I AM A CANCER DOCTOR WHO HATES THE DISEASE. So, I am delighted that a new report shows a whopping 58 percent plunge in breast cancer-related deaths over the last 44 years. Today, I offer you some good news on breast cancer.
I cannot resist turning to Shakespeare for some insights. Here he is, writing in Hamlet.
“Diseases desperate grown,
By desperate appliance are relieved,
Or not at all.”
Lest I be accused of always turning to the Bard for insights, I offer this from singer Sheryl Crow:
“More than 10 million Americans are living with cancer, and they demonstrate the ever-increasing possibility of living beyond cancer.”
TLDR
If you don’t care to read this entire piece, here are my takeaway messages:
- Early detection (mammograms) and treatment improvements after 1975 were associated with a 58 percent drop in breast cancer mortality by 2019.
- About 29 percent of this improvement appeared to be linked to treating metastatic breast cancer, 25 percent from screening, and the remainder to treatment improvements for stages I to III breast cancer.
These improvements translate to a decrease in U.S. breast cancer mortality from 48 per 100,000 women in 1975 to 27 per 100,000 in 2019.
Breast Cancer and Me
First, a nod to John Grogan’s Marley and Me:
“You know all that stuff we’ve always said about you? I whispered, ‘What a total pain you are? Don’t believe it. Don’t believe it for a minute, Marley.’ He needed to know that and something more, too. There was something I had never told him, that no one ever had. I wanted him to hear it before he went. ‘Marley,’ I said. ‘You are a great dog.”
Much of my work as a radiation oncologist is with women (and the rare man) with breast cancer.
I find this utterly fascinating: Our treatment approaches are similar to what you would have found in ancient Egypt.
Old Approaches, New Tools
Breast cancer is nothing new.
If you can read hieroglyphics, you will find the description of breast cancer in ancient Egyptian literature.
More specifically, the Smith papyrus (from around 3000 BC) states this:
“A bulging tumor of the breast is a grave disease, and there is no treatment for it.”
The Egyptians turned to tools you may recognize:
- Knives (today, we have scalpels)
- Cautery (fire; today we have radiation therapy)
- Salts
- Arsenic paste (chemotherapy, topical; today, we use more sophisticated drugs)
Recent Breast Cancer Mortality Improvements
For women in the United States, breast cancer mortality plummeted about 58 percent from 1975 to 2019.
Researchers reported these positive findings in JAMA.
Both screening and treatment advances are central to these improvements.
Screening and Treatment Contributions
Why has this improvement occurred?
Using clinical trials and observational data, the researchers created four simulation models to better understand the contributions of breast cancer screening (think mammograms) and treatment.
Study Findings – Good News on Breast Cancer
As I observed, breast cancer mortality in the United States, age-adjusted, dropped from 48 per 100,000 women in 1975 to 27 per 100,000 in 2019.
Here is how we achieved this improvement:
Mammogram screening accounted for 25 percent of the plunge.
Treatment of Stages I to III contributed another 25 percent.
Finally, 29 percent was secondary to the treatment of metastatic disease.
The largest breast cancer survival improvement following metastatic recurrence occurred from 2000 to 2019, with an increase from 1.9 years to 3.2 years.
Into the Future
While I am delighted that we have come so far in the management of breast cancer, we must continue to push.
As scientists better understand the genetics of the breast cancer cell, we will see more targeted therapies.
Dropping Your Risk
I began this essay by explaining that I hate breast cancer. In that vein, I would be remiss if I didn’t leave you with some risk-reduction tips.
The American Cancer Society recommends the following:
- Achieve and stay at a healthy weight. Increased body weight and adult weight gain are associated with a higher breast cancer risk after menopause. The American Cancer Society recommends maintaining a healthy weight throughout your life and avoiding excess weight gain by balancing your food intake with physical activity.
- Be physically active: Several studies show moderate to vigorous physical activity is linked to lower breast cancer risk. Move! Adults should aim for at least 150 to 300 minutes of moderate-intensity (or 75 to 150 minutes of vigorous-intensity activity) weekly (or a combination of these), preferably spread throughout the week. Getting to 300 minutes or more is ideal.
- Avoid or limit alcohol: Alcohol increases breast cancer risk. Even small amounts are associated with a risk increase. It is best not to drink alcohol. For women who do drink, aim for no more than one alcoholic drink a day. A drink is 12 ounces of beer, five ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).
- Other factors that might lower risk: Those who choose to breastfeed for at least several months after childbirth may also get the added benefit of reducing their breast cancer risk.
For women at increased breast cancer risk
Are you at increased risk for breast cancer (for example, because you have a strong family history of the disease, a known inherited gene mutation that increases breast cancer risk (such as in the BRCA1 or BRCA2 gene), or you have had DCIS or LCIS), you can consider these approaches that might help lower your chances of developing breast cancer (or help find it early):
- Genetic counseling and testing for breast cancer risk
- Medicines to lower breast cancer risk
- Preventive (prophylactic) surgery
- Close observation to look for early breast cancer signs
Your healthcare provider can help you calculate your breast cancer risk, as well as which, if any, of these options might be right for you.
More Potentially Risk-Reducing Maneuvers
Finally, there are these three strategies to lower risk:
- Cigarettes. If you smoke, quitting may lower your risk of breast cancer and other significant medical conditions.
- HRT. If you are taking or considering hormone replacement therapy or oral contraceptives (birth control pills), ask your healthcare provider about the risks and find out if it is right for you.
- Screening. Ask your healthcare provider about the right screening approach for you.
We have accomplished a lot, but it is insufficient. If you have met someone with breast cancer, you know what I mean.
One More Thing – Good News on Breast Cancer, But…
An editorial reminds us that, despite the overall progress in reducing breast cancer mortality, reductions have not been equally distributed across all patient populations.
Uninsured, rural, and Black patients remain at the greatest risk of suffering a breast cancer-related death.
I met six women with newly diagnosed breast cancer. This week.
We must do better, not only in early detection and treatment but also in prevention.
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