History of Breast Cancer Treatment

A diagnosis of breast cancer is traumatic. But today, with survival rates as high as 98%, there's more reason than ever to be optimistic. At one time, breast cancer could only be diagnosed when a tumor was big enough to see or feel. Now it can be recognized - and cured - far earlier, often before any symptoms have even appeared.
Important advances in breast cancer, diagnosis and treatment include:

• Mammography
• Surgical improvements
• Radiation
• Chemotherapy
• Drugs limiting estrogen
• Genetic testing
• Targeted molecular therapy

Over the past two decades, medical advances have helped revolutionize our understanding of cancer.

Advances in Breast Cancer Diagnosis

Since the 1950s, advances in mammography are credited for raising the 5-year survival rate for localized breast cancer (that hasn't spread from its site of origin) from 80% to 98%. Mammography is now the number one method of breast cancer detection. The following methods have been used over the years for detection:

• Standard Mammography - After 1967, diagnostic mammography gained popularity with the introduction of equipment specifically for breast x-rays. At that time, the purpose of mammography - much like that for an MRI today - was for further analysis of anomalies that had already been identified. Screening mammograms - now advised for all women age 40 and over - began in the 1980s.
• Digital Mammography - Digital mammography was introduced in the early 1990s and offers more detailed images and easier storage for future comparisons, but it's still not available in many areas, especially outside of cities and major teaching hospitals. Research suggests that digital mammography mainly benefits women younger than 50 who are also still having periods, and also those with dense breast tissue. Tissue with relatively little fat can obscure anomalies in standard mammograms. For most women, digital is not any more accurate than regular mammography, but it's about four times as expensive and less likely to be covered by insurance.

• Three-Dimensional Mammography - New technology approved by the FDA in 2011, three-dimensional mammography might produce clearer images with hopes to pinpoint more cancers and cut the number of repeat mammograms in half.
• Ultrasound - In the late 1970s, doctors began using ultrasound to determine if an already detected cyst was solid or liquid, which aided diagnosis.
• MRI - In 2007, the American Cancer Society (ACS) recommended yearly MRIs for women at high risk for breast cancer, but the procedure is expensive and only available in larger cities. Neither ultrasound nor MRI can detect microcalcifications, which sometimes is the only sign of early cancer. Another disadvantage is that the MRI cannot always distinguish cancer from benign (noncancerous) anomalies, resulting in more biopsies - a procedure used to remove the tissue sample(s) from a suspected tumor.
• Clinical Breast Exams and Self-Exams - The ACS formerly encouraged annual clinical breast exams by a physician along with breast self-examinations (BSEs), In 2015, they updated the guidelines to say they no longer recommend clinical breast examination for breast cancer screening among average-risk women at any age.

Surgery, Radiation, and Chemotherapy

The following various treatments have been used over the years:

• Surgical Approaches - Radical mastectomies - removal of the breast, chest muscles and underarm lymph nodes - were occasionally performed as early as the 19th century. The late 1940s brought the modified radical mastectomy, which spares the muscles. In the 1970s, a more limited surgical option came into use, focusing on removal of the tumor and a small amount of surrounding tissue - commonly referred to as a "lumpectomy." In 1985, the lumpectomy combined with radiation therapy was found to be as effective as the mastectomy in terms of survival rates but resulted in higher local relapse rates.
• Radiation - Around the turn of the 20th century, doctors first used radiation to shrink cancerous tumors.
• Chemotherapy - Introduced in the 1940s, chemotherapy can reduce tumor size before surgery, prevent recurrence afterward and treat cancer that has metastasized, that is, spread beyond its initial location. Although it still produces side effects, including nausea, exhaustion and bone marrow toxicity, chemotherapy is much less harsh today than in years past.

Pharmaceutical Breakthroughs

The following various pharmaceutical approaches have also been used:

• Selective Estrogen Receptor Modifiers (SERMs) - SERMs, such as Nolvadex (tamoxifen), fight cancers that need estrogen to grow by limiting the ability of estrogen to enter the cancer cell. In high-risk women, tamoxifen was found to reduce recurrence and the development of invasive breast cancer by 50% when taken over a 5-year period. Tamoxifen poses a risk of non-fatal uterine cancer; the risk, however, is very small. Evista (raloxifene), a similar, though generally less effective drug, has not been found to have a related uterine cancer risk. It is not considered a replacement for tamoxifen and only intended for those with estrogen positive breast cancer.
• Aromatase Inhibitors - For post-menopausal women, aromatase inhibitors- a class of medications that includes Arimidex (anastrozole), Aromasin (exemastane), and Femara (letrozole) - work by reducing the estrogen available to cancer cells and have been found to be more effective than tamoxifen in women who are postmenopausal and who have estrogen positive breast cancer.

• Targeted Hormonal Therapies - Herceptin (trastuzumab) is a targeted therapy that specifically binds to a particular form of breast cancer that has too much of the HER2/neu protein on its surface. It destroys the cancer cells, but very little healthy tissue. Herceptin paired with chemotherapy cuts recurrence of HER2/neu-positive breast cancer by 50%.There are now additional HER2 targeted therapies available, so treatment options exist even if a person becomes resistant to Herceptin.

Prevention and Genetic Testing 

Today, we know that healthy eating, regular exercise, keeping weight down and avoiding alcohol can all help women decrease their risk for breast cancer.
For some women, lifestyle choices may not be enough. In the late 1990s, science confirmed that certain variants (mutations) of the genes BRCA1 and BRCA2 cause up to an 80% increase in risk for breast cancer. Some women who discover that they are at high risk take the drastic step of removing their breasts - and sometimes their ovaries, too - in a move to avoid the disease.
Experts agree that genetics is the next frontier. Future strategies may involve genetic testing to individualize patient treatment and even techniques to repair or replace harmful genes before breast cancer occurs. However, rapidly expanding medical knowledge can also leave women feeling overwhelmed as they grapple with practical treatment decisions.
It's important to remember that you are not alone. Today, breast cancer survivors are a powerful force in our society, thanks to their increasing numbers and visibility through events such as the Susan G. Komen Foundation's National (annual) Race for the Cure. In addition, breast cancer support groups, online communities, and other developments offer an anchor to women diagnosed with this disease.