As we enter Breast Cancer Awareness month, it is important to step back and ponder where we stand in the fight against this deadly disease. The impact of breast cancer remains staggering, with almost 200,000 women expected to develop breast cancer in 2009. Over one fifth (20%) of these women will succumb to the disease, which represents the second most common cause of death from cancer in American women. Despite that, the incidence and mortality from the disease are slowly decreasing. The improvements in survival means more women are able to beat the disease and survive it. There are many reasons for this, but it is primarily due to the improvements in detection and treatment of breast cancer. Decades of extensive research have lead to many new ideas and effective therapies, which come at a more frantic pace each and every year. Here are a few examples of the recent developments in the treatment of breast cancer.

Screening for breast cancer is routinely recommended for women over the age of forty. Using mammography and breast exams at regular intervals, screening allows women and their doctors to find breast tumors when they are still small and remove them before they metastasize (i.e. spread) to other organs in the body. By doing so, you prevent the deadly effects of the cancer. Mammography has been instrumental in this regard and this simple tool is constantly improving; the newer digital technology allows radiologists to see more than ever before. Even more sensitive than mammography is Magnetic Resonance Imaging (MRI) of the breast which has helped many women with a higher risk of developing breast cancer. There are many other detection methods being investigated right now with the hopes of making the screening process easier and more accurate, so stay tuned.

In the last decade there has been a paradigm shift in the surgical treatment of breast cancer. Through pioneering research we have learned that more radical surgery (i.e. mastectomy to remove the entire breast which was the only surgical option available in the past), is simply not necessary. Total mastectomy did not improve the odds of survival when compared to lumpectomy (i.e. removal of the tumor only while sparing the remaining breast) combined with radiation therapy. In fact, Breast Conservation has now become the standard of care for most patients with breast cancer. Just as important, a lumpectomy is easier, faster, and much more cosmetically pleasing than a mastectomy. It has also been shown that removal of only a few but selected "sentinel" lymph nodes to determine the risk of spread from breast cancer is as effective as the more radical node dissections of yesteryear. Not intuitively, the sentinel node biopsy has proven to be much more accurate that it’s more aggressive
predecessor which could cause unwanted infections and arm swelling. Less surgery is therefore turning out to be better for most breast cancer patients.

Radiation therapy has improved over the decades quite significantly as well. The current treatment methods delivered to the breast or chest generally cause a lot less damage to the surrounding tissues (bone, lung etc.) than previous. That is because the newer technology allows for stronger beams to be delivered to a more precise area. The most recent advancement in radiation therapy is Accelerated Partial Breast Irradiation, or APBI, to treat certain women who opted for breast preservation. The radiation is targeted specifically to the tumor bed, sparing the rest of the breast tissue, which allows for much shorter treatment duration and even less injury to surrounding tissues and organs. Just like "less surgery" has become the norm, "less radiation" may be next.

Perhaps the most prolific research has been in the medical oncology arena. Chemotherapy regimens are continually being fine-tuned for better efficacy and fewer side-effects. The most exciting newcomers are antibodies that specifically target breast cancer cells and stop their growth. This novel approach is quite different from the standard chemotherapy that uses toxic drugs to kill cancer cells... and it is more effective. On another front, it has long been known that breast cancer growth can be stimulated by the female hormone estrogen and for decades there was only one drug prescribed to block this effect. Now there is a panoply of newer medications that can do this much more effectively and with fewer side-effects. So the treatment options are becoming more numerous and more complex. How is one to decide which therapy woks best? The very exciting field of genetic profiling helps in that regard. Simply put, doctors can now look at the genetic composition or profile of the tumor to know how aggressively it will behave and use that information to determine what therapy will work best. This individualized approach, or "personalized medicine", allows doctors to fashion a treatment plan to fit the individual patient and tumor characteristics.

All these exciting advancements make the treatment of breast cancer more complicated and difficult to navigate. It is certainly not a cookie-cutter process. In order to ensure that the right treatment plan is executed and the best possible outcome is achieved, a multi-disciplinary team of doctors is often needed to help in the decision-making process. This team approach ensures that breast cancer patients are given all the options and help in choosing the right one, but an opportunity to ask questions and discuss alternatives. More often than not, it is up to the patient to seek those ideal treatment centers. So patients should do a little research of their own before rushing into treatment. That may be perhaps the first and most important step towards the goal of achieving a better outcome.