New federal guidelines about mammograms have sparked another round of questions about how best to detect and treat breast cancer, which kills about 40,000 women in the United States each year. We’ve combed through the research to round up five surprising — and important — facts about the disease.
Physical breast exams aren’t helpful
They’re a staple of the annual checkup. And many gynecologists still urge women to do monthly self-exams. (So do some women’s magazines.) But the evidence shows there’s no benefit to manual breast exams, whether they’re performed by a physician or by the woman herself.
So the American Cancer Society doesn’t recommend regularly getting, or doing, such exams. Instead, the group urges women to “be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”
“Stage 0” cancer, formally called ductal carcinoma in situ, describes the early presence of cancerous or precancerous cells in milk ducts. It can indicate the possibility of a malignancy later in life, particularly for high-risk women, such as those with a strong family history of or genetic predisposition to breast cancer.
DCIS can be treated with surgery or radiation. But some doctors are advising women at this stage to do nothing. A big study published last fall in JAMA Oncology looked at 100,000 women with DCIS. Most had lumpectomies or mastectomies — until recently, the standard treatment for “Stage 0” disease. Yet they still died of breast cancer at the same rate as women who were never diagnosed with DCIS.
That evidence suggests “we should rethink our strategy,” Dr. Laura Esserman wrote in an editorial accompanying the study.
The sit-and-wait approach is controversial, however. And doctors urge more vigilance, including the use of screening tests that are more sensitive than mammograms, in high-risk women.
Magnetic resonance imaging “and ultrasound are important parts of the surveillance of these women,” said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. “They have to be watched very carefully.”
For advanced cancer, surgery can sometimes be the first resort
Even after cancer has spread, surgically removing the primary tumor appears to increase longevity in women with Stage IV breast cancer, according to a study of 21,000 women published last fall in the Journal of the American Medical Association.
When cancer has spread, the conventional approach is chemotherapy, which reaches the whole body, or radiation. Going after the initial tumor with surgery “is a little counterintuitive,” said Mary Schroeder, assistant professor of health services research at the University of Iowa.
But the study found that patients who underwent surgery in their first round of treatment had a median survival of 28 months, compared to 19 months for those who did not.
Chemotherapy can discriminate
For certain aggressive types of breast cancer, the cure rates for African-American and Hispanic women are slightly lower than those for white or Asian women, according to an analysis published last fall in the Journal of Clinical Oncology.
Researchers looked at outcomes for nearly 18,000 women with four types of aggressive, harder-to-treat forms of breast cancer. They all received chemotherapy prior to surgery.
In the most dramatic example, a subgroup of nearly 6,000 women, the treatment eliminated tumors in 54 percent of the white women in the study, compared to 43 percent of the black women. No one seems to know why, said the study’s lead author, Dr. Brigid Killelea, a professor of surgery at Yale University.
“That’s a difficult question,” she said. “The answer is probably multifactorial. And that’s why it’s so important to include black women and Hispanic women in clinical trials, and to encourage them to participate.”
Breast cancer isn’t the most deadly cancer for women. But it is among the best funded.
Lung cancer kills considerably more women in the United States than breast cancer each year.
Nearly 72,000 women died last year from lung cancer and 40,000 died from breast cancer, according to the American Cancer Society.
Breast cancer, however, still receives far more federal research funding than lung cancer. The National Institutes of Health spends about $685 million on breast cancer research, compared to $255 million on lung cancer.
That works out to roughly $17,000 of research funding for every woman who dies from breast cancer in the United States, compared to less than $4,000 in research for every woman who dies from lung cancer.
