Two local breast cancer treatment professionals have promising things to say about the newest options and advances, but they are still believers in regular self-exams and annual mammography checkups.
Local oncologist Dr. Rebecca Barrington outlined some of the newest treatment options.
“Mammography is much better now and we have 3-D mammo as an option. Because it’s digital, doctors can turn the image sideways and upside down if they need to see another angle. And it’s more definitive, so there’s less guesswork about what we’re seeing.”
For those who hope every year that the actual mammogram experience will be less physically “squashing” and more comfortable, sorry, the machines are still built much the same as always, she said.
“But,” Barrington said, “the information we get is more specific.”
Tumor biology has more advanced testing and information for physicians, Barrington said.
“They can examine individual tumors and separate out contributing genes. We are learning that ‘biology trumps stage designations’ and defines who needs what in treatment,” she said. “A positive lymph node does not necessarily mean automatic chemotherapy.”
Specialists also are better able to determine a patient’s chances of recurrence of breast cancer.
She said a small percentage of women have “HER2 estrogen receptor-positive” tumors, about 20 percent of women patients.
In “medical-speak,” one test related to this is the “onco-typeDX Breast Recurrence Score” from Genomic Health, Inc., which tests tissue samples after a diagnosis of early-stage invasive breast cancer, from a woman’s original biopsy or surgery.
This test gives the physician a score ranked as a percentage chance of recurrence.
She said insurance companies weren’t so on-board with this in the early development of the test, and sometimes refused to cover even partial amounts for patients’ tests. She has made insistent and not-so-polite phone calls to insurance offices herself about this.
The insurance carriers are more cooperative about this now, she said.
If that score is in single-digits or considered low, the doctor’s and patient’s decisions about future treatment might be different than if that score was a high percentage.
“If a woman has a tumor that has mutated, sometimes that means moving chemo to first response,” Barrington said. “I’ve had patients whose tumors shrink with chemo before their scheduled surgery. And for a couple of patients, we couldn’t find the tumor after chemo at all.”
Barrington said death rates from breast cancer are down, due mostly to new therapies and more screenings are done earlier.
“If the statistics say there’s an increased incidence of breast cancer, it could be that we’re finding them earlier and more often,” she said.
She called MRI’s a great imaging tool because it lessens the breast density in the resulting images and with help, the tumors light up. In some cases, it guides the surgery decisions. But it is more expensive, she said.
She said there are new drugs for treatment.
Physicians also are checking closely their patients whose breast cancer they thought was all gone but could attack the patient’s body in a different place or cause a second occurrence.
But Barrington said even for those patients, when a three-six months survival rate used to be the norm for a recurrence, now many survive years longer.
“We still discuss hormonal therapy, the pills, and shots, that are hormone-driven. But we have added new drugs to it to extend the patient’s time and enhance its use.
“In lots of ways, we have changed breast cancer to a chronic disease. It’s evolving and changing,” she said.
Radiation oncologist Dr. Valerian Chyle said the major advances recently in radiation treatment have been in digital software. Otherwise, the basic machinery that delivers the treatment have remained “status quo.”
“What the new software has done is let us mobilize a patient’s treatment plan sooner, and then minimize its intrusion on their life.”
He said the software technology now allows the technicians to spare normal tissue and concentrate the radiation all on targeted areas.
“When we’re treating the chest wall for breast cancer, we have to be careful about the heart that’s so close to the left breast.”
At his Kerrville clinic they now call that “Intensity Modulated Radiation Therapy.”
Chyle compared it to basic calculus computations. Instead of “picturing” the cancer-affected area to be treated as one box or space to be the target of two or six beams of radiation, the digital technology now allows them to split the “picture” into halves or fourths or 16ths or more than 200 different small beams.
That targets the radiation beams more at worst-affected areas than lesser affected areas.
“That’s a computer technology advance. It’s done in the treatment planning system software, and the machine delivers what and where we tell it to,” Chyle said.
Parts of his staff get training as each of these advances are made. Then delivery of the radiation treatment is nearly the same by their Linear Accelerator for the rest of his staff.
He said the more advances in medical oncology they have when women show up, he and his staff need to know each one’s risk of occurrence and recurrence.
“The big benefit is forgiving the treatment for those who don’t need it,” Chyle said.
As a long-time medical professional here who have dealt with changes in treatment recommendations, he said lately the word from national health studies and organizations seems to back off of regular breast self-exams and annual mammography tests.
“I still recommend those exams regularly and annually,” Chyle said.
Brian P. McDonough, MD, FAAFPPeer
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