Breast cancer - Evaluation and Treatment

Breast Cancer

Early Diagnosis of Breast Cancer

Significant progress in mammography technology continues to help physicians diagnose breast cancer in its earlier stages. When coupled with new treatment options, early diagnosis through mammography screening can significantly improve a woman's chances of survival. That's good news because in the United States more than 200,000 new cases of invasive breast cancer are diagnosed each year. Mammography screening is the single most effective method of early detection. That's why an annual mammogram is recommended for women over 40. A clinical breast examination by a health care professional should also be done on a regular basis. Additionally, women can take charge of their own breast health by understanding their personal risks of the disease, performing a breast self-exam every month and reporting any breast change promptly to their health care provider. Unfortunately, studies have indicated that a significant number of women over 40 years of age fail to get a mammogram, and of those who do, many never follow up with a second mammogram. Women cite a number of reasons for their nonparticipation, including lack of finances and lack of time. It is important that women know that there are resources available to help address these issues. For example, throughout the year, low-cost or free mammography screening is available to many women who are over 40 and underinsured or uninsured. Additionally, many mammography centers offer extended hours and some even provide child care for moms having mammograms. In an effort to encourage women to have an annual mammography screening, National Breast Cancer Awareness Month (NBCAM) sponsors recommend making every day National Mammography Day. Whether it means scheduling an appointment on a 40th birthday, or if it means reminding a friend to make an appointment, every step counts.

In 2006, more than 250,000 U.S. women will be diagnosed with breast cancer. This deadly disease will claim the lives of more than 40,000 friends, neighbors, mothers and daughters. These are staggering statistics. However, breast cancer death rates are going down. This decline is largely attributed to the benefits of annual mammograms that enable physicians to detect cancer at its earliest stages, and improved treatment programs that help patients better manage their cancer. Both digital and film-based mammography can identify breast disease in women who may have no obvious signs of breast cancer. Historically, mammograms have been conducted using medical X-ray film. Now, new digital imaging technologies are emerging that offer a complementary method for early detection of breast cancer. The arrival of more digital imaging options sometimes can cause some patients to "wait it out" until their health care provider installs digital imaging systems. But the advice from physicians appears to be overwhelming: Do not wait for the latest digital technology. One of the most critical aspects for a full recovery is early detection, and it is far better to have any kind of mammogram than to delay or skip a mammogram entirely. The decision on which imaging technology to use should be a secondary issue that patients can discuss with their physicians. "Digital technologies show great promise in helping to detect breast cancer in certain patients," said Dr. John M. Lewin, Diversified Radiology of Colorado, a leader in providing technologically advanced radiology imaging. "In fact, the Food and Drug Administration (FDA) is considering relaxing guidelines that may make it easier for manufacturers of digital mammography systems to bring new products to market faster." Should the FDA adopt revised guidelines, it is possible that health care providers and patients could have access to a broader range of new digital mammography products earlier-and perhaps at a lower cost-as more competition among manufacturers may drive down prices of these systems.

One of the innovators of digital medical imaging systems is Eastman Kodak Company, which currently markets a digital mammography system for use in Europe, Latin America, Asia and other parts of the world. Kodak has applied to the FDA for approval to market this system in the U.S. and the company is conducting clinical trials of this system in the U.S. and Canada. "We applaud the FDA for examining ways to streamline the approval process for digital mammography products that may lead to increased adoption and improved access to these innovative systems," said Michael Marsh, vice president, Kodak's Health Group. Given the benefits and improvements in both digital and film mammogram technology, there is more reason now than ever before to encourage mothers, grandmothers, sisters and friends to get an annual mammogram. The American Cancer Society continues to recommend the importance of mammograms as a highly effective tool in the detection of breast cancer. What is critical is not the technology used to produce a mammogram, but ensuring that women age 40 and older have regular mammograms as part of maintaining a healthy lifestyle.

Is Tamoxifen Effective In Curing Breast Cancer?

