By Cristina Alencar, MD –
Thanks to 3D mammography, breast cancer screenings have improved – reducing the need for follow up imaging, detecting slightly more cancers than a standard mammogram, and improving cancer detection in dense breast tissue. Because of these advances, more women are being diagnosed with early stage breast cancer. Treatment options also have advanced and become more personalized.
Surgery is the most common treatment option for most stages and types of breast cancer. Most women with early-stage cancer can undergo a lumpectomy followed by radiation, or they can have a mastectomy depending on tumor size or genetic predisposition. They may not even need sentinel lymph node biopsy if they have “ in situ” or Stage 0 breast cancer and have a good prognosis overall.
Family history of breast or ovarian cancer is very important. If two first degree relatives (mother, sister or daughter) have had breast cancer, or one family member has a history of ovarian cancer, genetic testing is highly recommended to ensure patients do not carry the BRCA1, BRCA2 or other important mutations. When these mutations are present, lifetime risk of breast cancer or risk of recurrence is high. The surgical approach may change, and women may require bilateral mastectomy and removal of both ovaries and fallopian tubes. Fortunately, only around 8 percent of breast cancers are hereditary, although this still adds up to thousands of women each year.
Most breast cancers are positive for estrogen and/or progesterone receptors. Another very important test result is knowing if the breast cancer is positive for the HER2/neu protein. Most cases are hormone positive and HER2/neu negative. Rarely, tumors are triple negative (estrogen, progesterone and HER2/neu negative), but these tumors tend to be the most aggressive.
Genomic tests such as Oncotype Dx or Mammaprint provide medical oncologists with a recurrence score that can guide further treatment, especially to determine if a woman with early stage breast cancer will need chemotherapy after surgery. Genomic tests are done on the surgical specimen and usually take about 14 days to come back.
Though there is still more to discover, our understanding of how breast cancers develop and spread has grown immensely over the past decades. With the help of genetic testing, gene assays and other tools, we can tailor treatment to a woman’s exact cancer. When cancer is caught early and women receive the correct treatment, they have excellent outcomes and reduced risk of recurrence.
Dr. Alencar is an oncologist with Virginia Oncology Associates. She is the author of numerous abstracts and publications on topics in Hematology and Oncology. She is committed to providing personalized cancer care and engaging patients in the latest cancer clinical trials. Virginiacancer.com