Vigilance, Advances in Technology Contribute to Improved Breast Cancer Survival Rates

An estimated 290,000 cases of breast cancer will be diagnosed in 2022, according to the National Breast Cancer Coalition. The encouraging news is that the breast cancer survival rate has improved over the last 30 years, says an MUSC Health breast cancer surgeon.

Dr. Andrea Abbott medical director of the Comprehensive Breast Program at the NCI-designated MUSC Hollings Cancer Center, cites multiple reasons for the lower mortality rate, from advances in screening technology and tailored treatments to increased knowledge of ways to modify one’s risk for breast cancer.

 “Improvements in imaging quality, more precise screening such as 3D mammography, expanded access to health care, as well as increased education about the importance of early detection are all factors that have contributed to the improved survival rate,” says Dr. Abbott, who also is medical director of Quality Assurance and Program Improvement at Hollings and an associate professor of surgery.

People are taking ownership of their health and changing behaviors that heighten their risk for breast cancer. Increased alcohol consumption, being overweight or obese, particularly after menopause, lack of physical activity and being on hormone replacement therapy late in life can all increase the risk for developing breast cancer.

“Weight gain late in adulthood is associated with an increased risk for breast cancer,” she says. “Hormone replacement therapy (HRT) is appropriate for bone and heart health in women who have their ovaries removed at an early age, but if they’re still on HRT at age 70, that’s a time when we want to re-evaluate the necessity for the estrogen supplement. Estrogen levels decrease as we age and HRT should be tapered off at the same time women go through menopause.”

Bioidentical hormone therapy, a natural estrogen alternative that is derived from a plant, has the same risk profile as estrogen and should not be considered a safer alternative to HRT, she says.

In the other hand, certain factors are beyond control. Being female, aging, having dense breast tissue, genetic mutations or a strong family history can increase one’s risk. That’s why it’s so important to know if your risk is high so you can get into a screening program early, Dr. Abbott says.

She advises women to sit down with a parent when they’re between the ages of 25 and 30 and review their family history.

“Find out who had breast or ovarian cancer and at what age. If early, that should trigger an alert that you may have an increased risk for breast cancer. Then meet with a specialist or your primary care physician to calculate your risk. If you have a greater than 20% lifetime risk, you’ll qualify for high-risk screening that could begin as early as age 30, or 10 years younger that the relative who had breast cancer.”

High-risk women with a genetic mutation may require mammograms or MRI starting at age 25; women at average risk should begin having mammograms at age 40. Dr. Abbott also recommends clinical breast exams.

“It’s very important to have a breast exam at the time of your annual mammogram (or twice a year if you are high-risk). Between those exams, women should perform their own breast exams. A proportion of patients come to me without significant symptoms because cancer was detected at an early stage on a screening mammogram, and a fair number come because they felt something.”

If detected early, breast cancer is very survivable, Dr. Abbot says. “The overall five-year survival rate for patients whose cancer has not spread beyond the breast is 99%. The earlier breast cancer is detected, the less treatment a patient will need.”

Dr. Abbott says Hollings offers advanced treatments, including customized treatments with fewer side effects and new surgical techniques, to improve patient outcomes.

“At Hollings, we can tailor the treatment and better predict which patients may benefit from therapy and which patients may not need therapy,” she says. “There is a constant balance to be aggressive enough without being overly aggressive when there would be no benefit to the patient. We know that not everyone responds to chemotherapy the same way, and we have tests that allow us to determine if a patient needs chemotherapy. Not everyone does. Our radiation oncologists are able to be precise when we use radiation therapy, so a patient does not receive any more radiation than is needed.”

Specialists at Hollings also are using immunotherapy, a new class of drugs that activates the body’s own immune system to fight cancer cells and monoclonal antibody therapy, which targets the specific cancer cells in patients diagnosed with HER 2 cancers.

If a patient does require a mastectomy, she’ll have access to the latest surgical techniques for breast reconstruction and to minimize risk of lymphedema and its associated discomfort. Hollings surgeons perform the latest techniques in breast reconstruction, including nipple sparing and reconstruction with nerve preservation. Patients also can have a procedure that allows lymph fluid to drain even after lymph nodes have been removed.

Patients who choose the NCI-designated Hollings Cancer Center will be cared for by a multidisciplinary team of nationally recognized oncologists, plastic surgeons, navigators, counselors, therapists to manage their care. A lot of exciting developments are happening on many fronts.”

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Dr. Abbott is a board-certified surgical oncologist who specializes in the treatment of breast cancer, melanoma and non-melanoma skin cancer, and soft tissue sarcoma. She sees patients in Mount Pleasant (843-876-8282), at the Hollings Cancer Center (843-792-9300) and in North Charleston (843-792-1414.)