We are winning the fight against breast cancer: Here’s how

The lump she found was ultimately diagnosed as triple positive breast cancer.

Her initial reaction was denial, she said, followed immediately by fear. Fear for her children, fear for how she and her husband would pay for treatments.

Credit: Bryant Billing

Credit: Bryant Billing

Had the diagnosis come just a few years earlier, Katawick’s initial reaction may have been fear for her life.

“Before Herceptin this was a doomsday scenario,” she said.

Herceptin is a brand-name medication for the drug trastuzumab.

Approved by the Food and Drug Administration in 1999, the drug reduced recurrence rates, extended survival and changed the way cancer was treated by using targeted therapy.

Its introduction was one of many advances over the last 25 years that led to breast cancer no longer being the death sentence it once was.

According to the National Breast Cancer Foundation, 1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. This year alone, an estimated 316,950 women will be diagnosed with invasive breast cancer.

Breast cancer is the most researched and heavily funded cancer in the United States, according to the National Cancer Institute, with more than $500 million in federal money spent on research annually.

That figure doesn’t include money from private organizations like the Breast Cancer Research Foundation, the National Breast Cancer Foundation and Susan G. Komen which provide tens of millions dollars more to the fight.

The result has been life-saving advances in medications, equipment, surgical procedures and other areas of treatment.

The National Breast Cancer Foundation estimates 1 in 39 women diagnosed with breast cancer will die, about 2.5%. It’s an overall decline of 44% from 1989.

When caught at its earliest stages, the 5-year survival rate is now 99%.

Screenings

“First and foremost, our screenings are so much better than they ever were,” said Dr. Kelly Miller, a surgical oncologist with Kettering Health.

In the early 1980s, the American Cancer Society started recommending all women 35 and older receive a baseline mammogram, with women 40-49 getting one every 1 to 2 years, and those older than 50 getting one yearly. It required a trip to a doctor’s office.

Miller said that today there is more awareness about their importance, and they are more accurate and much easier to get.

On Sept. 2, 2015, Premier Health’s Mobile Mammography Coach welcomed its first patient.

“When we launched the Mobile Mammography Coach 10 years ago, our goal was simple: bring high-quality breast screening closer to the people who need it most,” said Theresa Gustafson, Premier Health system manager of breast imaging. “Every year since, we’ve met women who tell us they wouldn’t have had a mammogram if the coach hadn’t been in their community.”

Since then, the coach has traveled an estimated 120,000 miles to 12 different counties, and completed more than 20,000 screenings.

Improvements in early detection have been key to improving the survival rates of breast cancer patients, said Deanne Rose, director of Kettering Health Breast Centers.

Rose began her 28-year career as a staff mammography technologist when film screenings were the cutting-edge science.

Dependent on the radiation-heavy technology and the skill of the technologist, film screens made it difficult to discern between healthy tissue and potential cancer.

“It was like looking for a snowball in a snowstorm,” Rose said about identifying potential cancer cells in the low contrast imagery, especially in dense breast tissue, a condition where breasts contain a higher proportion of fibrous and glandular tissue compare to fatty tissue. While not dangerous on its own, it makes scanning for cancer more difficult.

Around 2010, detection took a “huge leap” forward when digital mammography came into the picture, Rose said.

The use of digital imagery reduced the amount of radiation patients were exposed to while giving a much clearer, higher contrast picture.

Today, tomosynthesis is the cutting-edge tool.

The advanced technique creates a 3D rendering of breast tissue by taking multiple images from different angles creating greater accuracy and minimizing overlapping tissues that can obscure abnormalities.

Used in conjunction with artificial intelligence, radiologists have their best look ever.

“It’s like a second pair of eyes in detecting breast cancer,” Rose said.

Surgery

Dr. Selyne Samuel’s field has transformed from near-butchery to a delicate procedure that not only saves lives, but maintains the quality of life for the patient.

“It used to be ‘Let’s take care of the cancer. We won’t worry about what it looks like, what it feels like’,” said Samuel, a breast surgical oncologist with Premier Health. “Sixty, eighty years ago we would remove the entire chest wall. The patient died from morbidity.”

