Pensacola, Florida
Monday October 20th 2014

Follow the Blog

On Sale:

Archives

Closer to a Cure

Discussing recent advances in breast cancer treatment
By Jennifer Leigh

The reality is one out of every eight women in the United States will be diagnosed with breast cancer in her lifetime, and that the harrowing statistic hasn’t changed in the past year.

However, there is still much to be optimistic about. As the years go on, advances in breast cancer treatment and prevention continue to increase. In fact the American Cancer Society recently reported that the death rate of breast cancer has decreased 34 percent since 1990.

“I don’t think anyone believes they will get cancer, but the reality is that one out of eight women will be diagnosed with breast cancer,” said Dr. Nutan DeJoubner, oncology, Baptist Medical Group. “However, if detected early, the survival rate for invasive breast cancer is 98 percent.”

It’s difficult enough to fully digest the black and white facts of cancer, let alone try to make sense of all of the new studies and drugs. That’s when you seek the advice of a medical professional. The IN spoke with DeJoubner about some of the new advances in breast cancer treatment and prevention that have been making headlines in 2013.

Detection and Prevention

Studies continue to demonstrate that regular exercise and a healthy diet can reduce your risk of breast cancer, and research from recent studies describes why. Exercise changes the way the body handles estrogen, which then fuels breast cancer. A University of North Carolina study has found that just a few hours a week of physical activity can lower the risk of breast cancer—yet another reason to not skip out on the gym.

“We learn everyday how lifestyle choices can lead to breast cancer,” said DeJoubner.  “Obesity, diet and alcohol consumption are linked with higher estrogen production and increase the risk for breast cancer. However, these are relatively new discoveries.”

Early detection is key to beating breast cancer. By knowing your family history as well as your own body, you are one step ahead of the game.

This past summer, Angelina Jolie made headlines when she underwent a preventative mastectomy after learning she carried a mutation of the BRCA1 gene, which increases the risk of breast and ovarian cancers. It’s important for women to discuss their family history and risk factors with their primary physician, noted DeJoubner.

“Women should consider genetic testing if they have had a close relative — mother, sister, aunt, grandmother — who developed breast cancer prior to menopause,” DeJoubner said. “We offer genetic testing at Baptist and can help determine if the woman is a candidate. The National Cancer Institute also has an online tool [cancer.gov/bcrisktool].”

Mammograms have also come a long way in recent years thanks to technology. New in 2013 is tomosynthesis, a large word for 3D mammography, which provides a clearer, more accurate view allowing doctors to pinpoint any abnormalities.

“Tomosynthesis is breakthrough technology for women with dense breasts,” she explained. “Breast density is when the breast contains more glandular or fatty tissue. The denser the breast, the higher proportion of glandular tissue, which creates a higher risk for breast cancer. Dense breast tissue can also make it harder to see potential tumors on mammograms.”

Other screening options include a breast MRI for high-risk patients, individuals with a palpable mass or those who have had a previous diagnosis or surgical procedure. Baptist Hospital is the only healthcare provider in the area that provides 3D imaging, DeJoubner notes.

Scintimammography, or molecular breast imaging, may be used to supplement a mammography, but not replace it, DeJoubner said. During the test a radioactive fluid is injected into the vein and cancer cells light up. The test is only used at a few medical centers at this time, but there’s never any harm in asking your doctor about receiving the test.

Don’t forget the age-old self exam either.

“Woman should be familiar with their bodies and pay attention to any changes,” said DeJoubner. “When doing a self exam on your breasts, check for any lumps or thickening, discharge from the nipple, change in the shape of the breast or the nipple or any changes in the skin such as scaling or pitting. There are many things that mimic breast cancer, but the only way to be sure is to discuss any concerns with your physician and have routine mammograms based on your physician’s recommendations.”

Making Sense of Meds

Breast cancers are classified in categories by what encourages the tumor to grow. From there, oncologists determine the best treatment, DeJoubner said.

“About 75 percent of all breast cancers are estrogen receptor positive [ER+], meaning they grow in response to hormone estrogen,” she added. “Hormone therapy using anti-estrogen drugs are used to treat ER+ breast cancer.”

