Breast cancer a leading killer but detection improves

Wednesday , October 01, 2014 - 8:46 AM

Standard-Examiner correspondent

This year, approximately 1,440 Utah women will be diagnosed with breast cancer and 270 will die from the disease.

Nationally, 232,670 new cases of breast cancer are expected to be diagnosed among women and 40,430 breast cancer deaths are expected.

Breast cancer is also the second leading cause of cancer death in women, exceeded only by lung cancer, according to the American Cancer Society. The chance that breast cancer will be responsible for a woman’s death is about 1 in 36, or about 3 percent. At this time, there are more than 2.9 million breast cancer survivors in the United States.

Ogden Regional Medical Center women’s imaging director, Dr. Jose Perez-Tamayo said white women have the highest incidence of breast cancer. Under the age of 45, African American women have a higher incidence of breast cancer.

American Cancer Society spokesperson Eric Beikmann said since 1990, breast cancer death rates have decreased by about 34 percent. These decreases are believed to be the result of earlier detection through screening and increased awareness, as well as improved treatment.

“Early detection of breast cancer is a major factor in increasing a woman’s chance of survival,” Beikmann said. “The sooner it is found, the easier it can be to treat.”

Christi Layton, women’s imaging manager at McKay-Dee Hospital, said a mammogram is the most accurate and cost effective tool available in finding breast cancer.

“We cannot detect it if women don’t come in and get screened,” Layton said. “Utah continues to have the lowest screening rates in the country. The fears we hear the most include being embarrassed, not having time, not wanting to come to the hospital and that mammograms hurt.”

Layton said, the staff is very professional and all have mammograms themselves.

“So we know how to lessen embarrassment, we understand the discomfort and do our best not to hurt anyone during the procedure,” she said.

For women with dense breast tissue, an Automated Whole Breast ultrasound can be done in conjunction with a mammogram, Layton said. This test gives the radiologist a second look. A 3D Breast Tomosynthesis is also fairly new. TOMO is a mammogram using the same equipment with one significant difference. It takes several layered pictures of each breast. For those with dense breast tissue it can help detect a cancer when it is barely visible.

The hospital also uses radioactive seeds for breast localizations.

“Normally a patient who is having a localization for a suspicious lesion will come in by 7 in the morning and have wired places in her breast to help the surgeon locate the area of concern,” Layton said. “With radioactive seed, the placement of the seed can take place on a Monday or Tuesday, the patient can then leave the hospital and return for their surgery on a different day. This has been proven to be a very successful procedure and one that has increase patient satisfaction.”

The American Cancer Society recommends all women begin screenings at the age of 40 and continue to have them yearly. If a woman’s mother was diagnosed, screening should begin 10 years earlier than her mother’s diagnosis.

Dr. David Pennington, an obstetrician and gynecologist at Tanner Clinic, said new screening guidelines from the US Preventive Task Force recommend women wait until age 50 to start yearly mammograms. Their main focus was cost versus benefit of screening women age 40 to 50. They decided age 50 made more sense for the general population because of the low rate of cancers in the younger patient and the limitations of mammogram in younger breasts.

“Most other institutions that produce screening guidelines have not followed suit and still recommend mammograms yearly or every other year starting at age 40,” Pennington said. “Breast cancers in a younger patient can be more aggressive and have a higher likelihood of being related to an abnormal gene like BRCA.”

BRCA gene mutation testing is becoming more available at a cheaper price after a recent Supreme Court ruling that will allow companies other than Myriad Genetics of Salt Lake City to offer BRCA testing. Pennington said the Supreme Court ruled that genes cannot be patented and this gives many other companies the opportunity to offer genetic testing that was previously owned by only one company.

“This is good for patients because it should push the price of genetic testing down and allow more insurance to cover the costs. This gene is one of the best predictors of early and aggressive breast or ovarian cancer,” Pennington said.

Multi-gene testing panels are reaching the market now and more are to come, Pennington said. Myriad Genetics just released a “My Risk” panel of 25 genes which includes BRCA and many other genes. This gives patients who might test negative for BRCA a deeper analysis to why they might have developed their cancer or give better information to a patient who has several cancers in her family of what she might expect and precautions she might take to decrease her risk of future cancer.

Back to the topic of mammograms: A study published in the British Medical Journal found that mammograms may not cut mortality risk. The 25-year study period showed 3,250 women in the mammogram group and 3,133 in the control group were diagnosed with breast cancer. The number who died were almost identical: 500 women in the mammogram group, compared to 505 in the control group. Authors of the study also concluded one in five of the breast cancer diagnoses made from mammogram screening were over-diagnoses. In other words, if these tumors had never been detected they never would have caused health problems nor would they have required treatment.

“Younger women have more normal lumps and bumps in their breasts. This produces more interventions for benign problems, so early mammograms, early doctor’s clinical breast exams and self-breast exams may lead to unnecessary tests and procedures which may cause more harm than good,” Pennington said. “A good strategy is to always know your own breasts and if things change and don’t go away, bring it to the attention of your doctor.”

Dr. Sheila Garvey, a general surgeon and breast cancer specialist at Ogden Clinic, said most breast cancers are diagnosed by biopsies. Only about 20 percent by breast biopsies are positive.

“If your mammogram shows potential cancer, you cannot be officially diagnosed without a biopsy,” she said. “If cancer is found you will be grateful you did it. I know that talking about cancer is scary but knowing your body and taking an active role in your health is the best thing you can do. Technology, including digital mammography, ultrasound and needle biopsy is enabling earlier and earlier detection and treatment. Just as important is your part in making regular screenings a priority and talking with your doctor.”

Garvey said when she began treating breast cancer in patients in 1998 she was diagnosing 1 in 13 women. Today she is diagnosing 1 in 8.

“It’s not because breast cancer is more common. It’s because we have gotten better at finding it. When breast cancer is diagnosed at an earlier state it has a much better survival rate,” Garvey said.

Garvey said a self breast exam is very important. Women should begin doing them in their 20s and continue each month.

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