Breast cancer treatment options widen
BREAST cancer management options are changing, giving more women potentially less-invasive choices and better outcomes.
Breast physician and Breastscreen Queensland relieving senior medical officer Dr Deborah Pfeiffer, 64, reveals some of the most recent changes around the diagnosis and treatment of breast cancer.
Do I need personalised screening?
The standard screening is 2D mammography. However, for women who are at a higher risk of breast cancer, their screening may need to be tailored and involve 3D mammography, ultrasound and even MRI.
Their GP can advise what level of screening is suitable.
There is now before surgery treatment options
During the last 30 years about 75 per cent of women diagnosed with breast cancer have it screen-detected early and it was often less than 2cm in size.
Prior to widespread screening most women had larger, clinically detected breast cancer requiring a mastectomy and the axillary lymph nodes removed.
The difference now is that the specialists are able to know a lot more about the nature of the cancer before the woman goes to surgery.
They usually have at hand information on the tumour size, type and grade, and in many cases the hormone receptors, before surgery.
In some cases, they may also know whether the lymph glands are positive or not.
As a result, in appropriate cases such as when a woman has a large tumour or where two or more lymph nodes are affected, neoadjuvant chemotherapy may be offered before surgery to assist in reducing the size of the tumour. In some cases where the tumour is significantly reduced by the neoadjuvant treatment, the subsequent surgery may be only be a local excision (lumpectomy) and axillary node sample.
Another recent change is that some older women who have an oestrogen receptor positive breast cancer tumour may be offered an anti-oestrogen tablet before surgery.
And in some cases, for example, those aged over 80, they may not even end up having the surgery.
In the past women have often said 'it's cancer, cut it out'. The specialists are rethinking how much treatment they give to women aged 75 and over because for many they may not live long enough for the cancer to reoccur.
They know for older women there are some cancers, particularly if they are less than 1cm in size, low-grade and oestrogen receptor positive, they may not need any surgery.
Reconstruction is taking a different shape
With greater access and techniques in breast implant technology for reconstruction, more women are choosing a mastectomy after an early breast cancer diagnosis.
For the majority of women, lumpectomy with no reconstruction is chosen. However, for those with very small breasts they may want a reconstruction of the tissue that has been lost.
With large breasted women the incision may result in their breasts being unbalanced.
This can affect the woman's bra size and clothing fit, posture and even self-esteem.
So, it's become increasingly common for a woman to be offered a shaping procedure, such as a cosmetic reduction on the unaffected breast which can return both breasts to being symmetrical.
This can be done using implants or fat and muscle, or a combination of both, or lipofilling which is transferring fat only from one area of the body to another area.
Is genotyping worthwhile?
If an oncologist is uncertain as to whether chemotherapy will be beneficial to a woman due to the size, grade and hormone receptor of the tumour, they may recommend the patient have genotyping. This is done by a blood test or swab of the mouth and can cost about $2000.
Its purpose is to help the specialist refine the decision on what is appropriate treatment for that patient.
Dr Pfeiffer reminds all older women to remember to get screened.