Tamoxifen, known in the trade as Nolvadex, is usually prescribed by specialists in breast cancer and is taken in pill form. A patient will stay on the drug for about five years. Often the woman's cancer will be tested to see if it is sensitive to the amount of oestrogen in the system. If the cancer is oestrogen sensitive, tamoxifen will be given. Because tamoxifen is such a weak estrogen, its estrogen signals don't stimulate very much cell growth. And because it has stolen the place away from more powerful estrogen, it blocks estrogen-stimulated cancer cell growth. In this way, tamoxifen acts like an "anti-estrogen." Tamoxifen may also take the place of natural estrogen in the receptors of healthy breast cells. In that way it holds down growth activity, and possibly stops abnormal growth and the development of a totally new breast cancer. By blocking natural estrogen from getting to the receptors, tamoxifen is helpful in reducing the risk of breast cancer in women at high risk who have never had breast cancer. It also can help women who have already had breast cancer in one breast by lowering the risk of a new breast cancer forming in the other breast.

One study found that radiation plus tamoxifen was much better than tamoxifen alone at reducing the risk of breast cancer coming back after a lumpectomy in women with hormone-receptor-positive breast cancer. This was true even for women with very small cancers. For pre-menopausal women, tamoxifen is the best hormonal therapy. But tamoxifen is no longer the first choice for post-menopausal women. If Patient've been on tamoxifen for two to three years and now Patient're in menopause, Patient's doctor may recommend that Patient switch to an aromatase inhibitor to finish Patient's five years of hormonal therapy. However, Patient can still get a lot of benefit if Patient take tamoxifen for up to five years and then switch to an aromatase inhibitor. Tamoxifen was first used to fight breast cancer at the Christie Hospital in Manchester, England, in 1969. It has since proved its worth as means of stopping the spread or recurrence of the disease in women who have already been treated for it. But, it was noticed back in the early 1980s that some women who were receiving the drug for cancer in one breast did not develop any tumorous growth in the other. This prompted the suggestion that Tamoxifen might have another preventative role for those women who are at risk of getting breast cancer but have yet to develop any signs of the disease.

A US study of 13,400 patients showed Tamoxifen reduced the rate of expected cancers from one in 130 to one in 236 - a cut of about 45%. The American researchers ended their trial early when they said the drug's benefits became overwhelmingly obvious. Other studies found that tamoxifen AND chemotherapy improved survival improved survival rates by about 40–50% compared to taking one treatment or the other.

Should women taking tamoxifen avoid pregnancy?

Yes. Tamoxifen may make premenopausal women more fertile, but doctors advise women on tamoxifen to avoid pregnancy because animal studies have suggested that the use of tamoxifen in pregnancy can cause fetal harm. Women who have questions about fertility, birth control, or pregnancy should discuss their concerns with their doctor.

Does tamoxifen cause a woman to begin menopause?

Tamoxifen does not cause a woman to begin menopause, although it can cause some symptoms that are similar to those that may occur during menopause. In most premenopausal women taking tamoxifen, the ovaries continue to act normally and produce estrogen in the same or slightly increased amounts.

Do the benefits of tamoxifen in treating breast cancer outweigh its risks?

The benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks. Patients who are concerned about the risks and benefits of tamoxifen or any other medications are encouraged to discuss these concerns with their doctor. Tamoxifen ( ta-MOX-i-fen) is a medicine that blocks the effects of the estrogen hormone in the body. It is used to treat breast cancer in women or men. It may also be used to treat other kinds of cancer, as determined by Patient's doctor. Tamoxifen also may be used to reduce the risk of developing breast cancer in women who have a high risk of developing breast cancer. Women at high risk for developing breast cancer are at least 35 years of age and have a combination of risk factors that make their chance of developing breast cancer 1.67% or more over the next 5 years. Patient's doctor will help to determine Patient's risk of developing breast cancer.

How long should a patient take tamoxifen for the treatment of breast cancer?

Patients with advanced breast cancer may take tamoxifen for varying lengths of time, depending on their response to this treatment and other factors. When used as adjuvant therapy for early stage breast cancer, tamoxifen is generally prescribed for 5 years. However, the ideal length of treatment with tamoxifen is not known.

