Shannon Medical Center | Health Beat | Fall 2020

Fall 2020 5 What might make you vulnerable to breast cancer? Here’s a look. RISK FACTORS YOU CAN’T CHANGE ✔ Growing older. Most breast cancers are found in women 55 and older. ✔ Having a family history of breast cancer. About 15% of all women who get breast cancer have a family member with the disease. ✔ Having dense breast tissue. Women with dense breasts— breasts with more connective tissue than fatty tissue—have a heightened breast cancer risk. ✔ Inheriting gene changes. Between 5% and 10% of all breast cancers appear to be caused by mutations in certain genes passed on by a parent. ✔ Having a personal history of breast cancer or certain noncancerous breast conditions. Women with cancer in one breast have a higher risk of developing a new cancer in the other breast or in another part of the same breast. Some benign changes in breast cells found with a biopsy (such as atypical hyperplasia) raise the risk of getting breast cancer later on. ✔ Starting your periods early or hitting menopause later. Early periods, particularly before age 12, adds risk, as does going through menopause after age 55. RISK FACTORS YOU CAN CHANGE Not moving much. Sedentary women are more likely to have breast cancer. Being overweight. Extra pounds after menopause increase risk. Taking hormones. Hormone therapy—that combines both estrogen and progesterone—taken for more than five years may add risk. Drinking alcohol. The more alcohol you drink, the greater your risk. Sources: American Cancer Society; Centers for Disease Control and Prevention Are you at risk for breast cancer? You can read about our team of experts who treat breast cancer and our many treatment options at shannonhealth.com/ services/cancer-care . SURGERY Most women facing breast cancer will need sur- gery. Not so long ago, that meant women with breast cancer often had to choose between saving their lives and saving their breasts. But now many women with early-stage breast cancer can safely choose a lumpectomy (remov- ing only the cancerous tumor plus some nearby healthy tissue) instead of a mastectomy (remov- ing the entire breast). When a mastectomy is necessary, some doctors can now reconstruct the breast at the same time as the mastectomy. It spares women who opt for breast reconstruction separate surgeries. Doctors also do surgery to help stage breast cancer and find out if it’s spread to underarm lymph nodes. Today many women are able to have only one or a few lymph nodes removed, reducing the risk of lymphedema.This side effect of surgery can cause persistent swelling in the arm or chest. RADIATION THERAPY This lowers the odds that cancer will come back in the breast after a lumpectomy.The most com- mon type is external-beam radiation—where a machine delivers radiation to the breast. Traditionally, women needed five days of radiation treatments for five to six weeks. But now women may be able to have far more rapid therapy, including:    ● Hypofractionated radiation therapy. Women get larger doses of radiation with fewer treat- ments, usually for only three weeks.    ● Intraoperative radiation therapy . Women get a single large dose of radiation in the operating room right after surgery.    ● 3-D-conformal radiotherapy. Women receive radiation that very precisely targets where the tumor was removed. This speeds up treatment to twice daily for five days. Still another advance: Intracavitary brachytherapy.This is when a device that delivers radiation is put in the space left in the chest from surgery. Treatment is typically over in five days when the device is removed. CHEMOTHERAPY Not all women with breast cancer need this treatment. But it’s often advised after surgery to kill off any lingering cancer cells that can’t be seen, even on imaging tests. And it’s the main treatment for women with advanced breast cancer. Still, sometimes it’s not clear if chemotherapy will be helpful, especially for early-stage breast cancers.The good news: Tests are now available that look at the patterns of certain genes after biopsy or surgery.This information helps sort out which patients will most likely benefit from chemo. And when it is warranted, giving cycles of some chemo drugs closer together can also improve outcomes. HORMONAL THERAPY About 2 out of every 3 breast cancers grow in response to high levels of estrogen in the blood. They’re known as estrogen-receptor (ER) posi- tive or progesterone-receptor (PR) positive breast cancers. Hormone therapy prevents estrogen from helping these cancers grow.There are several types of hormone therapy, including:    ● Tamoxifen, which stops estrogen from con- necting to cancer cells.    ● Aromatase inhibitors (AIs), which stop the production of estrogen. Generally, AIs are only used in post-menopausal women. More than ever, doctors know how best to prescribe these drugs and extend lives. TARGETED THERAPY As researchers have discovered more about abnormalities in cancer cells that make them grow uncontrollably, they’ve designed drugs that target these changes. A prime example: Trastuzumab (Herceptin). It and several other drugs were developed to treat the roughly 1 in 5 women with what’s known as HER2-positive breast cancer.These cancer cells have too much of a growth-promoting protein called HER2. Targeted therapy interferes with that protein. Other drugs, known as PARP inhibitors, destroy cancer cells by preventing the cells from fixing their damaged DNA in women with BRCA gene mutations. IMMUNOTHERAPY This novel therapy uses the body’s own immune system to recognize and destroy cancer cells. Immunotherapy drugs are showing promise in treating triple-negative breast cancers, which aren’t fueled by hormones or the HER2 protein. Compared to other breast cancers, they can be more difficult to treat. Sources: American Cancer Society; American Society of Clinical Oncologists; National Cancer Institute +