When it comes to the prevention and treatment of localized and metastatic breast cancer, a lot has changed in recent years.
Medical oncologist Mark Marinella said in the past two decades he’s seen changes ranging from the importance of lifestyle choices to screening options and a new emphasis on targeted treatment. Marinella is with the Dayton Physicians Network with offices in the Miami Valley South Campus Comprehensive Cancer Center.
“The biggest news when it comes to localized breast cancer confined to the breast and lymph nodes under the arms is Perjata, a medication being used before surgery in women with HER2 positive breast cancer,” he explained. “The new drug is being used in combination with Herceptiin, which has been out for more than a decade. Because it is only approved before surgery, it’s important for women to see their oncologist before having surgery.”
When it comes to survival rates, Marinella said, studies have shown there is no difference between lumpectomy and mastectomy with radiation. For Stage 4 metastatic cancer, there are many new options.
“Most changes are targeted and oral therapies; a few new oral agents have been recently approved for Stage 4 estrogen-receptor positive metastatic cancer,” he said, adding that there have not been major major changes in chemotherapy which still plays an important role in treatment.
As for prevention, Marinella said diet has been shown to play a role to some degree. “A study just published in Europe last month showed an inverse relationship between the consumption of olive oil and development of breast cancer. It’s a good idea to limit saturated fat and to eat as much plant-based food as possible — seeds, nuts, olive oil.”
The latest news on alcohol, he said, is that no more than one glass a day is probably safe, especially if it’s red wine. “There is higher risk with excess alcohol consumption and it’s to be avoided for those who are actively getting chemotherapy. Exercise does decrease the risk of breast cancer, probably because of weight loss. And for women who have had estrogen-positive breast cancer — especially post-menopausal — exercise and weight loss have been known to decrease the risk of recurrence. And, avoid smoking, of course.
There are varying opinions on the importance of self-examination. “I think it’s a good idea although most cancers are not picked up by self-exams,” Marinella said. “But when you do what I do, you meet a fair amount of women who found their own lumps. And there are no side effects, it’s not going to hurt. And it increases awareness.”
A woman who wants to be proactive, he concluded, should ask about clinical trials in our area, educate herself through reputable web sites such as WebMD.com and investigate resources such as The Noble Circle and Pink Ladies organizations.
On these pages, we share thoughts from a variety of other medical experts in our area.
Early breast cancer detection is the key to improving the chances for a patient’s successful treatment and survival. Patients should confer with their physician and discuss the benefit of supplemental screening tools such as Automated Whole Breast Ultrasound. This leading edge technology helps us detect small cancers, especially in patients with dense breast tissue, which accounts for about 50 percent of all women. Basically, Automated Whole Breast Ultrasound lets us look for a needle in a haystack, if there is one. — Dr. Jennifer Daniels, Medical Director of the Ohio Valley Breast Center, General Surgeon and Breast Specialist, Springfield
I have the privilege of holding the hands of my patients and helping guide them through the beginning of their breast cancer journey. Not only am I a breast care health professional, but I have been personally touched by breast cancer. My mother has battled it twice and my aunt, uncle and grandmother had breast cancer. As a Nurse Navigator, I help patients and their families with their medical and emotional needs. I am with my patients before their biopsy, during the biopsy procedure and often share their diagnosis with them. I also go with patients on their day of surgery. — Amanda Bowsman, Ohio Valley Nurse Navigator and Breast Care Coordinator, Springfield
As a health care professional, I help patients understand their health insurance and medical bills. We all know how confusing that can be! Outside of work, I have dedicated myself to erasing cancer by working with the American Cancer Society and ‘Making Strides Against Breast Cancer.’ I lost one daughter to breast cancer and my other daughter is a breast cancer survivor. In addition to working through formal organizations, I knit and sell pink scarves; organize a Wall of Hope at Ohio Valley Surgical Hospital every October, organize chili cook-offs at work and sell pink bracelets. My advice is to be optimistic and positive and keep smiling. This journey is what you make it and I have chosen to travel through it with hope and faith.” — Janice Gaines, Ohio Valley Surgical Hospital Insurance and Billing Specialist, Springfield
I was diagnosed with breast cancer in June of this year and I am living proof that early detection can result in a more favorable outcome. Breast cancer typically produces no symptoms when the tumor is small and most easily cured. Therefore, it is very important for women to follow recommended screening guidelines for detecting breast cancer at an early stage. When breast cancer has grown to a size that can be felt, the most common physical sign is a painless lump.
