By BECKY GILLETTE
While women in the U.S. still face the probability that one in eight will develop breast cancer, the most common cancer in American women, survival rates are improving, said Dr. Barbara Craft, a medical oncologist who is an associate professor of medicine at University of Mississippi Medical Center Division of Oncology.
The American Cancer Society has reported that from 1989 to 2015, breast cancer death rates decreased by 39 percent. That means that an estimated 322,600 lives were saved from breast cancer deaths during that time period.
The ACS attributes the decline to increased mammogram screening combined with the decreased use of menopausal hormones after publication of the Women’s Health Initiative randomized trial results linking the use of estrogen plus progesterone menopausal hormone therapy to breast cancer and heart disease.
Craft said death rates are also declining because of new options for treatment.
“I have been on staff here for 10 years, and was treating breast cancer during my training for five years before that,” Craft said. “Today, we have more options including more targeted therapies. We can do more individualized treatment with fewer side effects. With metastatic breast cancer, there are so many more treatments available these days that, for certain patients, we are able to treat it almost like a chronic disease such as diabetes or high blood pressure. Lots of people are living years and years with metastatic disease.”
Craft attributes a lot of the advances in treating breast cancer to patient advocates who have worked so hard to raise more money for breast cancer research. That research has led to more FDA treatments for the disease.
“Funding is a major issue,” Craft said. “Luckily, through groups like the American Cancer Society, Susan G. Komen others, more funding has been provided for breast cancer research.”
The good thing about all targeted therapies is they have fewer side effects. But Craft said many are quite expensive.
“Some of these drugs are $10,000 a month or more,” she said. “While insurance may cover some of the cost, patients often still have co pays, so it is important to have patient financial assistance.”
A growing area for breast cancer treatment is to not attack the cancer directly, but the hormones that might be feeding it.
“There are a lot of patients who have estrogen or progesterone positive breast cancer,” Craft said. “These are treated with anti-estrogen therapy. For patients whose disease gets worse and comes back as metastatic disease, there are targeted agents that work in combination with anti-estrogenic drugs to halt the progression of cancer. Fortunately, we do have a lot of treatment options.”
Craft often tells patients that she has a backup plan.
“I encourage them to take it one day at a time and be hopeful,” Craft said. “We try to treat them and take care of their cancer, but also improve their quality of life and keep them feeling good. We don’t want them to just stay alive. We want them to enjoy life and be able to be there for important events such as weddings, graduations, vacations and other special events, and just to spend time with their family.”
She also counsels her patients on the importance of lifestyle. Having a healthy diet, exercising, maintaining a healthy weight and avoiding alcohol can be useful for prevention and help patients do better in terms of survival after their diagnosis. And those same lifestyle recommendations are good for other types of cancer, as well.
Craft said exercise is good for both physical health and mental health. She also encourages people to continue in their job and career if they feel well enough.
“Many do,” she said. “As an employer, try to be encouraging and be a little flexible. But I think it also important after all the breast cancer treatments to have work to go back to in order to feel normal again.”
One continuing issue is that non-Hispanic black women have higher rates of breast cancer deaths than non-Hispanic white women. Mississippi’s black to white mortality rate is the second highest in the country after Louisiana with 1.62 more deaths in white women than black women.
“Improving access to care for all populations could eliminate the racial disparity in breast cancer mortality and accelerate the reduction in deaths from this malignancy nationwide,” states the ACS.
The ACS has recently released new recommendations for breast cancer screening: “Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45. Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening. At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so. Regular mammograms should continue for as long as a woman is in good health.”
The ACS guidelines are for women at average risk for breast cancer. Women at high risk because of family history, a breast condition, or another reason need to begin screening earlier and/or more often. Talk to your medical provider to be sure.
The ACS no longer recommends breast exams, either from a medical provider or self-exams. However, Craft still recommends doing them as she said many people find lumps in the time period between their mammograms.
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