Two different women. The same deadly disease. One thought she couldn't get it. The other was told she didn't have it. Both opinions were wrong.

In 1994, one week before turning 35, Cathy Young received the devastating news. "I thought people had to be in their 50s to get cancer," the Oak Grove, Mo., resident says. "And then it happened to me."

Linda Hunter, 42, recalls that in January 1995, her mammogram results came back normal. But skin changes on one of her breasts compelled her to seek a second, third and fourth opinion — all of which supported the initial mammogram findings. Her tenacity finally paid off when a fifth doctor she visited detected a rare form of the disease.

Every three minutes a woman in the United States learns she has breast cancer. It is the most common cancer among women, next to skin cancers, and is second only to lung cancer in cancer deaths in women. Only 5 to 10 percent of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The overall risk for developing breast cancer increases as a woman gets older.

Although treatment is initially successful for many women, the American Cancer Society (ACS) says that breast cancer will return in about 50 percent of these cases.

"It's hard to say that things are back to normal when one survives breast cancer," says Young, "because a survivor always has a fear that one day the cancer may return."

New drugs, new treatment regimens, and better diagnostic techniques have improved the outlook for many, and are responsible, according to ACS, for breast cancer death rates going down.

"Women have greater options in breast cancer treatment compared to a decade ago," says Harman Eyre, M.D., chief medical officer for ACS. "New drugs and procedures open up a whole new era of effective treatment."

Breast Cancer Treatments

Breast cancer can be treated with surgery, radiation and drugs (chemotherapy and hormonal therapy). Doctors may use one of these or a combination, depending on factors such as the type and location of the cancer, whether the disease has spread, and the patient's overall health.

Most women with breast cancer will have some type of surgery, depending on the stage of the breast cancer. (See "Stages of Breast Cancer.") The least invasive, lumpectomy (breast-conserving surgery), removes only the cancerous tissue and a surrounding margin of normal tissue. Removal of the entire breast is a mastectomy. A modified radical mastectomy includes the entire breast and some of the underarm lymph nodes. The very disfiguring radical mastectomy, in which the breast, lymph nodes, and chest wall muscles under the breast are removed, is rarely performed today because doctors believe that a modified radical mastectomy is just as effective.

While removing underarm lymph nodes after surgery is important in order to determine if the cancer has spread, this procedure may add chronic arm swelling and restricted shoulder motion to the discomforts of the overall treatment. But a new method, sentinel node biopsy, still under investigation, allows physicians to pinpoint the first lymph node into which a tumor drains (the sentinel node), and remove only the nodes most likely to contain cancer cells.

To locate the sentinel node, the physician injects a radioactive tracer in the area around the tumor before the mastectomy. The tracer travels the same path to the lymph nodes that cancer cells would take, making it possible for the surgeon to determine the one or two nodes most likely to test positive. The surgeon will then remove the nodes most likely to be cancerous.

Radiation therapy is treatment with high-energy rays or particles given to destroy cancer. In almost all cases, lumpectomy is followed by six to seven weeks of radiation, an integral part of breast-conserving treatment. Although radiation therapy damages both normal cells and cancerous cells, most of the normal cells are able to repair themselves and function properly.

Radiation therapy can cause side effects such as swelling and heaviness in the breast, sunburn-like skin changes in the treated area, and lymphedema (swelling of the arm due to fluid buildup) if the underarm lymph nodes were treated after a node dissection.

Drug Options Expand

Drugs are used to reach cancer cells that may have spread beyond the breast — in many cases even if no cancer is detected in the lymph nodes after surgery.

While doctors once believed that the spread of breast cancer could be controlled with extensive surgery, they now believe that cancer cells may break away from the primary tumor and spread through the bloodstream, even in the earliest stages of the disease. These cells cannot be felt by examination or seen on x-rays or other imaging methods, and they cause no symptoms. But they can establish new tumors in other organs or the bones. The goal of drug treatment, even if there's no detectable cancer after surgery, is to kill these hidden cells. This treatment, known as adjuvant therapy, is not needed by every patient. Doctors will make recommendations regarding specific types of therapy based on the stage of the breast cancer.

FDA has approved several new drugs and new uses for older drugs in recent years that improve the chances of successfully treating breast cancer. These drugs include:

Herceptin: About 30 percent of women with breast cancer have an excess of a protein called HER2, which makes tumors grow quickly. A genetically engineered drug, Herceptin (trastuzumab), binds to HER2 and kills the excess cancer cells, theoretically leaving healthy cells alone.

Herceptin, made by Genentech Inc., San Francisco, Calif., and approved by FDA in September 1998, is an intravenous treatment that is used alone in patients who have had little success with other drugs, or as a first-line treatment in combination with the drug Taxol (paclitaxel).

Recent follow-up research shows that Herceptin, in combination with chemotherapy, also may modestly extend the lives of terminal breast cancer patients. Updated survival figures reported from a two-year study by one of the drug's key developers from the University of California at Los Angeles showed an improvement in survival (about 4 months on average) in those getting Herceptin. Scientists say that while the improvement is small-about four months on average-it is especially noteworthy in a disease that until now has eluded many efforts to slow its progression to death.

Tags: Breast Cancer

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.