Action plans against breast cancer
By Chris Cunningham
For Register Guard Special Publications
Appeared in print: Friday, Oct. 14, 2011, page E20
SPRINGFIELD, Ore. -- In the early years of her medical career in the emergency room, ambulance drivers sometimes would carry in women with “breast cancers that were almost the size of the breast,” remembers Dr. Cathryn Chicola, a radiologist and director of women’s imaging at Oregon Imaging Centers.
Back then, “We just had industrial strength X-rays,” says Chicola. Breast imaging technologies such as mammograms and ultrasound were “virtually nonexistent.”
There were no public health campaigns that openly discussed breast health or that encouraged women to have mammograms. Even in the late ’70s and early ’80s, women “were afraid” to talk about discomfort and lumps in their breasts, Chicola says.
The lack of imaging technology often meant that a woman would have unnecessary surgery on a breast lump that was a noncancerous cyst, she says.
And, Dr. Christine Kollmorgen, a surgeon with Northwest Surgical Specialists, adds, “Back in the day, we used to take the whole breast, chest wall muscle and all (the) lymph nodes out of the armpit.”
It was a “horrible, traumatic surgery,” she concedes. “These poor patients didn’t know if they were going to wake up with their breast.”
She asks rhetorically, “Can you imagine that?”
Breast screening
It may be hard to imagine, now that all women in Lane County, regardless of economic status, have access to state-of-the-art screening technology, say Chicola and Kollmorgen, and two other local physicians — Drs. Winnie Henderson and Merideth Wendland — who work with cancer patients.
All four physicians say regular breast self-exams, beginning in early adulthood, and yearly mammograms, starting at age 40, are key to breast cancer prevention.
Death rates from breast cancer have been declining since 1990, which is a result both of earlier detection and improved treatment, according to the National Cancer Institute at the National Institutes of Health.
Unlike the earlier film mammography, digital mammography uses “detectors” that produce electronic images as pixels, a technology that allows Chicola to “zoom in and zoom out” of each patient’s mammograms, and to scrutinize every inch of the breast image.
The electronic images “show us things, particularly in dense breasts, which are the hardest to read, that we just didn’t see before,” Chicola says.
What’s more, digital mammography has one-third less radiation than conventional analog film screening, she says. “The risk of breast cancer induced by radiation is so much lower than the very real risk of getting breast cancer.”
According to the National Cancer Institute, 12.2 percent of women will receive a diagnosis of breast cancer sometime in their lifetime.
Surgical procedures
If a mammogram shows abnormal results, Chicola may use the high-frequency sound waves of ultrasound imaging for real-time displays of the inside of the breast.
Sometimes the ultrasound will show that a breast lump is a benign pocket of fluid, or a cyst. In that case, there is no need for a biopsy.
A biopsy, the removal of a sample of the woman’s breast cells, is the only way to tell if a suspicious area in the breast is benign or cancerous. A physician might order an MRI (magnetic resonance imaging) to assist with diagnosis if a patient has a personal or family history or another high risk factor for breast cancer.
Once a physician diagnoses breast cancer, the next step is to determine the size of the tumor and if and how far the cancer has spread, a process called staging. Stages 0 through 4 describe whether cancer is localized in the breast, has invaded nearby lymph nodes, or has spread to other organs, such as the lungs. Each stage determines the treatment a patient receives, including surgery, radiation therapy and chemotherapy.
Henderson, a surgeon at Northwest Surgical Specialists, says 75 to 80 percent of their breast cancer surgeries involve lumpectomies, a breast conserving surgery that removes the tumor and a small margin around it, while leaving the breast intact. These days, far fewer patients either need or choose mastectomies, in which the entire breast is removed.
She and her colleague Kollmorgen have been applying a new surgical technique called oncoplastic surgery to lumpectomies and mastectomies. During oncoplastic surgery, the surgeons remove the tumor, while a plastic surgeon cosmetically repairs the breast — during the same surgery.
Henderson says oncoplastic surgery eliminates a second surgery to improve the appearance of the breast.
Oncoplastic surgery “marries all the principles we know well from aesthetic surgery, with all the principles we know well from oncological surgery,” Kollmorgen says.
Henderson says, “Breasts are very personal to every female. And I think that breast surgeons are much more inclined to pay more attention to outcome of the surgery.”
Post-operative treatments
Radiation therapy significantly can decrease the risk of cancer returning after surgery, versus surgery alone, says Wendland, a radiation oncologist with Willamette Valley Cancer Institute and Research Center.
Women who undergo a lumpectomy or partial mastectomy “usually will receive radiation as part of the treatment course,” she says.
“To allow time for the body to heal after surgery,” Wendland says a woman typically will wait three to four weeks before starting radiation therapy, the high-energy rays that damage cancer cells and prevent them from growing and dividing. Sometimes a machine dispenses the radiation; other times the radiation is in substance form.
In recent years, radiation oncologists have been giving “larger doses of radiation with each treatment and delivering fewer treatments. The approach helps reduce the length of therapy,” Wendland says, and is appropriate for some cases, such as a patient with early stage breast cancer who has had a lumpectomy.
The patient’s medical oncologist also may recommend “systemic” treatments that destroy or kill cancer cells, including chemotherapy drugs, hormone therapy and biological therapy.
“Of course, once treatment is complete, close follow-up with regular breast exams and mammograms is of critical importance,” Wendland says.
Writer Chris Cunningham can be contacted at sp.feedback@registerguard.com.
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