation and chemo is that they also destroy some healthy cells. Targeted therapies seek to eliminate this side effect by using drugs and other treatments that target specific cancer cells and leave normal cells unharmed.
A type of targeted therapy called monoclonal antibody therapy uses antibodies made in the lab from one type of cell in the immune system. The antibodies can detect certain markers on cancer cells or certain substances that help cancer cells grow. They then attach to the substances and either kill cancer cells, block their growth or keep them from spreading. This therapy is done by infusing the antibodies into the patient's bloodstream. Herceptin is a type of monoclonal antibody used to treat certain types of breast cancer.
Some patients may want to consider participating in a clinical trial for a breast cancer treatment. Clinical trials are research studies seeking to find new ways to fight cancer that have shown enough promise in previous stages of testing to begin testing the treatment(s) on humans. They may be trials of new drugs or vaccines; new surgical, chemotherapy or radiation therapy techniques; or new combinations of treatments.
Different studies will need participants of certain types or stages of breast cancer, or patients at certain stages of treatment.
To learn more about clinical trials, visit this website of the National Cancer Institute and talk to your doctor.
Eirish Sison is a health writer based in the San Francisco Bay Area.
Published October 4, 2011.