Mastectomies have been performed for thousands of years in one form or another, but it wasn’t until the early 1980s that efforts were made to preserve the breast and underlying tissues.

While an improvement, the procedure still resulted in numbness, leaving the patient unable to feel light touch or temperature extremes.

“Women would burn themselves because they couldn’t feel heat,” Samuel said.

Credit: Will Jones

Credit: Will Jones

She now performs nerve-preserving nipple-sparing mastectomies.

Working in conjunction with a plastic surgeon, Samuel identifies nerve endings that are then reattached to the preserved tissues during the mastectomy procedure.

The result: Up to 90% of patients who undergo the procedure have 100% of their sensitivity return, Samuel said, slightly less for some breast cancer patients due to the side effects of chemotherapy.

Nutrition

Advances in medications, equipment and surgical procedures aren’t the only factors contributing to the high survival rate of breast cancer patients.

Research into diet and cancer dates back to the 19th century, but it wasn’t until 2003 that the American Cancer Society published its first comprehensive guidelines on nutrition and exercise for breast cancer survivors.

Today nutrition care is a focal point not only in the treatment and recovery of breast cancer, but in the all-important realm of prevention.

“It was once seen as a kind of subject we didn’t want to focus on,” said Lauren Murray, a clinical dietician with Premier Health’s oncology support services. “Now nutrition expands beyond the normal timeline of diagnosis to when you’re cured.”

The American Institute for Cancer Research was founded in 1982 to fund research into the links between diet, nutrition, physical activity and cancer prevention.

Its Continuous Update Project was started in 2007 to continuously review and update the rapidly growing body of scientific evidence connecting nutrition and lifestyle with cancer prevention.

Murray said the nutritional side of cancer treatment is constantly evolving, and while there is no “superfood” to stave off breast cancer and other diseases, little changes in diet and exercise patterns make big differences.

“What we’ve found is it doesn’t take a whole lot,” Murray said. “There are things we can do instead of just waiting around.”

The key is finding the right nutrition and exercise combination tailored to the person’s genetics and lifestyle, experts say.

The future

Perhaps the biggest change of the last 25 years has been the focus on individual treatments instead of a “one-size-cures-all” approach to breast cancer treatment.

More and more hospitals are using a Cancer Center approach to treatment by including all the doctors, equipment and ancillary support systems — such as Kettering Health’s Renew Boutique and Spa, which offers wigs, bras, specialty skin care products and more — all in one place.

Chemotherapy remains the main treatment, but over the last five to 10 years immunotherapy has come to the forefront and is now considered “tried and true,” Miller said.

Immunotherapy uses substances made by the patient’s body or in a lab to stimulate or boost the immune system to find and attack cancer cells.

Breast cancer treatment is becoming more and more individualized to the point where terms like molecular profiling, gene therapy and cryoablation — the destruction of individual cancer cells using extreme cold — are used daily by those in the business.

Is it a cure?

“Realistically if they live and live their natural life and die of something else, is that a cure?” Miller said. “At the end of the day, that’s what the patient wants.”

Rose sees imaging getting better and better as technology keeps improving.

“It’s not always the forklift upgrade,” she said, referring to new pieces of large equipment. “It’s the software.”

Rose said all of the following are within reach:

“We’re going to get to where breast cancer is treated without surgery,” Samuel said.

But even with all the advancements on the physical side, it’s the mental side that Katawick wants focused on in the future.

“I don’t think people realize how hard it is,” she said.

While there is plenty of medical assistance available, she said, mental health care needs to be just as prevalent during and after treatment.

She said she probably had post-traumatic stress disorder, and still has pangs of survivor’s guilt.

She said she went through physical and occupational therapy, but never did anything about her mental state, something she recommends to cancer patients who feel they need it.

Today, Katawick is cancer-free.

“It’s definitely mind over body,” she said. “I talked to my cancer and told it it wasn’t welcome.”