Fighting fears with facts: How breast cancer is treated today

Dr. Jane Mendez, a surgical oncologist at Miami Cancer Institute in South Florida, has long been driven by a particular experience she had as a medical student in the early 1990s.

“I remember a patient being treated for a mass in her breast. She was on the operating table, and she didn't know whether she had cancer or not,” she recalls. “In those days, the surgeon would send a tissue biopsy to the lab to be examined while the patient was in surgery.”

If the lab results confirmed cancer, Mendez said the surgeon would decide whether or not to merely remove the lump - called a lumpectomy - or be more aggressive and perform a mastectomy, which involves removing the entire breast. In those days, the patient didn't have a choice in the matter.

“Once that patient awoke from anesthesia, she asked me if she had a drain in place - which the patient knew meant a mastectomy. I told her she had a drain. I'll never forget the look of horror on her face.”

Fortunately, much has changed since that time, and treatment options for women diagnosed with breast cancer have vastly improved. So have the survival rates. That's welcome news, considering that breast cancer is the most common cancer in women worldwide, accounting for nearly one in four cancer cases among women, per the Breast Cancer Research Foundation.

“Today, most forms of breast cancer are treatable. There's a lot of hope surrounding the outcome of breast cancer treatment nowadays as technology, and medical treatments get better and better,” says Dr. Anne Peled, a breast cancer surgeon and co-director of San Francisco-based Sutter Health California Pacific Medical Center's breast cancer program. “As a breast cancer survivor myself, I think it's so important that women realize they now have options that can help them not just survive but also thrive.”

In 2020, the two most common breast cancer treatment options remain lumpectomy - typically followed by X-ray radiation therapy - and mastectomy with or without breast reconstruction.

“With lumpectomies, only part of the breast containing the cancer is removed. Advances in reconstruction techniques now allow for immediate reconstruction of the surgery site using the patient's own tissue - called oncoplastic surgery - which decreases the chance of a divot or defect at the tumor removal site after surgery,” explains Peled.

Mastectomy is used to treat existing breast cancer, but it can also be a preventive approach for those with breast cancer gene mutations who have a high chance of developing cancer.

“Mastectomies can be done in many ways, but more recent advances allow for keeping the entire outside part of the breast skin, including the nipple,” says Peled. She adds that a new surgical breast neurotization technique, called Resensation, can even regenerate nerves and restore breast sensation, which is commonly lost after the nerves are cut during a mastectomy.

Other breast cancer treatment options include chemotherapy, in which pills or intravenous medications help kill or shrink cancer cells; hormonal therapy, designed to prevent cancer cells from accessing the hormones they need to grow; and biological therapy, which collaborates with your body's immune system to aid it in battling cancer cells or controlling side effects from other cancer treatments.

“And other new therapeutic advances in the treatment of advanced breast cancer have substantially improved patient outcomes, too,” says Dr. Daniel Vorobiof, an oncologist in Tel Aviv, Israel. “These include targeting DNA repair and immune checkpoint inhibitors as well as developing monoclonal antibody-drug conjugates.”

Physical treatment isn't the only consideration, Peled notes; it's also important for patients and survivors to work through the emotional and mental repercussions by joining a support group and talking with a psychotherapist so that they can feel better about their body image, enjoy intimacy and experience healthy self-worth.

The bottom line? You don't have to feel hopeless, powerless or alone. Those with breast cancer have choices and many resources to turn to in 2020.

“Today, we know that one size does not fit all. We can tailor the treatment to the patient and the biology of the tumor,” Mendez says. “We can screen a detected mass accurately using mammography, a minimally invasive technique. We can prepare for the treatment and learn as much as we can before any intervention. We can have a thorough discussion with the patient on her options.”

Also, Mendez notes, “we can help her transition from being a patient to becoming a survivor.”