Breast Cancer Awareness
October is breast cancer awareness month. One out of eight women over a lifetime will be diagnosed with breast cancer. Even though the incidence of this disease has gone up over the last two decades, the mortality has actually gone down and this is thanks to prevention, screening, early detection, and new, improved therapeutic modalities. MD Anderson recently published the 10 year survival rate of 57,000 patients from 1944 to 2004. While the 10 year survival rate from 1944 to 1954 was only 16%, the 10 year survival rate from 1995 to 2004 was markedly improved to 74% and I am certain that from 2004 to 2011 has continued to improve due to a multitude of factors.
Chemotherapy is no longer the only modality used to fight this disease. We currently have new treatments that include monoclonal antibodies like herceptin, tirosine kinase inhibitors like tykerb, antiangiogenic agents like avastin and many new agents on the horizon like the PARP inhibitors. With molecular fingerprinting of tumors by Oncotype DX and mammaprint the treatment for patients is being more individualized and only patients who will benefit from chemotherapy will be treated with it. In the near future, the genetic makeup of breast cancer will determine the drug choice for the patient.
Only a decade ago, we only had tamoxifen as hormonal therapy for estrogen receptor positive breast cancer while we currently have a total of six agents including arimidex, femara, faslodex, examestane, raloxifene and new agents are currently being tested.
While the majority of breast cancers are sporadic, 10-15% are genetically predisposed and we are now very familiar with the BRCA, and BRCA-2 genetic abnormalities that can be easily detected in the blood. Commercial kits are now available to all physicians who are interested in genetic counseling. The purpose of genetic counseling for women considered high risk is to offer improved screening methods like breast MRI, instead of simple mammograms, and implement preventive measures including bilateral mastectomy which would decrease the chance of developing breast cancer from 90% to < 10%. Oophorectomy is recommended after the age of thirty five which decreases 90% the incidence of ovarian cancer and 50% the development of breast cancer.
My mother was diagnosed with breast cancer when I was in medical school and my sister was diagnosed with breast cancer 15 years ago and I can guarantee that enormous strides have been made in treating this disease. I am hopeful that additional diagnostic and therapeutic modalities will be available in the near future.