While medications such as tamoxin, or Nolvadex, have been used for more than 30 years to treat breast cancer by blocking estrogen receptors, it has recently been approved to use such anti-estrogen drugs as a preventative measure for women who are at high-risk for breast cancer, but use has been limited because of side effects.

“Newer types of drugs being used on ER+ cancers are called aromatase inhibitors,” explained DeJoubner. “Aromatase is an enzyme that changes hormones into estrogen. It lowers estrogen levels in the body, taking away the fuel that causes ER+ cancers to grow.”

Another new drug option may be Exemestane, which has been studied in the prevention of breast cancer in higher than normal risk women, may be an option in the future. Right now, however, it is still waiting for FDA approval.

In Treatment

On the treatment side, a new line of chemotherapy drugs, called “targeted therapies” deliver medicine directly to what is driving the cancer and eliminate the cancer cells without causing problems to normal cells, which means minimal side effects.

“Breast cancer research has been able to identify hormones and proteins that are linked to tumor growth,” explains DeJoubner. “Drugs like Herceptin and Kadcyla are examples of targeted therapies.”

While a cancer diagnosis leaves little time for women to worry about their looks, many women may not be comfortable with losing their hair and/or a breast.

“With a cancer diagnosis, physical, emotional and spiritual concerns need to be addressed,” said DeJoubner. “Body image changes associated with breast cancer can be short-term such as hair loss, or long term changes in how their breasts look. It is important for women to talk about their feelings and seek out resources.”

Some surgeries such as a lumpectomy or partial mastectomy provide some patients with the option to conserve their breast tissue.

“During surgery, after removal of the tumor, surgeons remove surrounding tissue and send it to the pathology lab for testing,” said DeJoubner. “This tissue testing determines if there are any remaining cancer cells.”

Advances in breast cancer treatment are working to take it a step further. The MarginProbe, while still in development, is a device that will allow surgeons to test tissue for cancer during surgery. This could reduce the need for more surgeries.

A new surgery term you might be hearing:  Oncoplastic surgery is for breast cancer patients who opt for plastic surgery after a mastectomy.

“Many women choose to have reconstructive or plastic surgery along with their breast cancer treatment,” DeJoubner said. “It is important that the woman communicates her goals with her physicians prior to treatment because the oncologist, general surgeon and plastic surgeon must all work together if reconstructive surgery is the goal.”

Another development is the DigniCap. Like the MarginProbe, the cap is still being tested. The DigniCap is a tightly-fitted cap filled with gel chilled to -15 to -40 Fahrenheit that patients wear for 20-50 minutes before, during and after chemotherapy treatment. DeJoubner says that studies using cold caps to prevent hair loss have been ongoing for years.

“Unfortunately, with some drugs, hair loss is just part of the treatment,” she said.

‘Education is Empowering’

Thanks to social media and the constant flow of information, Breast Cancer Awareness is everywhere. More than likely, it offers up more questions than answers, which doctors are more than happy to answer.

“Use trusted resources and discuss concerns with your physician,” advises DeJoubner.  “For online cancer resources, refer to credible sites such as the National Cancer Institute, cancer.gov, or the American Cancer Society at cancer.org.”

But there’s a purpose to all of the pink madness you see around you. It’s reminding women to be in charge of their health. Those bizarrely named events help local and national foundations raise funds that go toward cancer research and free mammograms to women who cannot afford them. Last year, 15,000 showed up for the Making Strides Against Breast Cancer event. The event raised $500,000 for the American Cancer Society.

“Education is empowering patients to get their screening and reducing the risk of developing breast cancer, by stopping smoking, eating healthy and being active,” said DeJoubner. “That is what the month of October is about, getting people more aware of the disease.”

NUTAN DEJOUBNER
BAPTIST HOSPITAL
WHERE: 1717 North E St. Tower 3, Suite 231 and 9400 University Pkwy. Suite 408 in Pensacola and 1114 Gulf Breeze Pkwy. in Gulf Breeze
DETAILS: 469-7975 or baptistmedicalgroup.org