Treating Breast Cancer as a Chronic Disease
by Dr. Julia Lawrence
The new federal guidelines on mammograms for women in their 40s, which were released late 2010, left a lot of women more confused and frightened about their health than ever.
So let me see if I can clarify the recommendations and most importantly offer some much needed reassurance.
Until recently, the standard in medical care called for women to get an annual mammogram after age 40. We all knew that mammograms couldn’t catch every case, but we also knew that early detection gave women with breast cancer the very best shot at survival.
Mammograms are more reliable in older women than in women in their 40s because younger women have denser breast tissue which can conceal malignancies. So late last year, the U.S. Preventive Services Task Force, an independent panel of physicians, said that women should wait until their 50s to start regular mammograms, and then have them only every other year.
The recommendation was based on solid science. Studies show that about half of women in their 40s have at least one false positive result from a mammogram and that mammograms on younger women often fail to detect a cancer. So why spend all that money on a less than perfect test? I still recommend annual mammograms for women in their 40s -- and so do many other physicians --because early detection is still the best bet against cancer. And I’m glad that so far insurance companies have agreed to pay for these tests, even if they are less than perfect. But my advice comes with a caveat. A clear mammogram, especially in a younger woman, doesn’t mean she won’t find a lump a month from now.
While more women are likely to die of heart disease than breast cancer, breast cancer remains the disease most feared by women. I’ve been working with breast cancer patients for more than 20 years and I still can’t tell you why that is. Maybe it’s because so many women know someone afflicted early in life with breast cancer. And it’s a disease that affects women in a place that so defines us.
I can put some of your fears to rest. The good news is that a diagnosis of breast cancer is no longer the death sentence it once was – even in cases of metastatic cancer, where the cancer has spread to the bone, the brain or the lungs.
With the advances in treatment options, metastatic cancer can be managed much like other chronic diseases.
Most patients with metastatic breast cancer come to me terrified.
They’ve already seen a surgeon. Or they’ve survived and now the cancer has returned. And they are afraid they will die. Here’s what I tell them: “I don’t want you to devote your life to fighting cancer. That’s my job. I want you to devote your life to the things you love. Your job. Your family. Your passion.”
Here are the facts. Each year about 190,000 new cases of breast cancer are diagnosed. In about 10 percent of those new cases, the cancer has spread or metastasized. The other cases of metastatic breast cancer are among women who suffer a recurrence. Yes, about 40,000 women die of breast cancer each year, but think of the more than 2 million breast cancer survivors living in the United States.
When I started in oncology, treatment for breast cancer was often as damaging as the disease. We gave massive doses of chemotherapy, leaving our patients sick and exhausted. And we didn’t know how to target specific forms of breast cancer, or even diagnose them. Today, we have all sorts of drugs and protocols and more on the way. Breast cancer disrupts my patients’ lives, but it doesn’t define them.
I still treat patients with chemotherapy, but in lower doses and with fewer side effects. Some forms of breast cancer respond to drugs that block estrogen and other hormones. These estrogen blockers have even fewer side effects than low-dose chemotherapy. About 20 percent of metastatic breast cancers respond to a drug called Herceptin, which works by blocking a gene associated with certain forms of cancer.
The textbooks still say that women with metastatic breast cancer have a life expectancy of between two and five years. But I have many patients who have been living with metastatic cancer for 20 years. And each year brings new treatments. My own research focuses on breast cancers that are resistant to estrogen blockers and Herceptin. I’m also involved in research to help breast cancer survivors live fuller lives. Some women say that they don’t think as clearly after chemotherapy. They call it “chemo brain.” And many report general fatigue. I can help with these conditions, too.
I am amazed by the strength and resilience of my patients. Women often ask me, “What would you do if you had this disease?” And I say, “Until I’m in your seat, I don’t know.” But I like to think that as their physician I can offer relief and the promise of a balanced life – even with cancer.
Dr. Julia Lawrence is a board-certified internal medicine specialist and an assistant professor in hematology and oncology at the Comprehensive Cancer Center at Wake Forest Baptist Medical Center.
Learn more about the research efforts at the Comprehensive Cancer Center.