The 411 on Breast Cancer

Advancements over the last 40 years have increased survival rates and improved the quality of life for many women who were diagnosed with breast cancer, although researchers continue to search for new and better ways to treat the disease. “Breast cancer is one of the most heavily researched fields in oncology,” says Touro’s George Zacharia, M.D. “In the past, we would look under a microscope to decide upon a treatment plan, but now we are looking at the biology and personality of each tumor — not just the size. There are different types of breast cancer, and, depending on the individual, the cancer grows in different ways.”

For many years, chemotherapy treatment and radiation therapy were the primary treatments for those diagnosed with breast cancer. However, Dr. Zacharia is quick to explain that when it comes to breast cancer, there are no shortcuts. Every woman’s journey is unique and each cancer treatment has its own variables. Chemotherapy is a
systemic therapy that uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. For those with early breast cancer, chemotherapy is usually given after breast surgery (called adjuvant chemotherapy), but before radiation therapy. For women with large tumors who need a mastectomy, chemotherapy may shrink the tumor enough for it to be removed by a lumpectomy. If a woman has locally advanced breast cancer, chemotherapy can be used to reduce the size of the tumor in the breast and/or in the lymph nodes, and make it easier to surgically remove the cancer.

Ten years ago, oncologists recommended chemotherapy for all women with early stage
breast cancer. Today, thanks to genomic testing of breast tumors to determine their receptivity or resistance to treatment, up to 50 percent of women can forego traditional chemotherapy for the less toxic alternative referred to as targeted drug therapy. With so many options available to treat breast cancer today, treatments can be tailored to the individual based on factors such as her genetic profile, location of the tumor, the type of tumor and whether the cancer has spread.

In cases when chemotherapy can be spared, the use of targeted therapy is merited.
Targeted cancer therapies are treatments that target the specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Less likely than chemotherapy to harm normal, healthy cells, some targeted therapies work like the antibodies made naturally by our immune systems.

Dr. Zacharia and his colleagues at Touro prefer to treat the patient rather than the disease. One example of this preference is using integrative oncology or integrative
medicine. These therapies work in concert with standard treatment methods (surgery, chemotherapy, radiation) to treat the breast cancer patient’s body, mind and spirit. “We believe integrative therapies contribute to the overall goals of treatment, symptom management [and] distress relief, and may improve overall treatment efficacy and adherence,” he says.

An advocate of patient education, Dr. Zacharia makes sure to explain the procedure at Touro. Before any patients start chemotherapy, they attend a type of “chemo school.” After meeting with their physician, who discusses the treatment plan, an oncology nurse provides patients with an education packet and a video and personally explains the
risks, benefits and side effects of chemotherapy treatment. Each individual patient is then provided with a personalized regimen and an explanation of what is normal to expect as well as how to know when to be concerned. “Evidence suggests that when patients gain
more knowledge, they perform better self-care, cope better and have better symptom control,” Dr. Zacharia says. “No chemotherapy goes from A-Z without hiccups, but
what we have found is that when a patient is more comfortable and has less anxiety about
chemotherapy, they respond to the treatments better and this improves the outcome.”

Decreasing Risks of Breast Cancer

Over the years, breast imaging technology has evolved to allow early detection of many breast abnormalities and cancers, thereby saving many lives. “Mammograms are not a perfect tool, but, on a large scale, they are the best tool we have for early detection,” Dr. Zacharia says. “Mammograms decrease a woman’s chance of dying from breast cancer by greater than 30 percent.” The American Cancer Society recommends the following guidelines for early detection of breast cancer:

• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exams every three years for women in their 20s and 30s, and every year for women 40 years and older.

“If you have breast cancer, it’s best to find it at an early stage when the chances of survival are highest,” Dr. Zacharia says.

Warning Signs of Breast Cancer:

• Breast or chest pain
• Itchy breasts
• Upper back, shoulder and neck
• pain
• Changes in breast shape, size
• or appearance
• A change in nipple appearance
• or sensitivity
• Swelling or lump in the armpit
• Red, swollen breasts

“If you have any of the warning signs described above, it’s always best to see your health care provider,” Dr. Zacharia says. “In most cases, these changes are not cancer. For example, breast pain is more common with benign breast conditions than with breast cancer. However, the only way to know for sure is to see a provider and get checked.”