Less women are dying of breast cancer.
An American Cancer Society study found there are 39 percent fewer deaths of women, and men, diagnosed with breast cancer between 1989 and 2015. Early detection and money spent on research have led to great strides against the disease that will claim 41,000 deaths this year alone, according to www.cancer.net.
For UPMC breast surgeon Dr. Donald M. Keenan, MD, he nears the completion of his second decade working with breast cancer patients and finds himself doing less surgery than when he began his career.
“I can tell you almost on a yearly basis there is some new treatment, some new medication and a different way to approach breast cancer,” Dr. Keenan said. “It is all based on research.
“I knew the rate of women dying of breast cancer had decreased. There has been about a 40-percent reduction in breast cancer mortality of the past 30 years. When you think about it, we are doing much less surgery than we did three decades ago. It is about understanding now. Breast Cancer treatment is no longer shooting clay pigeons, it is due to tricking the cells.”
Dr. Keenan said the reduction in death rates and surgery illustrates how far the industry has come in winning the battle.
“In my 20 years, there has been less surgical treatments, the mortality rate has dropped 40 percent,” Dr. Keenan said. “It means we are getting smarter with medicine.”
With death rates declining, the survival rates are growing. The average 5-year survival rate for individuals afflicted with breast cancer is 90 percent , according to www.cancer.net, and the 10-year survival rate is 83 percent. If cancer is found in one breast, the 5-year survival rate is 99 percent, while 61 percent of cases are diagnosed at that stage. If the cancer has spread to lymph nodes, the 5-year survival rate is 85 percent, but if it has spread to another part of the body, the survival rate is 26 percent.
Dr. Keenan said advancements in breast surgery has drastically changed. In the past, the Halsted radical mastectomy was used. The surgery would remove the breast, chest muscles and all the lymph nodes under the arm. He said that method is “used rarely now.
“Doctors consider radical mastectomy only when the tumor has spread to the chest muscles,” Dr. Keenan said. “At the turn of the last century, the operation for breast cancer was a Halsted radical mastectomy. All the breast, lymph nodes, skin and muscle were removed from chest wall.
“The thought process was the cancer grew in this contiguous fashion and spread from the breast to the lymph nodes and surrounding tissues. The quicker you could get to a patient and take the tissue off the chest wall the better you would be.”
Dr. Keenan credits a Pittsburgh physician by the name of Dr. Bernie Fisher who performed clinical trials in the 1970s that led to patients not having that specific surgery.
“It was thought breast cancer was this contiguously growing process on the chest wall,” Dr. Keenan said. “It was a disease where it could spread early before it took over the chest wall. We found out doing that surgery didn’t help.
“Thanks to Dr. Fisher’s work in the 1970s and 198s, when found out we didn’t need to remove the breast,” Dr. Fisher said.
Dr. Keenan said the most significant change is not having to remove the breast and lymph nodes.
“That surgery had horrible affects,” he said. “The biggest surgical change in my 20 years is we don’t have to take out all the lymph nodes. We can take a couple.”
Dr. Keenan said advancements in medicine have led to allowing women to keep their skin for reconstruction.
“Surgically for women who need mastectomies, we can preserve the skin and the nipple,” he said. “It is an added benefit that we can still preserve some aesthetics for her and how she looks.
“For women who need mastectomies, we can preserve the skin and that sets them up for beautiful reconstructions,” Dr. Keenan said. “I don’t know if there is a field in medicine that has benefited from the research that has been done [for breast cancer]. The funding at NIH, the National Cancer Institute, I would just stress to people the reason we are where we are today compared to 20, 40, 50 years ago is just from the people who have dedicated themselves to research.”
Not only has the surgery aspect changed in the treatment of breast cancer, but Dr. Steve Wilson, MD, a radiation oncologist at UPMC, has been using a new technique that allows patients to receive more radiation to affected areas near the heart.
“Most of radiation is focused on preventing the spread of the cancer in the breast and lymph nodes,” Dr. Wilson said. “Most of what we do allows the patients the convenience and cosmetic convenience of keeping the breast.
“One of the big things we have been doing in the last two to three years is utilizing shorter treatment times for many of our breast cancer patients,” Dr. Wilson said.
According to Dr. Wilson patients receive a slightly higher dosage in a shorter period of time which is easier on the patient in terms of day-to-day life.
“We have found that some breast cancer patients can benefit from four weeks of treatment without any risk of failure,” Dr. Wilson said. “That research came out and really helped.
“It is a convenience factor of not having to drive to a radiation center for five days a week for six weeks,” Dr. Wilson said. “Now the patient only goes five days a week for four weeks.”
“The most common patient only needs four weeks of treatment.”
With Deep Inhalation Breath Holds, a technique that Dr. Wilson utilizes, the patients hold their breath which in turn expands the chest cavity allowing radiation treatment near the heart but far enough away to treat the affected area without damaging the heart.
“We either miss the breast cancer, or we can have the patient inhale deeply and hold their breast during the treatment to get the breast further away from the heart,” Dr. Wilson said. “We don’t have to compromise some of the breast tissue. We can inflate the lungs during the treatment and treat more of the area that might be at risk.”
Dr. Amanda Laubenthal, DO, a medical oncologist at UPMC, said early detection is the key to fighting breast cancer, but “new developments has let us see better survival rates.”
For chemotherapy patients, Dr. Laubenthal said they are now better able to “pick out patients to get the treatment right after surgery.
“With the treatment, we are better able to pick out patients to get the treatment right after surgery,” Dr. Laubenthal said. “Surgery is the most important part, but we are better able to select the right person for chemotherapy. Most of those patients in the 1980s and 1990s got chemotherapy after surgery.
“We now test the tumor to decide if the person will benefit from chemotherapy. That way we can spare people from having to suffer the side effects. We get effective treatment to those who need it.”