CAROLINA REGIONAL CANCER CENTER ANNOUNCES PILOT PROGRAM FOR ADAPTIVE TREATMENT PLANNING TO FURTHER EXPAND THE BENEFITS OF ITS TOMOTHERAPY HI•ART TREATMENT SYSTEM

Carolina Regional Cancer Center (CRCC), an affiliate of MUSC Hollings Cancer Center, has initiated a Pilot Program to study the benefits of Adaptive Treatment Planning utilizing the TomoTherapy® Hi•Art® Treatment System, one of the most effective forms of radiation treatment available.  Adaptive tr... [read more]

CAROLINA REGIONAL CANCER CENTER WELCOMES NEWS AS AFFILIATE, MUSC HOLLINGS CANCER CENTER, RECEIVES PRESTIGIOUS DESIGNATION BY NATIONAL CANCER INSTITUTE

Carolina Regional Cancer Center (CRCC), affiliated with the Medical University of South Carolina (MUSC) Hollings Cancer Center (HCC), announced today that HCC recently received designation by the National Cancer Institute (NCI) as one of the top cancer research centers in the country. HCC is one of only 64 other can... [read more]

Breast Cancer Overview

By Stephen F. Andrews, DO

In 2007 ~ 180,000 women were diagnosed with breast cancer.  It remains the most common malignancy in women.  Although it will account for over 40,000 deaths in 2007, there has been progress.  Once the leading cause of cancer death in women it now ranks second to lung cancer.  Death rates continue to decline with the largest improvement seen in women under the age of 50.  These improved outcomes are due to earlier detection and better treatments. 
The majority of breast cancers come in two types, ductal or lobular.  Stage for stage there is no difference in outcome.  Approximately 80% of breast cancers are invasive and 20% non-invasive.  Invasive breast cancers have a Stage of I-IV depending on the tumor size, lymph node status and evidence of distant metastasis.  Non-invasive breast cancer (in-situ) is Stage 0.

The cause of the vast majority of breast cancers is unknown. Aside from being female (1% of breast cancers are male) age is the single greatest risk factor for the development of breast cancer.   The disease is uncommon in women under the age of 40, occurring in approximately 1 in 200 women.  The risk of a woman between 40 and 50 developing breast caner is 1 in 25.  The risk continues to increase with age with an overall lifetime risk of about 1 in 8. 
Additional risk factors for developing breast cancer include a 1st degree relative with breast cancer (sister, daughter or mother), other proliferative breast disorders such as atypical ductal hyperplasia or lobular carcinoma in-situ, and the use of hormone replacement therapy (HRT).  A study of 16,000 women randomized to receive either HRT or a sugar pill after menopause showed that the risks of estrogen plus progesterone outweighed their benefit.  Some other factors that may raise a woman’s risk of breast cancer are moderate alcohol intake, high fat diet and obesity.

Only 5-7% of women have hereditary breast cancer.  The two genes on the human chromosome that have been linked to the development of breast cancer are BRCA1 and BRCA2.  Women who have mutations of these two genes have a significantly higher risk of developing breast cancer as well as other cancers.  Tests for these mutations are commercially available. Screening of the general population is though, not currently recommended. However, women who develop a breast cancer at a young age (<50), have a history of ovarian cancer, develop breast cancer in both breasts, are of Ashkenazi Jewish heritage or have male breast cancer are at increased risk of having BRCA mutations.  These patients plus individuals with a strong family history of breast cancer may benefit from genetic testing.  This clearly has the potential to benefit patients and family members.  Women who carry mutated BRCA1 and BRCA2 genes need earlier and more rigorous screening. 

Screening
There are three main components in the diagnosis of breast cancer—imaging, physical exam and biopsy.  With an increase in screening, the first sign or symptom of breast cancer is often an abnormal mammogram.  Mammographic abnormalities include asymmetry, small calcifications, a mass or architectural distortion.  When a screening mammogram shows an abnormality a diagnostic mammogram is performed and may be accompanied by other imaging modalities recommended by the radiologist. 
Despite conflicting coverage in the lay press, the benefit of screening mammogram is well established.  The American Cancer Society, American College of Radiology, the American Medical Association, the National Cancer Institute and the US Preventative Services Task Force all recommend screening of the general population to begin at age 40.  Between ages 40-50 mammograms should be performed every 1-2 years and annually after the age of 50.   The importance of yearly mammograms cannot be understated, even in the elderly. An analysis of randomized trials (the best trials in medicine) studying the effectiveness of screening mammography demonstrates reductions of 20-35% in mortality due to breast cancer for women aged 50 to 69 years.

Despite its usefulness mammography has its limitations.  Twenty percent (20%) of women who are diagnosed with breast cancer have a negative mammogram and an abnormal lump.  This percentage is probably higher in younger women with dense breast tissue. 

Several new technologies are available to improve on the accurate detection of breast cancer. One new technology is digital mammography.  It allows the radiologist to electronically adjust the mammogram for a more complete review.  Studies indicate that digital mammography may be better at detecting breast cancer in women with dense breasts.  In a study, 42,760 women at 33 centers underwent both digital and standard film mammography. In the population as a whole, the diagnostic accuracy of film and digital mammography was similar. However, digital mammography was significantly more accurate in women with dense breasts.
Another tool gaining popularity in breast imaging is MRI.  It holds much promise but currently it should not replace mammography.  As a screening tool the American Cancer Society currently recommends women who have a lifetime risk of 20% or higher risk of developing breast cancer should be screened with yearly MRI.  These include women with known BRCA1 or BRCA2 mutations, women with strong family history of breast or ovarian cancer or who were treated with chest radiation for Hodgkin’s Lymphoma.  Other situations where breast MRI may be useful are in women who already have a biopsy proven breast cancer who on mammogram have dense breasts making the extent of the disease difficult to assess.  Also for patients who present with an axillary lymph node with no evidence of cancer in the breast by physical exam or mammography then MRI should be pursued. 
There are limitations of breast MRI.  There is an overlap in the appearance of malignant and benign disease.  Thus many more women are exposed to unnecessary biopsies with the anxiety that comes alone with it.  The cost, time, and false-positive result make it unlikely that MRI will become a screening tool in the general population.  Most importantly, screening MRI has yet been proven to result in better outcome for women with breast cancer and few researchers think such a study will be performed. 

Summary
Breast cancer can be an overwhelming diagnosis for those inflicted with the disease.  You are not alone though in your diagnosis as close to 200,000 women each year has a new diagnosis.   Recent data shows that outcomes are getting better with reduced side effects enabling you to have good quality of life.   The staff at Carolina Regional Cancer Center will do its best to make your treatment a manageable, informed, professional experience.