MDNews - Cleveland-Akron-Canton

2014 issue of Ame r ican Jour nal of R oentgenolog y t hat ma mmog raphy remains beneficial for women in their 40s. According to the study, women between ages 40 and 49 who under- went routine screening mammography were diagnosed at earlier stages with smaller tumors and were less likely to require chemotherapy. "Our findings clearly underscore the impact of neglecting to screen women w ith ma mmography for women in their 40s," says Dr. Plecha. "Foregoing mammography for women in this age group leads to diagnoses of later stage breast cancers. We continue to support screening mammography in women between the ages of 40 and 49 years." She goes on to say that annual screen- ing mammograms starting at the age of 40 saves lives. "Breast cancers caught in the initial stages by mammography are more likely to be cured and are less likely to require chemotherapy or as extensive surgery." Tomosynthesis (3-D mammography) helps in this regard. 3-D Is Better than 2-D Mammography According to a large, retrospective study published in a June 2014 issue of the Journal of the American Medical Association (JAMA), 3-D mammography (aka tomosynthesis) finds significantly more invasive cancers and reduces unnecessary recalls. The study features data from University Hospitals Case Medical Center Seidman Cancer Center. The study, the largest of its kind, focused on the impact of 3-D mam- mography at a diverse range of 13 sites across the U.S., looking at nearly half a million ma mmogra ms. Key find- ings include a 41 percent increase in invasive ca ncer detected w ith 3-D mammography, a 15 percent decrease in unnecessary recalls for false alarms, and a 29 percent increase in the detec- tion of all breast cancers. "This study confirms what we already knew: 3-D mammography finds more of the invasive, harmful cancers we want found and saves women the anxiety and cost of having additional exams for what turns out to be a false alarm," says Dr. Plecha, the study's co-author at UH Case Medical Center. Assessing Risk: Family History Most Important St at i s t ic s i nd ic at e t he aver a ge woman has a one in eight to ten risk of developing breast cancer during her lifetime. If a woman has two or three first-degree relatives with breast cancer, the risk jumps to one in four or five. For women who inherit defective copies of the BRCA1 or BRCA2 genes, the risk climbs to almost 80 percent. "One of the things about all of the breast cancer publicity is that it puts fear into women, so we need to educate them on their risks," says Dr. Shenk. "Only about 7 percent of breast cancers are actually related to breast cancer genes, according to the information we currently have, so the vast majority of women who get breast cancer don't have a gene. Family history is the big- gest thing for referring a patient who is concerned about their risk." For these patients, UH Seidman's Center for Breast Cancer Prevention (CBCP) provides comprehensive evalu- ation of patients' risk of breast cancer from familial history to environmental exposures. The Center is staffed by a genetic counselor, cancer genetics physician, nurse practitioner and breast surgeon ava ilable to help patients understand and monitor their specific risk factors on a long-term basis. " Wit h a ll of t he publicit y about breast cancer and genetic testing, I think there's pressure on primary care physicians by their patients to refer for genetic testing," says Dr. Shenk. "In most cases, genetic testing isn't appropriate. So what we do at the CBCP is assess a patient's risk based on all of the factors — family history, menstrual cycle histor y, pregnancy, breast feeding, density of the breast, lifestyle factors such as alcohol use which inf luences breast cancer risk. A nd then we create a progra m for each individual patient, that is, what is the best screening method, what is appropriate for prevention, etc." He emphasizes that communication with referring physicians is a priority throughout the entire process. They also receive copies of all treatment plans and progress reports. New Treatments Are Curative Brea st c a ncer at e ver y st a ge is treatable, and about 90 percent who present with breast cancer are treated w ith curative intent, according to Dr. Silverman. "O ur latest t reat ments a re more accurately directed towards the exact type of tumor a patient has," she says. "We've known for a very long time that some breast cancer tumors are estrogen dependent and, therefore, hormonal therapies a re ef fective. A nd those that aren't estrogen dependent tend to respond to chemotherapy. But as we learn more about breast cancer and find that there are probably more than two types of breast cancer, we can more accurately target the abnormalities in cancer and exploit those." She points out, for example, that about 20 percent of breast cancers are HER-2 positive — the most aggressive ty pe of breast cancer — and, until recently, the most fatal. With newer a ntibody-ba sed treatments, which not only work in conjunction with chemotherapy but also on their own, HER-2 positive breast cancers are now the most treatable. "And we're finding that even combin- ing antibodies targeting HER-2 can be ver y effective for this type of breast cancer," says Dr. Silverman. "So this has been a huge step forward." Breast cancer researchers are also looking at targeting resistance path- ways within cancer for patients with estrogen-receptor positive ca ncers. These patients, Dr. Silverman explains, have a more indolent course of their disease. But they eventually run out of hormonal options. 2 0 1 4 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 9

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