Constantly evolving research and treatment result in higher survival rates
by Jack Coleman
HYANNIS - Any time the subject of breast cancer comes up, local residents take notice.
Women on the Cape have long known they are at higher risk to the disease than women on the mainland, although the reasons for this - polluted groundwater and an older population are often cited - remain unclear.
What is not unclear is that women facing breast cancer now stand a better chance of prevailing against it than ever before, according to Dr. Susan Pories, a breast cancer surgeon and scientific investigator at Beth Israel Deaconess Medical Center.
Dr. Pories, who is also an assistant professor of surgery at Harvard Medical School, spoke to a group of 60 people on Friday as part of the Suffolk University Fall Breakfast Series, organized through Suffolk's degree program at Cape Cod Community College. The forum was held at the Sheraton Hyannis Resort hotel.
Pories (pronounced "Por -rees") cited several positive recent developments that are helping women survive breast cancer.
Mammography, long a method of detecting tumors, is moving from film toward more effective digital mammograms. Women considered at high-risk are now urged to get both mammograms and magnetic resonance imaging (MRI) every year.
Another promising development involves scrutiny of so-called "biomarkers," which are traces of cancer's presence that show up in blood, urine and saliva.
By finding evidence of cancer in biomarkers, Pories said, doctors may avoid invasive and problematic methods of treatment.
The Food and Drug Administration has approved only one drug for breast cancer, Tamoxifen, "which we know can also reduce the risk of breast cancer," Pories said (correction: Tamoxifen is the only drug approved by the FDA for reducing the risk to breast cancer).
Breakthrough drugs & surgeries
A potential breakthrough was reported in the week before Pories's visit to the Cape, in the form of another drug, Herceptin.
"Many doctors and patients are embracing a drug described as perhaps the most powerful cancer medicine in a decade, taking their cue from recent studies showing it can halve the risk of relapse for a very aggressive form of breast cancer," began a story from The Associated Press on Oct. 20.
The AP story cited research on Herceptin described earlier this month in The New England Journal of Medicine. In one study, 220 women receiving standard forms of therapy for a year were stricken with breast cancer again, showed other types of tumors or died. These occurred with only 127 women when Herceptin was used, according to the research.
Another promising form of treatment, Pories said, is "sentinel node surgery" (not "central node," as originally reported) - which she likened to "Star Wars surgery" - involving removal of only a few cancerous lymph nodes, rather that two or three dozen as often done. Patients undergoing this are at no greater risk of relapse but bounce back faster after surgery and suffer less pain around the armpit and shoulder, Pories said.
The timing of chemotherapy and radiation, traditional forms of treatment, is also being changed with good results.
Radiation is often used after a small tumor is removed in a lumpectomy. Women who avoid the treatment are at higher risk of relapse, Pories said.
Rather than undergo radiation treatment five days a week for six weeks, a standard and debilitating practice, doctors will now use it for only four days, twice a day and focus on a smaller area.
Another technique involves tubes with tiny "seeds" of radiation inserted into a breast and removed a few days later. "This is still being investigated but it looks very promising," Pories said.
With chemotherapy, a "dose dense" approach is being explored. The regime is reduced from three to two weeks while the immune system is boosted in a separate treatment. This gives cancer cells less time to reappear.
Advances in post mastectomy plastic surgery
Advances are also being made in plastic surgery after mastectomies, when a portion or all of the breast is removed to prevent cancer from spreading.
"When we are done, it looks like the woman had not ever had cancer," Pories said. As with advances in treatment, reconstruction techniques are also better than in the past, with "more natural looking outcomes" the result.
In one approach, tissue is taken from the buttocks to restore a breast without the loss in muscle tone that comes with tissue taken from the stomach.
The Geraldine F. Lavin Memorial Scholarship
Friday's forum was also the occasion to announce the winner of the annual Geraldine F. Lavin Memorial Scholarship, one of the founder's of Cape Cod Community College's collaborative degree program with Suffolk University and the late wife of Michael T. Lavin, an associate professor of public management in the program.
Mrs. Lavin, who died of breast cancer in March 2001, was enrolled in the program until her illness forced her to withdraw.
This year's recipient of the $1,000 scholarship is Tammy Glivinski of Yarmouthport, who was on hand with her daughter, Elizabeth, 13, and mother, Mary Lou Karras of West Yarmouth, a breast cancer survivor.