The number of breast cancer survivors has in-creased thanks to medical advances, but early detection also plays an important role.

By Don Vaughan

Rebekah Repper owes her life to a progressive medical practice that suggested she get her baseline mammogram at age 35 rather than age 40, as is typically recommended. The exam, which Repper admits she had done so she wouldn’t have to worry about it for another five years, revealed ductal carcinoma in situ, a precursor lesion that progresses to invasive cancer. It was a dire diagnosis that required immediate intervention. ■ Nearly a decade ago, Repper underwent a mastectomy that left a scar from her sternum to her armpit. But there was also some good news: Because her cancer had not spread to surrounding tissue, she did not need chemotherapy. In December 2005, Repper celebrated her seventh year as a breast cancer survivor. The experience, she says, has made her an advocate of early baseline screenings. “If my doctor’s office had not suggested early baseline pictures, my results could have been very different,” Repper notes. “I have been very vocal with my women friends in encouraging them to get mammograms.”

An estimated 200,000 new cases of breast cancer are diagnosed in the United States every year. But thanks to ongoing medical advances, the disease is being treated earlier and better than ever before, doctors report.

Risk factors

A variety of factors can increase a woman’s breast cancer risk, notes Dr. Marisa Weiss, a breast cancer oncologist in Philadelphia and president and founder of www.breastcancer.org. One of the biggest factors is age — the older a woman becomes, the greater her risk of developing the disease. From birth through age 39, a woman’s statistical risk is approximately 1 in 231. From ages 40-59, the chance is 1 in 25. And from age 60 through 79, it’s 1 in 15.

Other risk factors include:

■ Family history. A strong family history of breast cancer may be a result of an inherited gene abnormality. Most inherited cases of breast cancer are associated with two specific genes: BRCA–1 and BRCA–2.

■ Menstrual history. The early onset of menstruation and the late onset of menopause are both believed to increase a woman’s chances of developing breast cancer because they add years of exposure to estrogen and other cancer-stimulating hormones, Weiss notes.

■ Late pregnancy. Women who have their first full-term pregnancy after age 30 or who never become pregnant are at higher risk for breast cancer than those who give birth earlier in life.

■ Race. After age 40, breast cancer is more common among white women than black, Asian, or Latina women. However, among women 40 and younger, black women have the highest risk, Weiss says.

■ Breast density. Research has shown that women with “dense” breasts (i.e., whose breasts contain less fat tissue) are more likely to develop breast cancer than women with less dense breasts.

According to Dr. Sharon Giordano, one of the nation’s leading experts on breast cancer, “These are all factors that women cannot prevent. The one potentially preventable risk factor would be receiving hormone replacement therapy after menopause, which is known to increase the risk of developing breast cancer.”

Early detection

Screening mammography is considered one of the most effective tools in the detection of breast cancer in its earliest stages. “Mammography can detect breast cancer before a woman can even feel a lump in her breast,” says Dr. Maura Dickler, assistant professor in the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York. “Sometimes it detects calcifications in breast tissue, which can alert a doctor to the fact that there may be breast cancer lurking in the background.”

Ultrasounds and MRIs also are effective detection tools, though the latter is used almost exclusively on women who are at the highest risk, such as those with family history of cancer. “We don’t use MRI more often because the false positive rate is 20 percent to 30 percent,” Dickler explains.

Breast self-examination is another good weapon in the detection arsenal, adds Giordano. Women are encouraged to examine their breasts on a regular basis, preferably after their menstrual period. (See sidebar below.)

Treatment

In the past, doctors treated all breast cancer in pretty much the same fashion; first with surgery, then with follow-up radiation therapy or chemotherapy as needed. But treatment now is highly individualized and usually based on the type and “personality” of the cancer, its size and stage of development, and the patient’s risk of recurrence.

“Treatment tends to be mix-and-match,” says Giordano. “All patients need surgery. Some women will also require radiation. And after that, hormone therapy is probably the most commonly prescribed treatment.”

Indeed, hormone therapy has proved to be a godsend for the 50 percent to 70 percent of women who develop estrogen receptor- or progesterone receptor-positive tumors, notes Dickler.

“These types of cancers can be treated with surgery and radiation as appropriate for local therapy, but we prefer hormone therapy for systemic treatment,” she explains. “This involves the use of estrogen antagonizers such as tamoxifen and, more recently, aromatase inhibitors such as letrozole and anastrozole, which lower estrogen levels to starve the cancer cells.”

Another common type of breast cancer is HER2 positive cancer, which afflicts 20 percent to 25 percent of women who develop the disease. “HER2 is a growth-factor receptor that can be over-expressed on the surface of the breast cancer cell,” Dickler says. “A drug called Herceptin, which is a monoclonal antibody, targets the HER2 receptor and has been found to be very effective. Recent data has shown that Herceptin added to chemotherapy for early-stage breast cancer markedly reduces the risk of recurrence and improves overall survival.”

There is another type of breast cancer in which the patient is negative for both the estrogen/progesterone receptor and HER2. “We refer to those women as triple negatives,” Dickler says. “They tend to have an aggressive type of breast cancer, which we’re learning better how to treat.”

“Breast cancer is a very curable disease,” states Giordano. “Women diagnosed with early-stage breast cancer have excellent survival rates, and most go on to live normal, healthy lives.”