Regional Cancer Center
Breast Cancer Therapies Change, Commitment Remains
October 2013 For most healthy women, the thought of breast cancer doesn t occur when they are young. When they are into their 40s, their physician usually recommends a mammogram as a benchmark for detection of breast abnormalities and breast cancer.
By age 50, all women should get a mammogram yearly, says oncologist Lowell Hart, M.D. While there are varying opinions about conducting these screenings at an earlier age, both the American Medical Association and the National Cancer Institute recommend starting at age 40, as do I.
Many physicians stop performing mammography between ages 75-80, or when a woman has another medical condition that significantly limits her life expectancy. MRI and ultrasound are sometimes used in conjunction with mammography, but do not replace this screening test, says Dr. Hart. Other tests, such as thermography, are not yet proven to have any advantage over mammography.
All women are at risk for breast cancer. Those with a close relative with breast cancer, those who have never been pregnant or who have taken hormone replacement therapy are at an increased risk, Dr. Hart says. Most patients have no obvious risk factors, so anyone can develop breast cancer. Men can get it too, but only 1 percent of breast cancer patients are male.
Most patients with localized, early stage breast cancer will receive all three types of treatment, which usually gives them the best chance of cure, Dr. Hart says. For patients with advanced or metastatic breast cancer, the systemic treatments are the most important, but radiation can help control pain, and surgery can sometimes play a role.
Luckily, we have nationally known programs in breast cancer surgery, radiation oncology and medical oncology available in our area, as well as a Multidisciplinary Breast Clinic each week at the Regional Cancer Center.
Patients who receive a referral to the Multidisciplinary Breast Clinic meet with doctors from each specialty area on the same morning, along with nurse navigators to help with support. Treatment options vary, depending on how far the cancer has advanced.
Our goal for early stage patients is cure, so we are aggressive in keeping treatments on schedule and at full dose to ensure that the patient s outcome is as favorable as possible, Dr. Hart explains. For advanced stage patients, our goals differ. We want to prolong life and ensure a good quality of life for as long as possible, but cure is not yet possible, unfortunately.
Therefore, we want to minimize the side effects and focus on controlling pain and other symptoms. We frequently work with palliative care doctors to help these advanced patients, and when cancer treatments need to stop, we involve hospice.
Cancer patients are living with the disease longer and many lead normal lives. The breast cancer survival rates have improved significantly over the last 20 years, due to a combination of more screening with mammography and better treatments, Dr. Hart says. We can now tailor treatments so that patients receive what is best for them whether it be hormonal or chemotherapy and so they have a much lower chance of nausea or other side effects.
Treatment has advanced and includes more targeted therapy based on understanding the genes that go bad in cancer. Within 10 years, I anticipate that chemotherapy will be used very rarely for breast cancer, Dr. Hart says. The key to all these advances is research and I strongly encourage everyone to support cancer research.
A well-done clinical trial is often the best option for a patient with a serious cancer, so I am glad that we have many available for our breast cancer patients within our practice in Southwest Florida through our partnership with Sarah Cannon Research Institute.
Breast Genome Study
Lowell Hart, M.D.
Florida Cancer Specialists & Research Institute
8931 Colonial Center Drive
Fort Myers, FL 33905