Photograph shows a patient with advanced breast cancer.
Dear Dr. B: What’s new in breast cancer?
Answer: There are many good things happening in the field of breast cancer. To start with the prognosis is getting better. Nearly 98 per cent of women with early-stage breast cancer will survive at least five years. Most of these women will live a long healthy life.
But the bad news is the incidence of breast cancer is increasing. The numbers have been rising steadily since screening was established about 15 years ago. Because of the better screening methods more breast cancers are picked up at earlier stage with better cure rate. So, it is a mixture of bad news with good news. Without screening these cases would have eventually come to the surface (so to speak) probably with poor prognosis.
There is more good news. A recent trial showed Herceptin (trastuzumab), a drug used for late-stage breast cancer also helps women with early-stage breast cancer. The drug reduced recurrence of breast cancer by 50 per cent in early-stage breast cancer. It is useful in 20 to 30 per cent of these women whose tumours are HER2- positive.
Since 1999, Herceptin has been used in hospital setting for women with metastatic breast cancer. There was no funding for patients with non-metastatic breast cancer. It is an expensive drug. The annual cost of the drug per patient is $35,000-$45,000.
An article in the Canadian Medical Association Journal (Patient demand and politics push Herceptin forward) says some provinces have expanded funding for Herceptin to include non-metastatic breast cancer patients. The provinces are: British Columbia, Ontario, Saskatchewan and Quebec. Nova Scotia and PEI are extending availability on case-by-case basis. Women with breast cancer were happy to hear this. Alberta is in the process of finalizing the approval process.
All experts do not agree that such large amount of money should be spent on a small number of patients to gain few months of survival time. If the drug is curative then there would be no argument. But cure for cancer is no where in site. We just take baby steps and look for good news where ever we can find it. And there is no harm in experts debating issues. After all we live in a democracy. Let the best argument prevail.
The debate about the diagnostic accuracy of mammograms for screening purposes has been going on for many years. There is no dispute about the appropriateness of breast cancer screening in women aged 50-69 years. But the sensitivity of mammography in detecting breast cancer depends on the patient’s age, the size and location of the lesion, the hormone status of the tumour, and density of a woman’s breast, the overall image quality and the interpretative skills of the radiologist. So, mammography is good but not perfect.
What about obesity? Yes, weight gain increases breast cancer risk possibly due to excess estrogen derived from fatty tissue. Obese women are twice as likely to die from breast cancer. Women can reduce the risk of breast cancer by taking care of their weight. Studies have shown that there is an association between physical activity and breast cancer prevention. Physical activity also reduces the risk of cardiovascular disease and diabetes.
Those women who do not exercise regularly should take up the challenge. Most women do a great job looking after their families, but in the process they forget about themselves. An ounce of selfishness may be good for the rest of the family! As long as my dinner is ready when I come home!
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