When Arlene Dobren's mother was diagnosed with breast
cancer 30 years ago, the cancer had already spread to her liver. She died a
year later at age 62. Conversely, when Ms. Dobren herself was diagnosed with
breast cancer in 1995 during a routine mammogram, she underwent a
breast-conserving lumpectomy followed by chemotherapy and radiation and
remained cancer-free for nine years.
When the cancer recurred last year--picked up during a
routine chest X-ray--doctors quickly eased Ms. Dobren's panic, telling her that
these days, metastatic breast cancer can be treated as a chronic disease. While
she would have cancer for the rest of her life, they said, life could be
expected to go on for many years.
"That was quite a concept for me," recalls Ms.
Dobren, 58, a retired New York City guidance counselor. "They talk about
partial remissions and full remissions, and all I could think about was that
remissions had to do with leukemia. Now that a year has passed, I'm beginning
to understand it. I'm still being treated, and I'll always be treated. But I
still feel good."
"Things have progressed drastically in the last 20
years," says Margaret C. Kirk, CEO of the support and advocacy group, Y-ME
National Breast Cancer Organization. One example: When her organization was
created by two breast cancer survivors in 1978, "cancer" was known as
the "big C," and no one ever said the words "breast cancer"
out loud, she says
Today, millions of Americans proudly display pink ribbons
on their cars, women's magazines devote entire sections to breast cancer
coverage during October, and breast cancer research receives more government
funding than any other cancer. (1), (2)
New treatment options, solid research and women willing to
participate in clinical trials to identify better ways of screening, diagnosing
and treating the disease have led to a significant drop in the breast cancer
death rate in recent years, even though the incidence remains about the same.
Specifically, while the death rate increased by 0.4
percent a year between 1975 and 1990, it dropped 2.3 percent a year between
1990 and 2002. (3)
Women also are surviving longer with breast cancer, with
88 percent of women still alive five years after their diagnosis, and 63
percent still alive 20 years after their diagnosis. Those figures are
undoubtedly higher now, notes the American Cancer Society, since they were
based on women diagnosed before more recent treatment advances. (3)
However, the disease is still the most common cancer in
women, and the second most common cause of cancer death in women (behind lung
cancer). This year, breast cancer is expected to affect an estimated 270,000
women, killing about 40,410, according to the American Cancer Society. (3)
"There are still tremendous challenges around
diagnosis and screening tools," says Ms. Kirk. "Other challenges
include more effective, less toxic treatments, better translation of science into
the clinic and ensuring that all women with breast cancer receive quality care
based upon accepted medical guidelines and standards," she adds.
Every time Ms. Dobren pops another chemotherapy pill into
her mouth or spends a couple of hours at the oncologist's getting a Herceptin
infusion, she's aware of just how far breast cancer treatment has come since
she was first diagnosed 10 years ago.
The drug she swallows used to be given only by
time-consuming injection. And Herceptin (trastuzumab), a biological drug that
targets a specific protein on breast cancer cells, didn't even exist outside
the laboratory.
Today, both keep her cancer at bay while enabling her to
live a full life, complete with trips to Las Vegas with her husband, an evening
glass of wine, weekends at her country home in the mountains of Pennsylvania,
and regular workouts.
Indeed, breast cancer treatments have become not only more
targeted, but easier to bear, says Funmi Olopade, MD, a breast cancer
specialist and professor of medicine at the University of Chicago Medical
Center. "We've come a long way since I started in oncology," says Dr.
Olopade. "Today, we're all about having people live well, have a good
quality of life and be able to manage a normal lifestyle even when they're in the
midst of treatment."
For instance, she says,
many of her patients receive chemotherapy along with drugs to minimize nausea
or receive oral chemotherapy or hormone treatment with very few side effects
and are able to work during treatment. She and her peers also have new tools to
treat the low blood counts and fatigue that come with chemotherapy, such as
erythropoietin to treat or prevent anemia, and hormone growth factors to
stimulate the production of immune system cells.
Plus, newer chemotherapies like
capecitabine (Xeloda) can be taken as a pill alleviating the need to come to
the hospital for an intravenous infusion, says Toni K. Choueiri, MD, a
hematology and medical oncology fellow at the Cleveland Clinic Foundation in
Ohio, reducing the risk of infection.
Doctors also are getting better at treating
hormone-receptive cancers, which make up the majority of breast cancers. These
cancers rely on estrogen to grow, so anti-estrogen therapies aim to cut off
their fuel supply. The oldest anti-estrogen, tamoxifen, has been used for more
than 20 years to treat and, more recently, prevent breast cancer. Today a new
class of anti-estrogen drugs called aromatase inhibitors seems to work even
better. (4), (5), (6)