Turning the Tide Against Breast Cancer

(October 2009) - Breast cancer remains one of the greatest threats to life for women in America today. In 1975, there were 105 breast cancers per 100,000 women in the U.S. By the year 2000, that number had risen to 135 per 100,000. Fortunately, in 2000 we began to see a small, but encouraging decrease in the incidence of breast cancer. Rates have been decreasing at approximately 2 percent per year.

The deceased incidence of breast cancer has been attributed to two factors:

1. The decreased use of hormonal therapy, especially hormone replacement therapies that include progesterone
2. Increased early detection with the use of mammography

Even with the decrease, the rate of breast cancer remains extremely high, with 200,000 new cases diagnosed and 45,000 deaths nationwide in 2008. In Georgia alone, there were 45,000 new cases and 1,330 deaths in 2008. Today, there are more women alive and living with breast cancer in the United States than at any other time in our history.

At the Curtis and Elizabeth Anderson Cancer Institute (ACI) at Memorial University Medical Center, we concentrate on all facets of breast cancer, from diagnosis through treatment, recovery, and long-term survival. We not only want to increase survival, but also make that survival more natural and vital for the women we serve. Here are just a few of the things we’re doing to impact the lives of our breast cancer patients.

Mammography: The First Step

It is well know that the single most important factor affecting breast cancer survival is the stage of the cancer at the initial diagnosis. As the stage depends on the size of the tumor and the lymph node status, early detection is key. The Breast Imaging Center at Memorial University Medical Center helps women detect breast problems early, when they are most treatable. The Breast Imaging Center has a full-time expert mammographer. The center’s call-back rate for repeat mammograms and positive biopsies far surpasses national benchmarks. That means our patients know immediately when a problem is discovered so they can begin treatment as quickly as possible. The Breast Imaging Center also provides same day service for out-of-town patients requiring stereotactic biopsies, followed by rapid referral to our breast surgeons when necessary.

Making Strides in Lymphedema Care

Lymphedema, or swelling of the arm after removal of the lymph nodes under the arm, has been a long-standing problem for women with breast cancer. It causes discomfort and can negatively impact quality of life. A technique called sentinel lymph node biopsy can spare women the risk of developing lymphedema. With a sentinel lymph node biopsy, surgeons can pinpoint, remove, and examine the primary lymph node near the cancerous tumor. If there is no cancer in the sentinel lymph node, surgeons do not need to remove all of the axillary lymph nodes under the arm, thereby eliminating the risk of lymphedema.

My colleague, Paula DeNitto, M.D., and I were among the first to bring the sentinel lymph node biopsy to Savannah. Today, we have the largest breadth of local experience in its application. Through its use, thousands of women in our area have been spared the risk of developing lymphedema. For those still needing removal of all the axillary lymph nodes, Memorial University Medical Center has physical therapists specially certified in the diagnosis and treatment of lymphedema.

High Dose Rate Therapy

Another area that has had a positive impact on breast cancer treatment is high dose rate partial breast irradiation. We have long known that in order for lumpectomy (removal of the cancer tumor in the breast) to be as effective as mastectomy (removal of the entire breast), the lumpectomy must be followed by radiation therapy. This entails 33 radiation treatments, once a day, five days a week, for six-and-a-half weeks. The length and intensity of the treatment made it very difficult for women living outside of Savannah, or women with heavy work and family commitments. Physicians in the ACI were the first to introduce partial breast irradiation to the coastal region. This process uses high doses of radiation to directly treat the tumor bed. It shortens the treatment time to just five days and does less damage to the healthy tissue surrounding the tumor bed. The ACI was also the first in the region to place catheters in the tumor cavity for radiation treatment, and the first to use 3D imaging of the cancer site followed by standard external radiation.

Turning the Tide

Clearly, advances in modern medicine have made breast cancer treatment less invasive, but still highly effective. Breast cancer remains a significant risk for women in the United States, but we are slowly turning the tide toward prevention and long-term survival. Women can significantly affect their own survival by following the screening recommendations of the American Cancer Society. All women should have a yearly mammogram after age 40, a yearly clinical breast exam, and they should perform monthly self exams. Together, we can continue to decrease the incidence of breast cancer in our nation.

Ray Rudolph, M.D., is a retired surgeon and co-founder of Memorial Health University Physicians -- Center for Breast Care. It is the only facility in the region that specializes exclusively in the treatment of breast conditions. To request an appointment or learn more, call the Center for Breast Care at 912-350-2700.