September 25, 2000

Breast cancer continues to pose a significant health threat to women, but advances in diagnosis and treatment have moderated the effect of the once-fatal disease.

At the UConn Health Center, a multidisciplinary team has been assembled to treat breast cancer patients. The team includes cancer specialists, surgeons, radiologists, plastic- and reconstructive -surgeons, advanced practitioner nurses, physical therapists, social workers and case managers. Working together with the patient, the team devises and initiates a treatment plan that brings to bear the many different specialties in a coordinated way.

The statistics on breast cancer are unsettling:

• Breast cancer is the most common form of cancer to strike American women. More than 200,000 cases are diagnosed annually and more than 44,000 women will die from the disease. Connecticut has one of the highest rates of incidence.
  
  
• Today, the risk of a woman having breast cancer is one in eight. Thirty years ago, that number was one in 14.
  
  
• A new case of breast cancer is diagnosed in the United States once every three minutes; a woman dies of breast cancer every 12 minutes.
  
  
• It is the primary cause of cancer death for black American women and it is the leading cause of death for women aged 40 to 55.
  
  

Moreover, the disease can be devastating to women. It is deeply personal, with numerous psychological aspects that may not be present with other forms of cancer.

"Breast cancer strikes at the very essence of femininity," says Johanna Meehan, a UConn Health Center oncology nurse practitioner. "A woman with breast cancer struggles with issues and questions of body image, femininity, self-esteem, sexuality, fertility, and relationships with significant others. It can be overwhelming and even terrifying."

But the story isn't all grim. There are more than one million American breast cancer survivors. And yesterday's radical mastectomy - the standard treatment for breast cancer - has been replaced by new surgical techniques that offer effective therapies while frequently preserving tissue. Chemotherapy and radiation offer treatments that, when combined with surgery, expand the effectiveness of medical management. New drugs and medicines promote healing and recovery.

To mark Breast Cancer Awareness Month in October, members of the multidisciplinary team have prepared responses that address some of the myths surrounding the disease:

• Breast cancer will leave you mutilated and disfigured.
  

  Not all breast cancers require removal of the breast, says Scott Kurtzman, a surgeon and specialist in breast cancer and member of the multidisciplinary team. Other therapies have been developed to preserve the breast and are practiced in the northeast in particular. For example, lumpectomy is a surgical procedure that removes just the cancerous mass. Breast cancer treatment depends upon the type of cancer and at what stage medical attention is sought, Kurtzman says: "Not all cancers require surgery, but for those that do, physicians are at pains to preserve as much tissue as possible." Other treatment options for certain cancers include chemotherapy, radiation therapy, hormonal therapy, or a combination of the three.

• If you have lymph node involvement, it means the cancer has spread and you're going to die.
  

  Lymph node involvement means the breast cancer has spread, but it does not mean a death sentence. It does change the course of treatment, however. Lymph node involvement means a more rigorous course of therapy, says Jonathan Sporn, that could include systemic chemotherapy or hormonal therapy after the breast cancer has been removed or successfully treated.

• The big breakthrough in breast cancer treatment is about to occur.
  

  This may not be as much "myth" as it is unrealistic expectation. A tremendous breakthrough could occur tomorrow, but even if it did, it would be months if not years before the treatment was approved, and more importantly, proved effective. Sporn suggests that in the short term at least, standard therapies for breast cancer - surgery, chemotherapy and radiation, or a combination of all three - will continue to be the norm. "In the future standard therapies will not go away," Sporn says. "I suspect that chemotherapy and radiation therapy will play a role in treatment for some time to come."

• A woman is a "victim" of breast cancer.
  

  "Breast cancer can be a transforming experience," says Meehan, "but not in the ways you might think. Most women don't just survive breast cancer; they derive strength from the experience of having the disease." For some, she says, the experience helps solidify and redefine core values and women emerge with a new appreciation of what's important - family and friends - while material goods become less important. "It restructures one's perspectives and helps many to focus on the more rewarding aspects of life," Meehan says.

• Radiation therapy will leave you scarred and is likely to cause damage to the heart and lungs.
  

  Permanent skin damage is very uncommon today and collateral heart and lung damage even less so, says Robert Dowsett, a radiation oncologist and member of the multi-disciplinary team. There are several reasons why. Modern treatment planning simulators allow physicians to carefully plan treatment programs. In addition, high energy treatment machines such as linear accelerators, offer precision in radiation-targeting and dose-distribution. Years of refining radiation procedures and experience have contributed to a thorough body of knowledge and expertise, Dowsett says. "We've come a long way in knowing what is important to treat and how to treat it."

• A pregnant woman with breast cancer has to terminate the pregnancy, because the hormones associated with pregnancy fuel the growth of cancer.
  

  Some cancers may grow in response to hormones, but there is no proof that the hormones of pregnancy pour "gasoline on the fire" of cancer, according to Peter J. Deckers, dean of the UConn School of Medicine and a specialist in breast cancer surgery. He says one of the most important factors is what stage the cancer is in when the woman seeks treatment: "The current thinking is to treat the woman according to the stage in which she presents, independent of whether she is pregnant." For example, although chemotherapy after surgery in the first trimester can be disruptive to the fetus and the pregnancy, that is not necessarily so in the second or third trimesters. "The bottom line is that for the pregnant woman beyond the first trimester," Deckers says, "the most appropriate treatment is the same treatment that might be offered to the non-pregnant breast cancer patient."

Pat Keefe