By: Denise Johnson Miller, MD, medical director of breast surgery, El Camino Health
Except for skin cancer, breast cancer is the most common cancer in adult women in the United States. But new innovations give us new hope. Improved testing and screening methods are helping doctors detect cancer in earlier stages than ever before – when it is most treatable. More precise treatments are reducing side effects. Specialty-trained surgeons are using innovative techniques to conserve a woman's breast or reconstruct her breasts to achieve a more natural look after treatment.
Read on to learn how we're helping more women with cancer live longer, feel better and look better, too.
New Ways to Screen and Diagnose Breast Cancer
According to the National Cancer Institute, about 50% of women have dense or extremely dense breasts that contain lots of fibrous and connective tissue. Traditional 2D mammography does not always spot cancer that forms within this dense breast tissue. For this reason, we now advise most women to get 3D screening mammograms, also called 3D tomosynthesis.
3D Mammogram Screening
A 3D mammogram takes many low-dose, X-ray images – at many more angles than 2D mammograms. Radiologists are able to get a better look inside the breast tissue, increasing the likelihood of spotting breast abnormalities or cancer.
Automated Breast Ultrasound (ABUS)
If you have extremely dense breasts, we may advise another screening tool in addition to the 3D mammogram. It's called automated breast ultrasound or ABUS, and it uses sound waves to create vivid images of the entire breast. ABUS helps doctors detect anything that may be abnormal within the breast, including very hard-to-detect masses hidden within dense tissue.
Breast MRI – Magnetic Resonance Imaging
If we know you have a high risk of breast cancer – due to genetic testing or your family or personal history – we may recommend breast MRI in addition to regular screening. The MRI creates detailed pictures of the breast using powerful magnets with minimal radiation exposure. Another positive development is that more insurance companies are now covering advanced breast screening techniques. I recommend that you check your plan for your specific coverage.
New, Better Ways to Calculate Your Risk
We're also getting better at calculating your estimated 10-year and lifetime risk for breast cancer. To determine if you have a higher-than-normal risk, it's important to understand your family history.
Your risk of breast cancer is greater if your mother, father, brother or sister has had cancer. A family history of any type of cancer – breast cancer, ovarian cancer, colon cancer, gastrointestinal tumors, skin cancer, pancreatic cancer – puts you at greater risk.
Other personal factors that can increase your risk for breast cancer include:
- Being overweight or obese
- Age – being in the postmenopausal period of life
- Drinking excessive amounts of alcohol – three or more drinks per week can increase risk by 15%
- Sedentary lifestyle
To calculate breast cancer risk, researchers have created comprehensive models and algorithms – such as the Tyrer-Cuzick and the Gail models. We enter data into these models, including your family cancer history, personal health information, body mass index (BMI), lifestyle habits, genetic testing results and past biopsy results.
Then, these models estimate your risk of developing breast cancer within 10 years and over the course of your lifetime. With this information, your healthcare provider can design a personalized breast health plan and screening recommendations.
Ask your primary care doctor to order a breast cancer risk assessment test – especially if you have:
- Dense breast tissue
- A strong family cancer history (Your risk for breast cancer is higher if your first-degree relatives – parent, brother, sister or child – or other extended family members have had either breast or ovarian cancer, especially if the diagnosis was made at an earlier age than average onset.)
- Prior breast biopsies that showed an overgrowth of cells within the breast glands or ducts that are stated to be "atypical" on the pathology report
If you discover you're at risk for breast cancer, talk with your doctor about using the breast MRI or other advanced screening tools – in addition to the 3D mammogram and ABUS – to check for cancer.
New, Less Invasive Ways to Locate Tumors for Removal
When doctors need to remove a suspicious area of your breast, they now have less invasive options. In the past, they inserted a guidewire into the breast to find the exact location of the lump. Now they can use radioactive seeds or tiny radar devices that allow them to find the lump and save as much healthy breast tissue as possible. They work like this:
Radioactive Seeds and Magnetic Pellets
A radiologist inserts a tiny radioactive seed or magnetic pellet into the suspicious breast tissue. The surgeon uses a handheld device that detects the radiation or magnetic fields and locates the tumor that needs to be biopsied. No guidewire is needed.
Radar Devices Locate Tumors and Target Tissue
Another innovation is a system called SAVI SCOUT® that helps doctors locate and remove breast lesions. Using a special needle, the radiologist inserts a tiny radar reflector into the breast lump. Later, the surgeon places a guide device over the breast, which activates the antenna on the radar reflector inside. It works somewhat like a Geiger counter, making a sound that increases in volume and cadence as it gets closer to the targeted lesion.
Doctors use these reflectors to mark the precise site where they need to remove tissue – for a biopsy, a lumpectomy or lymph node removal. Other companies make similar devices, and are commercially available. At El Camino Health, we use the SAVI SCOUT® system, and we have intraoperative imaging that confirms that we removed the abnormality, biopsy clip and the SCOUT reflector at the time of surgery.