Sometimes breast cancer can spread to underarm lymph nodes and cause a lump or swelling, even before the original breast tumor is large enough to be felt. Less common signs and symptoms include breast pain or heaviness; persistent changes to the breast, such as swelling, thickening, or redness of the breast’s skin; and nipple abnormalities such as spontaneous discharge (especially if bloody), erosion, inversion, or tenderness. It is important to note that pain (or lack thereof) does not indicate the presence or the absence of breast cancer. Any persistent abnormality in the breast should be evaluated by a physician as soon as possible. — Christie Banford, Clinical Manager, Medical/Surgical & Oncology Nursing Unit, Atrium Medical Center, Middletown
New mammography options
An advanced form of mammography available in the Dayton region finds more invasive breast cancers, studies show, and may reduce callbacks for additional images. Three-dimensional (3D) mammography, also called tomosynthesis, enables radiologists to get a clearer image of breast tissue. As a result, they’re more likely to detect breast cancer at its earliest stage, when it’s most treatable.
In 3D mammography, imaging equipment moves in a slight arc over the breast, taking multiple images of the breast from several angles to form a 3D image. This can result in finding cancers that might be missed with traditional 2D mammography, where images are taken from the top and side of the breast to produce a flat image.
3D mammography is appropriate for most women undergoing a standard mammogram. It’s available at nearly all Premier Health breast centers. — Dr. Michael Gelbart, radiologist and medical director of Medical Imaging, Upper Valley Medical Center, Troy
Finding a doctor
If you are diagnosed with breast cancer, seek care with a provider that’s dedicated to a patient-centered approach composed of a team that supports your needs. Navigators provide specialized and individualized care, education, support, resources and encouragement, and can connect patients and their families to necessary resources. — Rae Norrod, Manager, Oncology Service Line, Oncology Clinical Nurse Specialist, Kettering Health Network
The Importance of Nutrition
Although every patient has individual needs, good nutrition is a major factor in the prevention and treatment of breast cancer. While going through treatment, good nutrition will help give you the strength and stamina you need to get through the fight, and provide the body with the nutrients that it needs.
Be sure to eat a variety of foods with a focus on fresh fruits and vegetables which provide vitamins and minerals that are important for strengthening your immune system to fight off infections. Lean proteins from both lean meats and plant-based proteins such as beans and nuts will help your body rebuild tissues that have been damaged by treatments or surgeries. There is also clear evidence in recent research that maintaining a healthy weight during breast cancer treatment leads to better recovery outcomes and a reduced risk of recurrence.
Reducing the intake of processed packaged foods, cured meats and alcohol has also been found to be important for both the prevention of many cancers and the reduced risk for recurrence. — Carla Metzler, Registered Dietitian Nutritionist, Licensed Dietitian, Fort Hamilton Hospital
On Clinical Trials
Kettering Health Network is conducting a breast cancer study to compare two different FDA approved drugs used to guide the surgeon during breast cancer surgery to aid in identification of the sentinel node(s), which is the most likely lymph node or group of nodes that tells us if the cancer has spread beyond the breast.
Patients have been very receptive in participating to help us learn more about the sensitivity and accuracy of these two agents in understanding the lymphatic pathway the cancer may have traveled. This is known as lymphatic mapping and it is critically important in making a precise diagnosis. — Suzanne Coleman, Network Director, Innovation, Research & Grants, Kettering Health Network
New radiation treatment options
In treating women who have cancer in the left breast, we use a state-of-the-art radiation technique called respiratory gating that synchronizes the delivery of radiation to the part of a woman’s breathing cycle when her breast is farthest away from her heart. This allows us to deliver precision radiotherapy that eliminates any significant radiation dose to a woman’s heart, thus substantially decreasing her risk of cardiac complications in the future..
