Monday, December 18, 2017

OCMA Blog

The Road Ahead: Diagnosis and Treatment of Breast Cancer

Cancer. Just hearing the word can bring you down. For many women, a breast cancer diagnosis is a reality they have to face. The thought of receiving a diagnosis can cause much distress and anxiety in women on top of all the stresses they experience every day. Fortunately, there have been great strides in breast cancer research, treatment and diagnosis. Breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis. With death rates down 34% since 1990, breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis.

The road to recovery begins with diagnosis. So, how do we do so with confidence and accuracy? Physicians employ a variety of breast imaging services including mammography, ultrasound and MRI to detect breast cancer, depending on various patient factors. However, breast cancer screening guidelines have become somewhat confusing in recent years, with multiple organizations offering different recommendations. The most common advice from radiologists and breast surgeons is for an annual mammogram starting at the age of 40. For women with denser breast tissue, tomosynthesis (3D) mammography may be beneficial and/or consideration of screening breast ultrasound. Those women whose lifetime risk of breast cancer exceeds 20% would also be screened with annual MRI. Still, I find it helpful for women to have a general sense of what is normal for them. For instance, if a new breast lump is identified by a patient that does not go away within one menstrual cycle, it is worth exploring with at least an ultrasound.  In a postmenopausal woman, a new lump warrants diagnostic breast imaging including ultrasound.
  

Once breast cancer is detected, the next step to recovery is treatment. There are three main forms available: medications, radiation therapy and surgery. Which one or ones are right for you is dependent on the type and severity of the cancer. Medications used for breast cancer include chemotherapy agents, hormone blocking drugs like tamoxifen or aromatase inhibitors, and immunotherapy. The biology and behavior of the cancer tend to influence which drugs, if any, would work best for a particular cancer. With radiation therapy, doctors take into account a patient’s age, surgery performed, and pathology characteristics to assess whether radiation is indicated, and if so, what course might be best suited for the patient. Breast surgery procedures range from lumpectomy, which conserves breast tissue, to mastectomy, which removes the majority but not all of the breast tissue. In determining which surgery is best for an individual, several factors are taken into consideration, including the size and location of the cancer, personal and family history, and the patient’s personal preferences. More and more women are benefiting from the use of oncoplastic surgery, where oncologic principles of taking out cancer with, ideally, widely clear margins, are combined with plastic surgery closure techniques. Oncoplastic breast conserving procedures and mastectomy reconstruction options have really revolutionized breast surgery, allowing women to boost their self-confidence and feel more like their usual selves. 

Reconstruction is an option for the vast majority of patients undergoing mastectomy and allows women to retain a natural, feminine appearance after surgery. Two main forms of reconstruction are available: reconstruction with implants and reconstruction with tissue. Reconstruction with implants is the most common technique used in breast reconstruction. It often involves the initial placement of a tissue expander to maximize the ability of the skin to heal, while allowing flexibility in the size of the reconstructed breast, followed by later removal and replacement with a formal implant. Some women may prefer to use their own tissue for reconstruction. In this case, tissue is taken from another part of the body, most commonly the abdomen or the back, and transferred to the mastectomy site, creating a natural texture to the reconstructed breast. 
The thought of being diagnosed with breast cancer can be frightening. Fortunately, great strides have been made in breast cancer research, and new technologies help women get back to their normal lives more quickly. 

For more information on breast cancer imaging, treatment and diagnosis, visit breastlink.com. 


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