Breast Cancer: Tips on Prevention, Screening and Latest Treatments

Dr. Jules Cohen of Stony Brook Medicine talks breast cancer awareness
Dr. Jules Cohen
Courtesy Stony Brook Medicine.

When October rolls around, it’s a month of mixed emotions: courage, fear, dread and hopefully relief. Welcome to Breast Cancer Awareness Month, which if you’ve ever had breast cancer, as I did eight years ago, is more than a month of awareness — it’s an everyday thing that you learn to live with over time, never letting down your guard. A lot of it is mental coping, managing your thoughts, staying in the present. The rest is being proactive about your health. Early detection is key.

So yes, all those pink ribbons are valuable reminders to get checked.

Last week, after my yearly mammogram/ultrasound, I got the good news, “See you next year.” I ran out to the street, determined to live even more fully. But after being diagnosed with an early stage HER2+ breast cancer that was thankfully treated (chemo, lumpectomy, radiation) and is gone, I’m constantly on the alert for information that will help me to continue to live a healthy life.

What are the latest treatments for breast cancer? How can you help prevent an occurrence or a reoccurrence? We checked in with medical oncologist Dr. Jules Cohen at Stony Brook Cancer Center for an update.

Dr. Jules Cohen Talks Breast Cancer Treatment

Where are we in terms of women diagnosed with breast cancer and treatments?

Something like 250,000 women per year in the U.S. are diagnosed with breast cancer and 30,000–40,000 women die in the U.S. of breast cancer — so most people who get breast cancer of course don’t die and are cured. The reason the cure rate is so high is: 1. Because of early detection, with screening mammograms; and 2. Judicious use of adjuvant or post-operative therapies such as chemotherapy, hormonal therapy and estrogen therapy.

In the curative setting, when people present with Stage 1, 2 or 3 breast cancer, or breast cancer that only involves the breast or what we call “local regional lymph nodes,” the therapies are very effective and again, the cure rates are very high.

What are some of the latest treatments?

If anything, what we are trying to do is get away from the more toxic therapies (such as) Anthracycline, the drug used (to treat high risk) breast cancer in the past … now we often substitute the regimen TCHP (Taxotere, Carboplatin, Herceptin, Perjeta) and sometimes we are even able to give THP (Taxol, Herceptin, Pergetta); we often will give that pre-operatively so the tumor can shrink … if it works really well and there’s no tumor left by the time we get to surgery, we may not give any more additional
chemotherapy.

For HER2 — breast cancer (the most common type), any new treatments out there?

Certainly we have anti-estrogen therapies and hormonal therapies that we’ve had for years, including Tamoxifen and aromatase inhibitors (AIs). But now there’s a new class of medicines that is not quite ready for prime time but hopefully soon — the Oral SERD — that stands for selective estrogen-receptor degrader — these are medicines that may be at least as good as the current anti-estrogens and may have particular utility to people who are resistant to conventional anti-estrogens.

For patients who have BRCA 1 or BRCA 2 genetic disposition (only about 5% of breast cancer patients have the BRCA gene) there is now a class of PARP inhibitors which can be useful in reducing the risk of breast cancer recurrence.

Similarly, patients with high risk estrogen receptor positive breast cancer may benefit from the use of what are called the CDK inhibitors which are now available for high risk patients in the early stage setting.

Best advice for prevention and for maintenance post treatment?

I recommend that people have as little surgery that they need; there is no advantage to getting bilateral mastectomies over a lumpectomy followed by radiation, so unless there’s a technical reason why you have to have a mastectomy or bilateral mastectomies, most of the time if you can get away with a lumpectomy and radiation I would recommend that you do that, and if you need chemo, to get a couple of opinions to make sure you are getting the right, appropriate level of chemo, and then take the anti-estrogen therapy as prescribed for 5–10 years depending on your oncologist’s recommendation.

Other than medications and therapies, what can people do to prevent breast cancer and/or reoccurrence?

Diet and exercise have been shown to be protective against breast cancer both for getting it in the first place and protective for having breast cancer reoccur once you’ve had it. We know that lots of aerobic exercise (and) a high fruit and vegetable diet is protective against breast cancer. We know that a high BMI (body mass index) increases your risk for developing breast cancer or having breast cancer reoccurrence so for people who are considered overweight or obese per their body mass index number, weight loss is definitely recommended.

Obviously regular screening for women. Something like 40% of women have dense breasts … sometimes the mammograms are less sensitive in women with dense breasts, so for some of those women we recommend a yearly MRI in addition to a yearly mammogram and they would alternate the mammogram and MRIs at six month intervals … We recommend they do the so-called 3D mammogram or mammogram with tomosynthesis — it’s a more comprehensive mammogram that improves their ability to detect breast cancers and to rule out so-called false positives … While the characteristics of an ultrasound may not be great, there’s really no risk associated with it — if it does happen to catch a breast cancer a mammogram doesn’t catch, obviously that’s a good thing.

What about alcohol use?

Apparently even a small amount of regular alcohol use increases your risk of developing breast cancer so the recommendations are very, very stringent — you really should drink as little as possible to avoid breast cancer and other types of cancer. That said, I think the goal, whether it’s prevention or treatment of breast cancer, is to allow people to have normal, happy, healthy lives so I don’t think any strict rules that are so strict they impede or impair your quality of life are really worth following, but I think you want to be reasonable, one should not drink alcohol on a regular basis and save it for special occasions.

Anything you would like to add?

We should never forget the patients who have metastatic disease, which is breast cancer that has spread beyond the breast to local regional lymph nodes or to the bone or liver or other regional parts of the body and that our treatments for metastatic breast cancer have also improved significantly over the last 50 years … Hopefully the goal is not only to prevent metastatic disease through screening mammograms and judicious use of systemic therapies, but also to be able to hopefully cure metastatic breast cancer one day so that nobody dies from it.

Dr. Jules Cohen is a Medical Oncologist at the Stony Brook Cancer Center (Lauterbur Drive, Stony Brook. 631-638-1000).

 The Phillips Family Cancer Center (740 County Road 39A, Southampton. 631-638-7400) provides Stony Brook Cancer Center services to East End residents. Visit cancer.stonybrookmedicine.edu for information.

Learn about the Ellen Hermanson Breast Center at Southampton Hospital (240 Meeting House Lane, Southampton. 631-726-8466) at southampton.stonybrookmedicine.edu.

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