Breast Cancer Treatments Have Dramatically Increased Survival Rates

McClatchy-Tribune Information Services -- Unrestricted

Fred Tasker

October 17, 2009

Though breast cancer is still deadly, it's not as fearsome a diagnosis as it may have been a few decades ago. In 1975, the five-year survival rate was 75 percent. Today, it's 89 percent.

"It's a combination of things: early detection, self-examination; more mammograms; newer, more accurate diagnosis methods, the use of MRIs and ultrasound," says Dr. Joseph Rosenblatt, cancer specialist at the Sylvester Comprehensive Cancer Center in Miami.

"Cancers are diagnosed earlier, when the lesions are smaller," he says. "And we've learned a lot about the biology of cancer."

There's more to it, as well, adds Dr. Atif Hussein, medical director for the Memorial Cancer Institute of the Memorial Healthcare System in South Broward. "Among those who are diagnosed later, we're better able to classify the cancer so we can hit it with targeted therapy so they will live longer."

There are some discouraging trends. While breast cancer death rates are down for white non-Hispanic and Hispanic females since 1975, they are up slightly for black women.

Hussein says doctors are learning that some black women, possibly for genetic reasons, have more aggressive cancers that strike at earlier ages, even in their 20s. Hispanic women, possibly for similar reasons, have lower rates of cancer and of cancer deaths.

Another problem: Doctors agree that mammograms are crucial to early detection of breast cancer. But while the proportion of women over 40 who had had a mammogram in the past two years soared from 29 percent in 1987 to 70 percent in 2000, it dropped to 66 percent in 2005.

Rosenblatt says it has to do with fewer women having health insurance that will pay for mammograms.

"I hope if there's health reform, it may help that," he says.

Here's what's new in breast cancer diagnosis and therapy:

New imaging techniques: Mammograms and sonograms are still essential to finding breast tumors, the doctors agree. But adding MRIs -- magnetic resonance imaging -- to the mix can find additional tumors when they are far smaller and easier to fight.

Chemotherapy: New forms of chemotherapy create less nausea, although temporary hair loss is still a problem.

"The new agents are not much more effective than before, but they're easier to take, less damaging," Hussein says.

"We're much more adept at preventing nausea than in the past, and significantly better at treating it if it occurs," Rosenblatt says.

Also, Hussein notes, 15 years ago chemotherapy often required hospital stays of three to four days; today, it's usually an outpatient procedure, making it more accessible.

Biological response modifier therapy: Chemotherapy today is assisted by this new therapy, which uses natural or laboratory-made antibodies to help the immune system's own natural antibodies fight cancer.

Says Rosenblatt: "For some of the most virulent cancers, the use of the antibody Herceptin in addition to chemotherapy helps. It can make an enormous difference, increasing survival chances by 30 to 50 percent."

Radiation: It's much more focused and targeted today, Rosenblatt says. "It does less damage to surrounding tissue, and there's a better cosmetic outcome."

One new method plants radioactive seeds in the tissue around a tumor when the tumor is removed, providing better targeting and less damage to surrounding tissue.

Surgery: Doctors over the past decade have concluded that lumpectomies, in which only the tumor and a bit of surrounding tissue is removed, when followed by radiation, can have survival rates similar to total mastectomies. "It's much less disfiguring," Rosenblatt says.

In the next five years or so, doctors also have hopes for new therapies such as genomic expression profiling, mapping the patient's cancer-causing genes.

"Then we can create drugs to target those genes," Hussein says. To see more of The Miami Herald or to subscribe to the newspaper, go to http://www.herald.com. Copyright (c) 2009, The Miami Herald Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

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