Breast cancer affects both men and women and is the second most commonly diagnosed cancer in
women after skin cancer. About one in eight women are expected to develop invasive breast cancer
at some point in their life. In 2021 experts estimate there will be more than three hundred
thousand women diagnosed with breast cancer, and more than two thousand men.
I'm Dr. Lydia Schapira and I'm a medical oncologist and professor of medicine at Stanford University.
Today we'll be focusing on breast cancer. In this video I will tell you more about early detection
methods and how we can personalize and customize treatment for people living with breast cancer.
The good news about breast cancer is that survival rates are increasing. The majority
of women diagnosed with early stage breast cancer will be cured. We have seen a substantial reduction
in death from breast cancer in the last 30 years and we think this is due to the fact that we're
able to detect the disease at an earlier stage and that our treatments have also gotten much better.
The most common screening test and the one we think of as the gold standard
is the mammogram. Mammography uses a specific type of x-ray and requires that the breast is flattened
between two plates and this can be quite uncomfortable. Besides it's not a perfect
test because it may miss some cancers especially in women with dense breasts, those with less fat,
and more milk producing glandular tissue. An abnormal mammogram usually requires more
pictures and may lead to a biopsy in some cases the tissue that is biopsied is normal and this
is called a false positive test and we know this can cause a lot of avoidable anxiety.
Additionally, like all x-rays, mammography exposes the breast to radiation but the total amount of radiation
over the lifetime of a woman is considered safe. Weighing these risks is important for all women,
but it's also important to reiterate the power that mammography can have to help doctors catch
breast cancer early. Recent advances in technology have made these tests more accurate. Tomosynthesis
or 3d mammography is a new technology that has an improved ability to detect small cancers and
also limits the number of false positives without adding more time to the test or making it any more
uncomfortable. The American College of Radiology and the Society of Breast Imaging recommend
starting annual mammography at age 40. The American Cancer Society recommends that women ages
45 to 54 receive mammography every year and that women 55 and older have mammograms taken every two
years or continue with yearly screening if they so wish. You see there is some variation in the
recommendation from different professional groups about when to start and how often to have the test.
There are currently no guidelines for women over the age of 74 and that means that we don't really
know when to stop screening. Ultimately the decision about when to start screening and
how often to do these tests will be specific to every woman and the advice they receive from their
doctor. For women at higher risk of breast cancer, perhaps because of a family history, or a genetic
susceptibility, screening may be recommended at an earlier age and at more frequent intervals.
Following a diagnosis of breast cancer treatment is delivered by a team of
specialists that typically includes a surgeon, a medical oncologist, and a radiation oncologist.
The type of surgery may be limited to removal of only a part of the breast or the entire organ.
And if the cancer is invasive surgery also includes sampling nodes in the armpit.
Women may want to consider breast reconstruction especially after removal of the entire breast.
This is surgery to recreate a breast using either tissue taken from another part of the body
or synthetic implants. Radiation therapy refers to the use of high energy x-rays
or other particles to destroy cancer cells. In treating breast cancer radiation is typically
delivered using a beam that is outside the body and directed at the breast. Either the entire organ
or the part that was affected by cancer. Radiation therapy is delivered in small installments given
five days a week most often given in three to six weeks. This is important to lower the risk
of the cancer recurring. Systemic therapy is the use of medication to get rid of cancer cells and
is taken by mouth or by vein under the direction of a doctor who specializes in cancer medicine and
that is a medical oncologist. The particular type of systemic therapy that is prescribed depends on
many characteristics of both the person with the cancer, for example their age and their individual
preferences, and the cancer itself. In some cases the treatment is delivered before surgery
and more often it is given after surgery with the intention of reducing the risk
of a cancer recurrence. For breast cancers that express receptors for the female hormones estrogen
or progesterone hormonal therapies are the cornerstone of what is called adjuvant therapy.
That is because medications that block the use of estrogen or reduce the amount available in
the body are very effective in stopping cancer cells from growing. Chemotherapy is the name
given to drugs used to destroy cancer cells and is also used in the treatment of breast cancer
but not every person needs chemotherapy. Targeted therapies in breast cancer work differently than
chemotherapy and focus on blocking the growth and spread of a particular group of cells
and are used in combination with chemotherapy and hormonal therapy. The best known and studied
target in breast cancer is the oncogene herd2. Treatment programs can last many years, and it
is very important to continue follow-up visits with the cancer team and to follow an organized
plan for exams and testing for years after treatment has been completed. Good survivorship
care is essential for reducing other health risks and for maintaining a good quality of life.
I hope you found this video useful in learning about how breast cancer is diagnosed, and treated, and the
role of the cancer team in treatment. Please reach out to your doctor if you have more questions.