Approximately 246,660 women are diagnosed with invasive breast cancer every year. Despite this considerable impact, the appropriate diagnosis and treatment of breast cancer remains less than perfect. This is especially true for women who have dense breast tissue and for Latinas. We also continue to see the overtreatment of women with mastectomy due to fear the disease will come back, when many can choose less invasive treatment options and lead healthy lives.
Latina’s and breast cancer
It’s common knowledge in the oncology community the Latina population has a higher incident rate of breast cancer. A recent study from the Avon Foundation for Women revealed disparities within the Latina population based on country of origin. Puerto Rican women (19.04 per 100,000 women) and Mexican women (18.78) have the highest breast cancer mortality rates of all Hispanic women with breast cancer in the United States. Central and South American women in the United States were found to be significantly less likely to die from breast cancer than other Hispanic subgroups observed (10.15 per 100,000 women).
Latina patients frequently have a biologically aggressive form of breast cancer. However, access to care also can be a contributing factor to the higher mortality rates we see. We can meet this challenge by better defining the genomic type of breast cancer and tailoring treatment accordingly. As a whole, the medical community needs to be better at delivering culturally competent care. As studies have shown, close family ties, especially among immediate family members, lead to better patient outcomes.
Screening the patient with radiologically dense breast tissue
The sensitivity of the mammogram is reduced in a woman whose breast tissue is dense. There is therefore a chance of a false negative mammogram because the tumor is obscured by background density. It’s important to also note that increased density on the mammogram does increase a woman’s risk for breast developing cancer.
There are newer imaging modalities, such as 3D tomography and molecular imaging that can, to some degree, deal better with denser breasts. Mammography is still considered the number one option for screening breast cancer and women should never skip their annual mammogram. Women need to empower themselves to discuss their breasts with their ob-gyn and the radiologist screening them. If dense breast tissue is a concern, her physician will determine any additional testing that may be necessary.
Lumpectomy vs. mastectomy
Surgery is an integral part of breast cancer treatment. Limited surgery, such as lumpectomy, has been proven to be as effective as mastectomy in most cases. In general, the majority of women diagnosed with breast cancer do not require a mastectomy.
Long term studies have shown little or no survival benefit to a double mastectomy when the remaining healthy breast is removed– the cure rate is exactly the same. Yet many women consider this option for fear of the cancer developing in the second breast. They believe by removing the other breast, they will never have to deal with cancer again. Breast cancer in the second breast is typically not a recurrence of the original cancer. Rather, it is a new type of cancer, seen at the genomic level.
Historically, surgery was always the first option for women diagnosed with breast cancer. We have moved into a new paradigm of breast cancer treatment in which every woman should meet with a surgeon and a medical oncologist prior to beginning any treatment. Surgery and drug treatment will still be the major treatment options, but the sequencing of treatment will depend upon the specific details of the woman’s individual cancer type. Drug treatment is quite often the initial treatment modality that is recommended before surgery.
I typically do not recommend mastectomy, specifically a proactive risk reduction surgery in the second breast. When a woman has a higher than normal risk of developing a cancer in the opposite breast - because she carries a BRCA mutation or has received previous radiation for Hodgkin’s disease — a prophylactic mastectomy of the opposite breast may be recommended. To avoid excessive surgery, it is important a patient discuss her lifetime risk of recurrence or developing a second cancer in the either breast with her oncologist.
We are living in the era of personalized care. Breast cancer treatment is no longer one size fits all. Patients should not only be provided with a recommended treatment plan, but understand the reasons and the rationale for the plan that was developed for them.
Dennis Citrin, MD, PhD is a board-certified medical oncologist at the Cancer Treatment Centers of America at Midwestern. He has more than three decades of experience and specializes in treating all stages of breast cancer. His research has been published extensively in Cancer and the Journal of Clinical Oncology. He is the author of, What Every Women Should Know About Breast Cancer. Follow him on Twitter @DrDennisCitrin.
The views expressed by contributors are their own and not the views of The Hill.