Breast Cancer Awareness Month

October is Breast Cancer Awareness Month. MPB’s Karen Brown spoke with Dr. Grace Shumaker with Jackson Oncology Associates about prevention, detection and treatment, starting with who's most at risk?

Dr. Shumaker: All women are at risk for breast cancer just by virtue of being a woman. The risk increases with age. There are some particular groups who are at higher risk. These women include women with a strong family history of breast cancer, women who are obese, women who drink moderate amounts of alcohol. Smoking can even be associated with a risk of breast cancer.

Karen: Is there a higher risk among different races?

Dr. Shumaker: The risk for breast cancer may be the same among different races. However, the risk of death is higher among certain races. African American women have a higher death rate.

Karen: Is that because they tend to be diagnosed at a later stage?

Dr. Shumaker: They think that may be one of the factors. They come to the doctor later. I don’t think that’s all the factors involved but I do think it’s one of the risk factors.

Karen: If breast cancer is detected early is the rate of survival high?

Dr. Shumaker: Absolutely. In our century women who have breast cancer detected at an early stage have a 97 percent, 5-year survival rate. That’s much improved from the 1980’s.

Karen: Are there other symptoms that would indicate breast cancer other than say, finding a lump in your breast?

Dr. Shumaker: At an early stage it can be finding a lump in your breast. Sometimes there’s breast pain. That’s a common myth among women that if the breast is painful it means it is not breast cancer but occasionally it can mean there is breast cancer there. As widespread disease, there are other symptoms that can occur such as bone pain, headache, shortness of breath, some GI complaints …

Karen: How many lumps turn out to be non-cancerous?

Dr. Shumaker: The majority of lumps turn out to be non-cancerous.

Karen: Have any advancements been made in treatment or prevention, say, in the past year?

Dr. Shumaker: The trend in the treatment of breast cancer has been toward more targeted therapy. Our initial targeted therapy was the finding of hormone receptor positive breast cancers and those are the ones we can treat with hormone blocking agents like Tamoxifen, Arimidex and Femara. The next targeted therapy that really improved patient treatment was the development of a medicine called Herceptin. About 20 percent of women with breast cancer will have a protein that’s over expressed. For those women we can take a monoclinical antibody called Herceptin that directly targets against those cells. That has tremendously improved the treatment and survival of women with R2 positive breast cancers. The most recent thing that is in the news that is not in a clinical situation but we’re in phase three trials is the development of something called PARP inhibitors. Those are targeted for women who have a triple negative breast cancer. That’s designed for women who are estrogen receptor negative, progesterone receptor negative and per 2 negative. We’re hopeful about that one because this is for a particular group of women; the ones with the triple negative breast cancers. We’ve been searching for something to improve their treatment.

Karen: Is a mammogram still the best way to detect breast cancer at an early stage?

Mammogram is still the best way. Now, they do MRI’s of the breast now for a select group of women, and those are the ones who at very high risk for the development of breast cancer. But, for the general population, mammogram as well as self-breast exam and a clinical breast exam by your doctor are the best ways to detect it.

Karen: At what age is your first mammogram recommended and then how often thereafter?

Dr. Shumaker: The American cancer society recommends the first mammogram at age 40 and annually thereafter. If there’s a high risk, we sometimes do it at an earlier age. It’s more difficult to get a good mammogram result on a very young woman because the breasts are still so dense and they’re hard to read but age 35 would be a reasonable age to start. They also need to be very aware of doing their own self breast exam and their yearly clinical breast exam.

Karen: Final thoughts?

Dr. Shumaker: The bottom line is we have made tremendous strides. We are targeting therapy. Women are tolerating chemotherapy well. I would want women not to be afraid to go get their mammogram and to be in control of their own health care and see their doctor.