The American Cancer Society, ACS, reports that the number of deaths from breast cancer has been declining in the U.S. since 1990. This decline is said to be due to improved screening methods and awareness, as well as advances in treatment methods.
The treatment of breast cancer depends on the size and location of the tumor, the extent of spread of the cancer and the state of health of the patient. Many different therapy choices are available today.
Surgery
According to the ACS, surgeons take two main approaches to breast cancer. Breast conserving surgery, including lumpectomy, segmental or partial mastectomy and quadrantectomy, involve removal of portions of the breast with the tumor and a portion of healthy tissue. More aggressive surgery is called mastectomy. A simple mastectomy is removal of the whole breast, sparing the underarm lymph nodes and underlying muscles. A radical mastectomy is the removal of the breast with underarm lymph nodes and underlying muscles. A modified radical mastectomy spares the underarm muscles and is preferred to radical mastectomy because, says the ACS, it is less disfiguring and still has the same outcome as the radical mastectomy. A simple mastectomy may be followed by breast reconstruction in some patients, if they so desire.
Surgery removes lymph nodes to check the extent of cancer spread. The ACS notes that this has a large part to play in determining outcomes and the need for further treatment with chemotherapy and/or radiation therapy.
Radiation Therapy
Radiation therapy involves the use of high-energy radiation to kill cancer cells or stop them from growing and spreading. If used before surgery to shrink the tumor and make surgery easier, it is called neoadjuvant radiation therapy. When used after surgery, it is called adjuvant radiation therapy. Adjuvant radiation therapy, explains the American Society of Clinical Oncology, produces the lowest chances of cancer recurrence.
Radiation therapy is given by either an external or internal source of radiation. External radiation therapy may be focused on only the tumor area, a process called partial breast irradiation, PBI. Internal radiation therapy, also called brachytherapy, is more focused and involves the introduction of the source of radiation into the body, close to the tumor site.
Chemotherapy
Chemotherapy uses drugs that kill cancer cells or stop them from growing. Chemotherapy can be adjuvant or neoadjuvant treatment, like radiation therapy. It can also be combined with radiation therapy. Doctors may combine drugs for more effective treatment, says the ASCO.
Targeted Therapy
Targeted therapy uses manmade components of the immune system targeted at specific structures or functions in the cancer cells. Trastuzumab and lepatinib target a growth-promoting protein on the surface of the cancer cells called HER-2. Bevacizumab, another manmade immune system protein, targets the function of growing new blood vessels in cancers.
Hormone Therapy
A majority of breast cancers depend on the female hormone, estrogen, for growth, according to the ACS. Hormone therapy in breast cancer involves removal of estrogen or blocking its influence on the cancer. Drugs used in hormone therapy of breast cancer are anti-estrogens like tamoxifen and toremifene, fluvestrant which destroys estrogen receptors, aromatase inhibitors like letrozole, anastrozole and exemestane, and leuteinizing hormone analogs like leuprolide and goserelin.
