Aging and Breast Cancer

Aging and Breast Cancer

Treatment and Research

There are many treatment options for women with breast cancer. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the breast, and other factors.

If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes.

People with cancer often are treated by a team of specialists. The team will keep the primary doctor informed about the patient's progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others.

Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.

Some breast cancer patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is both safe and effective.

Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. Women with breast cancer who are interested in taking part in a clinical trial should talk to their doctor. 

1. Women with breast cancer are often treated by only their primary doctor.

2. Doctors sometimes recommend that you get a second opinion if you are diagnosed with breast cancer.

3. The purpose of a clinical trial is to determine if a new treatment will be safe and effective.

4. Clinical trials often compare older versus newer treatments.

Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment.

Staging will let the doctor know

• the size of the tumor and exactly where it is in the breast

• if the cancer has spread within the breast

• if cancer is present in the lymph nodes under the arm

• if cancer is present in other parts of the body

Here are the stages of breast cancer

Stage 0 -- This is very early breast cancer that has not spread within or outside the breast. Doctors often refer to this type of cancer as in situ or non-invasive cancer.

Stage I and stage II also are early stages of breast cancer. Stage I means that the tumor has not spread beyond the breast. In stage II, the tumor may be larger and may have spread to the lymph nodes.

Stage III is called locally advanced cancer. Here the tumor has spread beyond the breast to lymph nodes or to other tissues near the breast.

Stage IV is metastatic cancer. In this stage the cancer has spread beyond the breast and the underarm lymph nodes to other parts of the body, most often the bones, lungs, liver, or brain.

The choice of treatment is based on many factors. For stage I, II or III cancers, the main goals are to treat the cancer and prevent it from coming back, either at the place where the tumor first occurred or elsewhere in the body. For stage IV cancer, the goal is to improve symptoms and prolong survival.

1. Staging is a term that means finding out how far cancer has progressed.

2. Breast cancer that is found at a very late stage is known as breast cancer in situ.

3. Women with breast cancer should receive the same treatment no matter what stage cancer they have.

There are a number of treatments for breast cancer, but the ones women choose most often -- alone or in combination -- are surgery, radiation therapy, chemotherapy, and hormone therapy.

Here is what the standard cancer treatments are designed to do:

• Surgery takes out the cancer.

• Hormone therapy keeps cancer cells from getting the hormones they need to survive and grow.

• Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors.

• Chemotherapy uses anti-cancer drugs to kill cancer cells.

Treatment for breast cancer may involve local or whole body therapy. Doctors use local therapies, such as surgery or radiation, to remove or destroy breast cancer in a specific area. Whole body, or systemic, treatments like chemotherapy, hormonal, or biological therapies are used to destroy or control cancer throughout the body. Some patients have both kinds of treatment.

If you have early-stage breast cancer, one common treatment available to you is a lumpectomy combined with radiation therapy. A lumpectomy is surgery that preserves a woman's breast.

In a lumpectomy, the surgeon removes only the tumor and a small amount of the surrounding tissue. The survival rate for a woman who has this therapy plus radiation is similar to that for a woman who chooses a radical mastectomy, which is complete removal of a breast.

If you have breast cancer that has spread locally -- just to other parts of the breast -- your treatment may involve a combination of chemotherapy and surgery. Doctors first shrink the tumor with chemotherapy and then remove it through surgery. Shrinking the tumor before surgery may allow a woman to avoid a mastectomy and keep her breast.

In the past, doctors would remove a lot of lymph nodes near breast tumors to see if the cancer had spread. Some doctors are also using a method called sentinel node biopsy. Using a dye or radioactive tracer, surgeons locate the first or "sentinel" lymph node closest to the tumor, and remove only that node to see if the cancer has spread.

If the breast cancer has spread to other parts of the body, such as the lung or bone, you might receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Radiation therapy may also be useful to control tumors in other parts of the body.

1. Which is NOT a standard treatment for breast cancer?

2. Which of the following is a local treatment for breast cancer?

3. If a woman has a lumpectomy, the surgeon

4. A sentinel node biopsy is done by first

Several new technologies offer hope for making future treatment easier for women with breast cancer. Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. In the future, doctors may use this tool to deliver treatment.

Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter -- a tube with a balloon tip -- doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days.

New drug therapies also are on the horizon. Findings from several clinical trials show that the chemotherapy drug paclitaxel combined with the drugs cyclophosphamide and doxorubicin can help women with tumors that have spread to other parts of the body.

This mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery.

New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence.

Also, other new research found a test that can predict both the risk of breast cancer recurrence and who is most likely to benefit from chemotherapy such as letrozole.

Several methods show promise in preventing breast cancer. In October 1998, the U.S. Food and Drug Administration, or FDA, approved the drug tamoxifen to prevent cancer in high-risk women.

The approval of tamoxifen followed a clinical trial sponsored by the National Cancer Institute that included more than 13,000 pre-menopausal and post-menopausal women. All of the women were considered at high risk for breast cancer.

One group of women took the drug tamoxifen and another took a placebo -- an inactive pill that looked like tamoxifen. The results of the study showed a 49 percent decrease in breast cancer among women who took tamoxifen.

Tamoxifen does have side effects. The most serious in some women are an increased risk of endometrial cancer -- which is related to the inner mucous membrane of the uterus -- and an increased risk of blood clots. Among 1,000 women taking tamoxifen for 5 years, 18 would be expected to develop endometrial cancer compared to 8 women not taking tamoxifen.

Recent evidence also indicates a possible increased risk of uterine sarcoma for some women. Women at high risk for breast cancer may want to consult their doctor to see if tamoxifen may help them.

1. Tamoxifen is a drug that all women should use to prevent breast cancer.

2. Tamoxifen can reduce the risk of breast cancer by almost half.

3. Some women experience side effects from taking tamoxifen.

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