Advice on prevention, screening, new treatments

When October rolls around, it’s a month of mixed emotions: courage, fear, dread and, hopefully, relief. Welcome to Breast Cancer Awareness Month, which if you’ve ever had breast cancer, like I did eight years ago, is more than awareness month – it’s a daily thing with which you learn to live with over time, without ever letting your guard down. A lot of it is about coping mentally, managing your thoughts, staying in the present. The rest is being proactive about your health. Early detection is essential.

So yeah, all those pink ribbons are great reminders to get checked.

Last week, after my annual mammogram/ultrasound, I received the good news: “See you next year”. I ran down the street, determined to live even more fully. But after being diagnosed with early-stage HER2+ breast cancer that was thankfully treated (chemo, lumpectomy, radiation) and gone, I’m constantly on the lookout for information that will help me get on with life. a healthy life.

What are the latest treatments for breast cancer? How can you help prevent an event or recurrence? We spoke to medical oncologist Dr. Jules Cohen of Stony Brook Cancer Center for an update.

Dr. Jules Cohen talks about breast cancer treatment

Where are we in terms of women diagnosed with breast cancer and treatments?

Something like 250,000 women a year in the United States are diagnosed with breast cancer and 30,000 to 40,000 women die in the United States of breast cancer – so most people with breast cancer of course do not die and are healed. The reason the cure rate is so high is: 1. Due to early detection, with screening mammograms; and 2. Judicious use of adjuvant or postoperative therapies such as chemotherapy, hormone therapy, and estrogen therapy.

In the curative setting, when people have stage 1, 2 or 3 breast cancer, or breast cancer that only involves the breast or what we call “local regional lymph nodes”, the therapies are very effective and again the cure rates are very high.

What are the latest treatments?

If anything, what we’re trying to do is move away from the more toxic therapies (such as) anthracycline, the drug used (to treat high-risk breast cancer) in the past. .. now we often substitute the TCHP diet (Taxotere, Carboplatin, Herceptin, Perjeta) and sometimes we can even give THP (Taxol, Herceptin, Pergetta); we will often give this pre-op so the tumor can shrink…if it works very well and there is no tumor left by the time we get to surgery we can give no more
chemotherapy.

For HER2 — breast cancer (the most common type), are there new treatments?

Granted, we have anti-estrogen therapies and hormone therapies that we’ve had for years, including tamoxifen and aromatase inhibitors (AIs). But now there’s a new class of drugs that’s not quite ready for prime time, but hopefully soon – the oral SERD – which stands for Selective Estrogen Receptor Degrader – these are drugs that may be at least as good as current anti-estrogens and may have particular utility for those resistant to conventional anti-estrogens.

For patients who have a BRCA 1 or BRCA 2 genetic disposition (only about 5% of breast cancer patients have the BRCA gene), there is now a class of PARP inhibitors that may be useful in reducing the risk of breast cancer recurrence.

Similarly, patients with high-risk estrogen receptor-positive breast cancer may benefit from the use of so-called CDK inhibitors, which are now available for high-risk patients at stage early.

The best advice for prevention and post-treatment maintenance?

I recommend that people have as little surgery as they need; there is no benefit to having a bilateral mastectomy over a lumpectomy followed by radiation, so unless there is a technical reason why you need to have a mastectomy or bilateral mastectomies, most time if you can get away with a lumpectomy and radiation I would recommend that you do that and if you need chemo to get some opinions to make sure you’re getting the right level of chemo then take the anti-estrogen therapy as prescribed for 5 to 10 years as recommended by your oncologist.

Besides medications and therapies, what can people do to prevent breast cancer and/or its recurrence?

Diet and exercise have been shown to protect against breast cancer, both to catch it in the first place and to prevent breast cancer from coming back once you have it. We know that plenty of aerobic exercise (and) a diet high in fruits and vegetables protects against breast cancer. We know that a high BMI (body mass index) increases your risk of developing breast cancer or having a recurrence of breast cancer. Therefore, for people who are considered overweight or obese based on their body mass index, weight loss is definitely recommended.

Obviously regular screening for women. Something like 40% of women have dense breasts…sometimes mammograms are less sensitive in women with dense breasts, so for some of these women we recommend an annual MRI in addition to an annual mammogram and they would alternate mammogram and MRIs at six-month intervals… We recommend that they do the so-called 3D mammography or mammography with tomosynthesis – it’s a more comprehensive mammography that improves their ability to detect breast cancers and rule out so-called false positives… While the features of an ultrasound may not be great, there’s really no risk associated with it – if he does happen to catch breast cancer that a mammogram doesn’t catch, it’s obviously a good thing.

What about alcohol consumption?

Apparently even a small amount of regular alcohol consumption increases your risk of developing breast cancer, so the recommendations are very, very strict – you really should drink as little as possible to avoid breast cancer and other types of cancer. That said, I think the goal, whether it’s prevention or treatment of breast cancer, is for people to have normal, happy, healthy lives, so I don’t think any rules strict rules that are so strict that they hinder or harm your quality of life are definitely worth following, but I think you want to be reasonable, don’t drink alcohol regularly and save it for special occasions .

Would you like to add anything?

We must never forget patients with metastatic disease, i.e. breast cancer that has spread beyond the breast to the local regional lymph nodes or to the bones, liver or breast. other regional parts of the body and that our treatments for metastatic breast cancer have also improved significantly over the past 50 years… Hopefully the goal is not just to prevent metastatic disease through mammograms of screening and the judicious use of systemic therapies, but also to be able to one day cure metastatic breast cancer so that no one dies from it.

Dr. Jules Cohen is a medical oncologist at Stony Brook Cancer Center (Lauterbur Drive, Stony Brook. 631-638-1000).

Phillips Family Cancer Center (740 County Road 39A, Southampton. 631-638-7400) provides Stony Brook Cancer Center services to residents of the East End. Visit cancer.stonybrookmedicine.edu for more information.

Learn more about the Ellen Hermanson Breast Center at Southampton Hospital (240 Meeting House Lane, Southampton. 631-726-8466) at southampton.stonybrookmedicine.edu.

Comments are closed.