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This has been a banner year in the fight against breast cancer. Scientists have identified more accurate tools for screening younger women -- who often get the most dangerous types -- developed strategies to treat newly diagnosed pregnant women, and created better, less-toxic drugs to guard against cancer's return.
Breast cancer deaths plummeted 24 percent between 1990 and 2000, and survival rates are soaring. The estimated 213,000 women who will be diagnosed with breast cancer in the United States this year will have a relative survival rate of 71 percent after 15 years. In fact, research has made more headway combating breast cancer than it has against any other kind of cancer. Here's what's been fueling these stunning advances:
About 60 percent of breast cancer patients have hormone- sensitive tumors fueled by estrogen and/or progesterone. Around 25 percent have a deadlier type with too much of the protein HER2. (Some cancers are hormone sensitive and HER2 positive.) Younger women are likelier to have a particularly difficult to treat cancer called a triple negative -- it's neither estrogen sensitive, progesterone sensitive nor HER2 positive. There have been important developments to help all three:
Hormone-responsive cancer. More than half the drop in breast cancer deaths is due to tamoxifen, a postsurgery drug that squelches hormones that can drive tumor growth. "Tamoxifen is probably the biggest home run we've hit in breast cancer," says Dr. Berry. Tamoxifen has serious side effects, however: increased risk of uterine cancer, hot flashes, vaginal bleeding, and blood clots -- and it can lose effectiveness after five years. In tests, three newer estrogen-blocking aromatase inhibitors -- Femara, Arimidex, and Aromasin -- offer the same or better protection.
HER2 cancer. The HER2 protein triggers the unchecked growth of cancer cells, creating a particularly aggressive form of breast cancer. Herceptin, a drug that stops the action of the protein, plus chemotherapy, more than halved the risk of recurrence in early, and operable, breast cancer and reduced death by about 30 percent. That should save 250,000 women annually diagnosed worldwide.
"What's even better is that there are newer experimental drugs that are every bit as effective as Herceptin," says Dr. Hortobagyi. In June a study showed that when a new drug called Tykerb was taken in combination with the chemo drug Xeloda by women who had previously taken Herceptin, it nearly doubled the time it took for breast cancer to grow or advance, compared with taking Xeloda alone. If it is approved by the FDA, Tykerb could be available in 2007. What's more, Tykerb is a pill, while Herceptin is taken intravenously.
Triple-negative cancer. There's hope from a traditional cancer medication that is now being studied for breast cancer treatment: Avastin, a colon cancer drug that, combined with standard chemotherapy, nearly doubled the time patients with advanced breast cancer lived without a progression compared with those who had chemotherapy without it.
In the past, expectant mothers who discovered they had breast cancer faced a wrenching choice: Save their own life or save their unborn child. No longer. New guidelines issued last December by the National Comprehensive Cancer Network advise that women can safely have either a mastectomy or a breast-conserving lumpectomy and begin chemotherapy as early as their second trimester. "In our studies we haven't seen any adverse effects on the babies that could be attributed to treatment. The kids are doing fine. The moms are doing fine," says Richard Theriault, DO, a breast cancer expert and oncologist at the M.D. Anderson Cancer Center. His work showed that the survival rate for pregnant women who follow the new treatment guidelines is 75 percent, about the same as for other women. Other research has shown that chemotherapy may affect a developing fetus in the second or third trimester, so women should discuss these new guidelines with their oncologist. Because radiation and estrogen therapy can injure the fetus, these treatments should be delayed until after the child is born.
Tammy Padgett was in perfect health. The trim, athletic now-44-year-old mother of two had a baseline mammogram in 2000 that found nothing amiss, so when she discovered a lump in her breast the following summer, her gynecologist assured her that she didn't need to worry.
When the lump got bigger, Padgett insisted on getting another mammogram before Thanksgiving 2001. A biopsy the following week found she had a mass so large that she needed a mastectomy. "I decided to have a double mastectomy so I didn't have to worry about a recurrence," says Padgett, who underwent the surgery in December. "My kids were 3 and 5."
On Christmas Eve she got her pathology report and it was devastating: The tumor was estrogen and HER2 positive, the cancer was extremely aggressive, and it had invaded three of her lymph nodes. "All I could think about was that I was going to die," she recalls, "and no one would love my babies the way I do."
That January she flew to the M.D. Anderson Cancer Center, in Houston, to get a second opinion. The trip may have saved her life. At Anderson she learned about the clinical trials of Herceptin for women with earlier-stage cancers. "My oncologist thought it was my best shot," says Padgett, who discovered that one of the test sites was her alma mater, the University of Oklahoma, not far from her home in a suburb of Oklahoma City.
Her treatment was harrowing. Chemotherapy threw her into early menopause, her hair fell out, and she was so weak she could barely brush her teeth. In May she started on Taxol infusions once a week for 12 weeks. Then in July she began the weekly infusions of Herceptin. She also received 36 rounds of radiation that fall. A year later, on her 41st birthday, she had her last Herceptin treatment.
"This December I'll celebrate my five-year anniversary," says Padgett, who still takes Arimidex every day to block production of estrogen. "Herceptin saved my life. If I hadn't found that trial, I'd probably be dead."The Breakthrough That Saved Her Life: Breast MRI
In May 2003 Stephanie Sharp noticed that her left arm was swollen and she figured it was just an infection. But when the swelling persisted, Sharp decided to see a doctor, who ordered Sharp's first mammogram, which she needed anyway because she had just turned 40.
A chest CT scan showed that the lymph nodes under her left arm were enlarged, but her physician still didn't know what was causing the trouble. Nothing showed up on an ultrasound test and a diagnostic mammogram. So in August 2003 she underwent surgery to remove five of her lymph nodes.
The pathology report results were a bombshell, recalls Sharp, a 44-year-old graphic designer who lives with her husband in Hamilton Township, New Jersey. "I had cancer, but they didn't know whether it was lung or breast cancer. Because I had such dense breast tissue, they couldn't find the primary tumor site."
When a chest x-ray ruled out lung cancer, Sharp went to Memorial Sloan-Kettering Cancer Center, in New York City, to get a second opinion. An MRI of her breast revealed three potential tumors, so surgeons there did an ultrasound-guided core-needle biopsy.
"Two of the places that lit up were nothing at all, but at the third one they finally hit pay dirt," she recalls. She had stage-3 hormone-negative cancer and it had spread to all 21 of her lymph nodes. "I was devastated," says Sharp. "But before I went in for my mastectomy, I told everyone I met that I had cancer. I figured the more people praying for me, the better."
After surgery, followed by five months of grueling chemotherapy, 28 radiation treatments, and the loss of all her hair, Sharp is now cancer free. She gets yearly mammograms and sees her medical and radiation oncologist every six months.
Originally published in Ladies' Home Journal, October 2006.