Up until the 1960s, the most common treatment for breast cancer was basically mutilation often the entire breast was removed. This frequently resulted in lymphedema swelling of the arm. If the lymph nodes were removed in the procedure, this in turn led to high rates of infection.
This butchery was the radical mastectomy popularized by William Halsted in 1894.
Another approach, breast-conserving surgery, was introduced in Finland in the 1930s, but did not become the accepted norm in the U.S. until the late 1960s and early 1970s. It is now the first step in treatment with a diagnosis of breast cancer.
Dr. Gilles LaChance, M.D., with Valley Radiation Oncology, discussed the changing treatments for breast cancer as part of Banner High Country Senior’s programs for Breast Cancer Awareness Month, which ends today, Tuesday, Oct. 31. He was the guest speaker at the Oct. 25 Doc Talk.
A specialist in treating cancer with radiation, he said while most consider radiation treatment “scary … it’s not that bad.”
“Breast cancer is most commonly treated with radiation, but it often requires a variety of treatments,” LaChance said.
He said the changes in treatments have been huge, increasing the survival rate by 40 percent just since 1989. Additionally, the severity of side effects is not as great with the new treatments.
“Almost every week new things are found (about breast cancer),” LaChance said.
Generally the multiple treatments start with surgery to remove the tumor. Once the tumor is removed it is sent to a pathologist for full examination. This exam determines the level of risk the patient has from the cancer — from forms that are unlikely to recur to aggressive, quickly spreading cancer. The level of risk determines the course of treatment. Most likely the patient will have radiation, which targets the tumor and the nearby lymph nodes; next chemotherapy is often prescribed, which kills the cancer cells wherever they may have migrated in the body.
Finally, the patient may be prescribed hormone therapy if the pathology of the tumor indicates it would help keep any remaining cancer cells dormant. Generally, the treatment involves one pill daily for five years — and can reduce the recurrence rate by 50 percent.
If tests of the tumor’s DNA show it’s the sort likely to return, the patient may undergo a prescribed, year-long genetic treatment.
The doctor may recommend additional surgery, including a double mastectomy. Actress Angelina Jolie opted to have a double mastectomy when a genetic test showed her at high risk for breast cancer.
Fully 8 percent of breast cancers are found to have the gene that makes it the most aggressive and most often fatal. Still, “We no longer do radical mastectomies,” LaChance said.