How Often Should I Take Tamoxifen?

Two studies have confirmed the benefit of taking adjuvant tamoxifen daily for 5 years. These studies compared 5 years of treatment with tamoxifen with 11 years of treatment. When taken for 5 years, the drug reduces the risk of recurrence of the original breast cancer and also reduces the risk of developing a second primary cancer in the other breast. Taking tamoxifen for longer than 5 years is not more effective than 5 years of therapy.

What is Tamoxifen

Tamoxifen is an oral selective estrogen receptor modulator which is used in breast cancer treatment, and is currently the world's largest selling breast cancer treatment. It is used for the treatment of early and advanced breast cancer in pre- and post-menopausal women. It is also approved by the FDA for the reduction of the incidence of breast cancer in women at high risk of developing the disease. It has been further approved for the reduction of contralateral (in the opposite breast) breast cancer.

Tamoxifen and Cancer

Tamoxifen is used to reduce the risk of breast cancer for women who:

  1. are at high risk of breast cancer but have no personal history of the disease
  2. have non-invasive, hormone-receptor-positive breast cancer, or DCIS (ductal carcinoma in situ)
  3. have hormone-receptor-positive invasive breast cancer at any stage.

Tamoxifen is sometimes used to treat gynecomastia in men. Tamoxifen is also used by bodybuilders in a steroid cycle to try and prevent or reduce drug-induced gynecomastia caused by steroids that are used in the same cycle. Tamoxifen is also used to treat infertility in women with anovulatory disorders. A dose of 10-40 mg per day is administered in days 3-7 of a woman's cycle.

More than 215,000 women are diagnosed with breast cancer every year. For many of them, surgery to remove the tumor is just the first step in the battle against the disease, often followed by radiation and/or chemotherapy. After that, these women may need to decide with their doctor whether to have "adjuvant therapy"-medication to help prevent their cancer from coming back.

When a woman's breast cancer does come back or spreads to other parts of the body, she may be at greater risk of dying from the disease. Women whose breast cancer is detected in the nearby lymph nodes at diagnosis and those who receive chemotherapy after surgery are considered to be at increased risk for breast cancer recurrence.

Postmenopausal women whose early-stage breast cancer is hormone-sensitive have a new option as their first hormone therapy following surgery. The U.S. Food and Drug Administration recently approved Femara® (letrozole tablets) on December 28, 2005 for this type of use. This approval was based on a median of 24 months of treatment. The study is still ongoing to determine the long-term safety and efficacy of Femara. Already a leading breast cancer treatment, Femara is now the only medicine in a group called aromatase inhibitors that is approved for use both immediately following surgery and after five years of tamoxifen. The FDA granted Femara a priority review, a distinction reserved for medications that could potentially offer a significant improvement compared to products currently on the market.

A panel from the American Society of Clinical Oncology, the country's leading group of oncologists, recommends aromatase inhibitors, such as Femara, be part of the optimal adjuvant treatment for this group of women. "One of the greatest fears confronted by women who have been treated for early breast cancer is that their cancer will come back. With Femara, we now have an option that can help address that fear early on, even in patients who we know face the greatest risk of recurrence," said Matthew Ellis, MD, PhD, FRCP, director of the Breast Cancer Program at Washington University in St. Louis. In a large clinical study of post-surgery breast cancer treatment, researchers compared the effectiveness of Femara and tamoxifen, another drug prescribed after surgery. An analysis performed after 26 months showed that Femara reduced the risk of breast cancer coming back by 21% over the reduction offered by tamoxifen. Patients taking Femara also showed a 27 percent reduction in the risk of the cancer spreading to distant parts of the body. In this study, women at increased risk of recurrence experienced the greatest benefit from Femara. Femara lowered this risk by 29 percent in women whose breast cancer had already spread to the lymph nodes at the time of diagnosis and by 30 percent in women who had prior chemotherapy. The results also showed that in these high-risk women, Femara reduced the risk of cancer spreading to distant parts of the body by 33 percent and 31 percent, respectively. In this study, Femara was generally well tolerated with the most common side effects including hot flashes, joint pain, night sweats, weight gain and nausea.

