Nearly 5,000 women are newly diagnosed with breast cancer every week in the United States. Despite the astounding number of women diagnosed, early stage breast cancer is a highly treatable disease from which many patients can confidently expect to be cured. There have been major advances in our understanding of the biology of breast cancer within the past three decades, and as a result, breast cancer treatment has become much more precise and effective.
The old paradigm
Historically, surgery was always the first option for women with breast cancer. Once diagnosed, a patient was immediately referred to a surgeon who typically performed a mastectomy to remove the entire breast. However, more recently, mastectomy has been replaced by breast conserving surgery.
Following surgical treatment, the patient was generally referred for appropriate drug treatment (chemotherapy and/or endocrine therapy) and often radiation. This anatomically based approach of surgery, followed by whatever additional treatment modalities were indicated, has been largely replaced by a new paradigm, where the biology of the cancer is recognized to be of great importance.
The new paradigm
The old paradigm was based on the question, “What is the stage of the cancer?” However, the new paradigm asks the question, “What is the biologic type of cancer we are dealing with?” Based on genomic studies, we now recognize there are different molecular sub-types of cancer. Each has a different prognosis and a unique responsiveness to specific medical treatments.
It is important to note that all relevant clinical staging information can be obtained from imaging studies before surgery, and all relevant biologic information can be gathered (from a core needle biopsy) before any treatment is instituted. It is, therefore, no longer appropriate to automatically send every newly-diagnosed breast cancer patient to a surgeon for primary surgical treatment. Instead, every patient should meet with a surgeon AND a medical oncologist, and often a radiation oncologist prior to beginning any treatment, to gain a comprehensive understanding of her individual cancer and determine the appropriate course of treatment.
Surgery, drug treatment and radiation remain the major treatment modalities, but their sequencing depends on the specific details of each patient’s individual disease. We are now living in the era of personalized cancer care. It is no longer one size fits all. Each and every patient deserves a detailed evaluation and explanation, not only of their recommended treatment plan, but also the reasons and rationale for that plan.
What you can do
As an oncologist, I strongly encourage every woman to understand their risks for developing breast cancer and familiarize themselves with their family medical history. It’s equally important for women to familiarize themselves with how their breasts feel and report any changes promptly. I also recommend regular mammograms after the age of 40. Breast cancer can happen to anyone—regardless of age, ethnicity or gender—so women of any age should seek medical attention if they feel a lump or other abnormality in their breast.
I want to emphasize the importance of early diagnosis. Despite all of the publicity regarding breast cancer, it has been my experience that even today, many women still delay reporting a breast lump to their doctors. In a study I recently reported, one out of every 10 women who felt a cancerous lump in her breast delayed seeking medical advice for a year. Typically, this delay was caused by fear. But as breast cancer is highly curable at an early stage, it is important that you don’t delay!
Take control of your health and don’t be afraid to get a second opinion if desired. Just like the title of my book Knowledge Is Power: What Every Woman Should Know about Breast Cancer indicates, our greatest weapon against breast cancer is education. Empower yourself with the knowledge of the different types of cancer and the new paradigm of breast cancer treatment available, that offers patients a more targeted and precise approach.
This post is sponsored by Cancer Treatment Centers of America.