The Versa HD, currently the fastest linear accelerator in the country, allows us to deliver pinpoint radiation with sub-millimeter accuracy to breast cancer that has spread with greater than 90 percent control rates. Typically patients have 3-5 treatments which take under 15 minutes and less than 10 percent of patients have any significant side effects. — Dr. Douglas B. Einstein, Medical Director and Chairman of Radiation Oncology, Kettering Health Network
Specialty garments covered by insurance
Every day I hear from women at all stages of their breast cancer journey who are not aware of the insurance benefits they have related to breast forms (prostheses), specialty bras, and compression garments. Under the Women’s Health and Cancer Rights Act, women who have undergone a mastectomy, lumpectomy or reconstruction have the right to prostheses, and treatment of physical complications of the mastectomy, including lymphedema.
At our Expressions of Hope retail locations at Miami Valley Hospital South and Good Samaritan North Health Center, we have certified fitters highly qualified to work with women and help restore their symmetry needs after a lumpectomy, mastectomy or reconstruction. — Sandy M. Nickley, Manager, Expressions of Hope, Fidelity Health Care
Studies show that the more convenient it is to get a mammogram, the more likely women are to schedule one.
A new mobile mammography coach from Premier Health and Atrium Medical Center is traveling to businesses and public venues like schools, churches and events. The mammography coach offers traditional 2-dimensional and new 3-dimensional mammography.
The mobile coach has a reception area, private dressing room and mammography suite. It’s staffed by an all-female team. Women make an appointment and visit a location near them. No doctor’s order is needed for a screening mammogram for women age 40 and older. To schedule a mobile mammography appointment, call (844) 453-4199. — Dr. John Weske, radiologist and medical director of medical imaging at Atrium Medical Center, Middletown
Dense breast tissue can hide breast abnormalities on a mammogram. Now, by Ohio law, women who have a mammogram must be notified by their breast imaging center if the exam reveals they have dense breast tissue.
A technology called Automated Whole Breast Ultrasound (AWBUS), when used with screening mammography, can find more cancers in women with dense breast tissue than mammography alone. The AWBUS exam is painless, safe and done without breast compression. It uses sound waves to examine all of the breast tissue, including lymph nodes under the arm and tissue between, under and around the breasts and the collar bone.
AWBUS is available at Samaritan Breast Center, the first location in Ohio to offer it. — Dr. Diane Anderson, Co-Medical Director, Samaritan Breast Center
High Risk Breast Cancer
About 5 to 10 percent of breast cancers cases are thought to be hereditary, resulting directly from gene defects inherited from a parent. You may be at high risk if you or a close family member has had ovarian or breast cancer or tested positive for a change in a gene related to cancer susceptibility. If you’ve had an abnormal breast biopsy with pre-cancerous changes, or radiation therapy to the chest, you also may be at high risk.
Genetic counseling can help women explore their family histories and understand the impact genetics may have on their cancer risks. — Dr. Melissa P. Roelle, Medical Director, High Risk Breast Cancer Center, Miami Valley Hospital South
Did you know?
We know that white women are more likely to develop breast cancer than black women. However, black women are more likely to develop a more advanced, often more aggressive breast cancer. Many women present with no symptoms and yet are diagnosed with breast cancer. That is why it is so important to get screened before symptoms appear. The earlier a breast cancer is detected the more successful treatment will be. — Sue Brake, manager, Kettering Breast Evaluation Center
Up until this year, physicians were relegated to testing patients for single syndrome hereditary genomes. Now physicians can run a 25 gene panel test on their patients to help them identify which patients have an elevated risk for breast, ovarian, endometrial, gastric, colorectal, pancreatic, and prostate cancers.
Panel gene testing will help practitioners identify 104 percent more positive mutations so that closer surveillance and risk reduction can take place. In addition, the screening management for breast cancer has changed. The National Comprehensive Cancer Network (NCCN) guidelines now state “If the physical examination is negative in an asymptomatic woman, the next decision point is based on Risk Stratification.” A woman’s five-year and lifetime risk for developing breast cancer can be ascertained utilizing risk stratification models. Women with a greater than 20 percent lifetime risk of developing breast cancer should have annual mammograms as well as annual breast MRI surveillance. In addition, women with an elevated five year risk for developing breast cancer should be offered chemoprevention and risk reduction techniques. — Dr. Caroline Peterson, Kettering Health Network, Director, Breast Cancer Screening and Prevention