Tips for Living Healthy

Discuss postsurgery treatment options with an oncologist. Whether Patient're one, five or 11 years beyond Patient's diagnosis, taking care of Patient's overall health and well-being can also reduce Patient's risk of cancer coming back and give Patient the energy to do the things in life that Patient love.

  • Practice good nutrition
  • Exercise regularly
  • Tap into a support network
  • Take time out for yourself

Femara® (letrozole tablets) is approved for the adjuvant (following surgery) treatment of postmenopausal women with hormone receptor−positive early breast cancer. The benefits of Femara in clinical trials are based on 24 months of treatment. Further follow-up will be needed to determine long-term results, safety and effectiveness.

Talk to Patient's doctor if Patient're allergic to Femara or any of its ingredients. Patient should not take Femara if Patient are pregnant as it may cause fetal harm. Patient must be postmenopausal to take Femara. Some women reported fatigue and dizziness with Femara. Until Patient know how it affects Patient, use caution before driving or operating machinery. There was an increase in cholesterol in patients on Femara versus tamoxifen (5.4% vs. 1.2%).

In the adjuvant setting, commonly reported side effects were generally mild to moderate. Side effects seen in Femara versus tamoxifen included hot flashes (33.7% vs. 38%), joint pain (21.2% vs. 13.5%), night sweats (14.1% vs. 13.5%), weight gain (10.7% vs. 12.9%) and nausea (9.5% vs. 10.4%). Other side effects seen were bone fractures and osteoporosis.

Planning Patient's Treatment

What types of treatment are available and which might be appropriate for Patient.

Surgery

Breast-conserving surgery (lumpectomy), mastectomy, and lymph node dissection, and what to expect from each. Surgery is usually the first line of attack against breast cancer. This section explains the different types of breast cancer surgery. Decisions about surgery depend on many factors. Patient and Patient's doctor will determine the kind of surgery that’s most appropriate for Patient based on the stage of the cancer, the "personality" of the cancer, and what is acceptable to Patient in terms of Patient's long-term peace of mind.

In our What to Expect with Any Surgery section, Patient can learn the basic steps common to all breast cancer surgeries. If Patient need to choose between surgeries, Mastectomy vs. Lumpectomy explains the pros and cons of each. Lumpectomy, also known as breast-conserving surgery, is the removal of only the tumor and a small amount of surrounding tissue. Mastectomy is the removal of all of the breast tissue. Mastectomy is more refined and less intrusive than it used to be because in most cases, the muscles under the breast are no longer removed. Lymph node removal, or axillary lymph node dissection, can take place during lumpectomy and mastectomy if the biopsy shows that breast cancer has spread outside the milk duct. Some people qualify for the less-invasive sentinel lymph node dissection. Breast reconstruction is the rebuilding of the breast after mastectomy and sometimes lumpectomy. Reconstruction can take place at the same time as cancer-removing surgery, or months to years later. Some women decide not to have reconstruction and opt for a prosthesis instead. Prophylactic mastectomy is preventive removal of the breast to lower the risk of breast cancer in high-risk people. Prophylactic ovary removal is a preventive surgery that lowers the amount of estrogen in the body, making it harder for estrogen to stimulate the development of breast cancer. Cryotherapy, also called cryosurgery, uses extreme cold to freeze and kill cancer cells. Right now, cryotherapy is an experimental treatment for breast cancer.

Chemotherapy

Who should get it, how it works, different types, side effects, and how to manage them.

Radiation Therapy

What it is, who it's for, advantages, side effects, and what to expect when Patient get it.

Hormonal Therapy

The link between hormones and breast cancer and how different groups of drugs — including ERDs, SERMs, and aromatase inhibitors can affect that link.

Targeted Therapies

Including Herceptin: How they work, who should get them, how they're given, side effects, and major studies.