With steady advancements in treatment, breast cancer outlook improves

The vast majority of individuals diagnosed with early stage breast cancer can expect to be cured of the disease. Some two decades ago, Sutter Roseville's Dr. Kristie Bobolis might not have made such a statement. A big reason why Bobolis and the entire medical industry can reassure newly- diagnosed patients and the public in general is because steady advancements in nearly every aspect of treatments. "Over the last 20 years, we have seen steady progress in the treatment of breast cancers," Bobolis said. "Really, there have been incremental improvements in the way we do surgery, the way we deliver radiation and systemic treatments we offer patients with breast cancer… If you look back 20 years, everything looks better as far as outcome." Dr. Helen Chew, the Clinical Breast Cancer Program director at the UC Davis Comprehensive Cancer Center, reiterated the medical opinion espoused by Bobolis. "I think over the last couple of decades, anyone who has had a loved one that's had breast cancer, they know now we do less surgery, both in the breast and the armpit area where the lymph nodes are," Chew said. "We can give less chemotherapy because there are more precise drugs. I think we are trying to get to the point where we can give better care that is less toxic and less disfiguring." Chemotherapy, which is a class of drug usually delivered intravenously and interferes with cancer cells ability to proliferate, continues to have its place in the care of patients, Bobolis said. Yet, in the last several years, Bobolis said drugs targeted to enter the immune system or to a pathway expressed on the cancer cell have become more prevalent. Bobolis added an even more recent advancement in medical oncology is trying to discern which early-diagnosed patient will do well enough on hormone-blocking therapy alone and forego chemotherapy. According to Bobolis, hormone-blocking drugs block pathways present in tumor cells and are used in about two-thirds of women diagnosed. With early stage cancer confined to the breast or lymph node, Bobolis said surgery is going to play a role and continues to be a mainstay in treatment. Bobolis said breast conserving surgery is typically sought as one of the first steps in treatment. In some cases, a mastectomy, which is the full removal of the breast, is required or specifically asked for by the patient. Clinical trials also play a role in treatment and help to advance the industry's understanding of the disease. At UC Davis, access to a wide breadth of clinical trials comes at a great advantage of medical professionals, Chew said. Whether it is trials in screening, minimization in surgery, radiation or chemotherapy, the trials serve to benefit advancements in treatment. Early trials are an option sometimes recommended for those who had "lots of different treatments" or perhaps with narrowing options, Chew said. Mature trials, where drugs may be approved shortly by the Federal Drug Administration, are also an option for some patients. Another major shift in the medical field toward treating those diagnosed with any type of cancer has nothing to do with advancements in technology or scientific breakthroughs. The idea of "patient-centric care," or providing coordinated resources through a "team" of specialists has proven to be critical in treating patients. "I think a lot of fear remains," said Bobolis about a cancer diagnosis. "But I think a vast majority of patients diagnosed with breast cancer can really expect to do well and to be cured of their cancer. I think what tends to allay fears is once a patient is diagnosed and they meet with their team, then they can really understand better what their prognosis is and what options they have to achieve best possible outcome for that individual." Bobolis added that the ability to see a radiologist, a surgeon, an oncologist, radiation oncologist and a pathologist as a team has an extraordinary effect. With the "plan" coordinated among several specialists, Bobolis noted patients get much more organized care, which in turn alleviates fear. This shift in the industry, Bobolis added, came directly from input from patients and illustrated how critical all approaches are. While treatments continue to push the needle toward more successful results, awareness of breast cancer and early detection play an understandably major role in the medical industry. Citing recommendations from the American Cancer Society, Chew said annual screening is recommended for women at the age of 40. Screening is also recommended at an earlier age for those individuals who might have an ancestral history of breast cancer. Chew also noted the importance of individuals knowing their own body and recommends self-exams and guidance with one's doctor. For more details about breast cancer treatments, visit the websites of UC Davis Comprehensive Cancer Center and Sutter Health. Direct links include health.ucdavis.edu/cancer and sutterhealth.org/services/cancer. Nationally-recognized resources are also available at the American Cancer Society website, cancer.org.