“I have breast cancer” – What’s next”

by Dr Mavreen Adams (SVG Medical Association)

In the realm of malignancies, specifically Breast Cancer, early detection is invaluable for a favourable outcome. I recently watched a touching video by Ananda Lewis, a popular American TV host, who previously denounced mammograms claiming excessive radiation exposure. She is now imploring all women over the age of 40 to get their yearly mammograms done, as she is currently battling stage 3 breast cancer. She has, thus far, had 2 PET scans done as a part of her treatment and progress tracking, One PET scan being equivalent to 30 mammograms. Do the math! If she had done her mammograms as recommended, they would have been able to detect cancerous changes in the breast long before she caught it advanced, with much less radiation exposure.

Having a diagnosis of Breast Cancer, as morbid and life changing as it may be, puts you on a rapid timeline for immediate action and treatment. In this new age of evolving medicine and technology, there are multiple treatment options for a woman/man diagnosed with Breast Cancer. Radical Mastectomy across the board, is a thing of the past in the majority of cases. I must explain however, that treatment is based on the stage of progression of the disease, and usually requires a multidisciplinary approach, with medical internists, radiologists, surgeons, surgical oncologists, medical oncologists and radiation oncologists at the helm.

Non metastatic breast cancer (ie: no spread to other organs) is broadly considered in 2 categories: Early stage (I to IIB) and Locally Advanced (IIb to IIIc). Early stage breast cancer affords the patient the option of Breast Conserving Therapy otherwise known as lumpectomy coupled with radiation. You get to save your breast! It is important that you discuss with your management team, your eligibility for this method, because recent studies have demonstrated equivalent disease-free and overall survival between mastectomy and breast conserving therapy. (ie: saving part of the breast)

If you are not eligible for breast conserving therapy, or it is not your preference, mastectomy is your next option, along with radiation and systemic therapy – ie: chemotherapy, endocrine therapy and/or biological therapy. The characteristics (genetic and hormonal) of the tumour dictate which patients are likely to benefit from each of the above-mentioned therapies. For locally advanced cancer, the goal of treatment is to shrink the tumour before surgery; hence systemic therapy is now administered before surgery.

Sadly, 5% of breast cancer is metastatic, that is, spread to other organs at the time of diagnosis. Although metastatic breast cancer is unlikely to be cured, there have been meaningful improvements in survival with the use of systemic therapy.

Non metastatic breast cancer, especially early stage breast cancer has a very good prognosis. Studies have shown that recurrence, if they do happen; occur mostly within the first 2 years of diagnosis; however there have been recurrences recorded long after. It is therefore important that survivors of breast cancer maintain a strict annual follow-up fos close surveillance.