New Genetic Testing Guidelines Improve Cancer Care
If you are diagnosed with breast cancer, the American Society of Breast Surgeons now highly recommends that you undergo genetic testing. This can be done by testing your blood or saliva. One in eight women has a gene that increases the lifetime risk of breast cancer and other cancers, too. If testing reveals that you have this gene, you can discuss the results with your doctor or oncologist.
Genetic test results can help you make better decisions about your treatment and future screening tests. For example, some women, who have genetic mutations that increase the risk of breast and ovarian cancers, may decide to take preventive measures. They may have a mastectomy or bilateral ovary and fallopian tube removal as a way to reduce their chance of developing cancer in the future. Your doctor may also recommend more frequent breast screenings, pelvic exams, colonoscopies and skin cancer checks.
New Approaches to Determine if Chemotherapy is Necessary for Hormone-Sensitive Breast Cancers
The most commonly diagnosed breast cancers, particularly in post- and perimenopausal women, are hormone-sensitive breast cancers. Specifically, these cancers have an overexpression of estrogen and progesterone, without overexpression of another common receptor called HER2/neu. (HER2/neu is a protein involved in normal cell growth.)
In the past, if your breast cancer was invasive, we typically prescribed chemotherapy plus anti-estrogen therapy. That recommendation changed based on decades of research and clinical trials. Now, we do a gene test called Oncotype DX to analyze the sample of a cancer tumor and help us decide which patients will benefit from chemotherapy. We’ve found that only approximately one-third of women who have early-stage breast cancer with three or fewer nodes positive for cancer really require chemotherapy. They still get anti-estrogen therapy, but not chemo.
Your provider uses this information to make a personalized treatment plan for you. Other genomic tests, such as MammaPrint®, also determine whether chemotherapy would benefit a patient versus endocrine therapy alone. This is a huge innovation and makes a world of difference for the patient.
Precise Drug Treatments and Precision Radiation
Today, new immunotherapy drugs target and boost certain cells in the body to help the immune system fight the breast cancer cells or find and destroy them. El Camino Health oncologists are well-versed in these agents. Additionally, we are opening international phase III treatment trials using these agents for breast cancer patients.
Radiation treatments are becoming more precise, too. Newer methods focus radiation treatment on the lumpectomy site greatly reducing the dose to the skin and normal breast tissue. Respiratory 'gating' techniques enable doctors to avoid dose to the heart and lungs.
With these targeted therapies, many women with breast cancer experience far fewer side effects, live longer and enjoy a better quality of life than they would otherwise.
El Camino Health's state-of-the-art radiation oncology department is ramping up to participate in several new, innovative breast cancer treatment trials.
New Ways to Preserve Breast Tissue or Reconstruct the Breast
Naturally, many women wonder what their breasts will look like after cancer treatment. Today we offer more options for breast-conserving surgery than anyone imagined a decade ago. Our goal is to remove the cancer and leave as much normal tissue as possible – even if the cancerous lump is very large or in a hard-to-reach location. To achieve this, our fellowship-trained cancer surgeons work closely with plastic and reconstruction surgeons. We have techniques that help result in breasts that look uniform in size and shape, even after cancer surgery. And this is important to know: Procedures to improve breast symmetry and shape after cancer surgery and radiation are covered by insurance. Please check your plan for details.
New Options After Mastectomy
If you decide to have a total mastectomy, you also have new options to reconstruct the breast. For example, specially trained surgeons can reconstruct a natural-looking breast mound using fat from the lower abdomen. This is just one of the advanced methods we offer.
Another technique is 3D tattooing of the nipple. Several months after breast reconstruction, skilled surgeons or other professionals can use color pigments to create the look of a natural nipple and areola.
If you are interested in breast-conserving surgery, explore your options to see if you are a good candidate. Ask your doctor for recommendations for qualified plastic surgeons. In many cases, insurance covers the cancer treatment, plus the plastic surgery. Again, check your specific plan.
New Ways to Prevent and Treat Lymphedema
Some women with cancer develop lymphedema, swelling in various parts of the body. The prevalence of chronic lymphedema is low in early breast cancer after treatments. In the last decade, we've taken major steps to prevent lymphedema. New surgical techniques can reduce the occurrence of lymphedema. We can also make early referrals to physical therapy and encourage patients to do certain arm exercises to minimize discomfort. Before surgery, you can discuss these options with your oncology providers.
New Advances; New Hope for the Future
Our overall message for women: If you notice any skin changes, nipple discharge or a breast mass, don't be afraid to see your primary care doctor or gynecologist for a breast exam. We have better techniques to catch breast cancer in its earliest stages. We also have new treatment approaches to help you fight the disease and novel techniques to help you feel good and be confident with your appearance afterward.
To find a primary care doctor or cancer care specialist, visit us at elcaminohealth.org/doctors. To make an appointment for a breast cancer screening, contact the Women's Imaging Center at El Camino Health.
This article first appeared in the October 2022 edition of the HealthPerks newsletter.