Breast Cancer Simplified

jeastridge, BSN, RN

My phone lit up with a message from a friend in a nearby town. "Let's get together for lunch this week.” I responded with, "Sure, what's up?” Her answer made me sit down. "Breast cancer.”

Breast Cancer Statistics

The "C" word is met with foreboding by us all, but breast cancer brings along with it a special dread to women: possible breast-altering surgery, treatment that can include chemo and radiation and the increasingly less likely risk of death. With statistics showing that according to the National Cancer Institute (NCI), "12.8% of women born in the United States today will develop breast cancer at some time during their lives,” and "2.6% of women in America will die of breast cancer.¹

As scary as that statistic is, the NCI emphasizes that the same numbers also show that there is a 7 out of 8 chance that an individual woman will NOT have breast cancer in her lifetime. All the statistics invite us to careful monitoring, including regular mammograms after age 40 or 50 for women with average risk. Additionally, many physicians recommend genetic testing such as for BRCA gene if there is a higher than average family history of breast cancer or any ovarian cancer.

How to Reduce Your Risk

All women have the opportunity to adhere to healthy lifestyle choices that can help decrease their chances of getting breast cancer including²:

Limit alcohol. Greater alcohol intake=greater risk.
Don't smoke.
Weight control.
Physical activity.
Breastfeed.
Limit duration and dose of hormone therapy.
Avoid radiation and environmental pollution.

Treatment Options

As professional nurses, we often get asked questions about breast cancer and treatment options. Unless we are actively working in the field, we are not usually qualified to answer questions and often must refer to others or to reliable published material. However, it is important for us to stay up-to-date and understand some of the more recent changes in breast cancer treatment.

Staging

According to LaCosta Brown, RN, MSN, OCN, a nurse navigator for breast cancer, a lot has changed in staging breast cancer since January 2018. Previously, staging involved one sheet of paper, one chart essentially, and noted tumor size (T), nodal status (N), and metastasis (M). The TNM staging method had been around for a number of years and served as the guide to defining surgery and treatment options. However, for the past 2 years, grade and biomarkers are also taken into consideration. The total picture is the TMN + G + B.

Grade

Grade refers to how abnormal the cancer cells are when examined under a microscope and range from G1 - Well-differentiated (low grade) to G3 - Poorly differentiated (high grade). Essentially, the higher the grade the faster the spread of the disease.

Biomarkers - HER2neu

Biomarkers include estrogen receptors, progesterone receptors and HER2neu (Human epidermal growth factor) status. 80% of tumors are hormone-positive and thus respond to treatments that help to curb their growth, treatments that include drugs like Tamoxifen and Arimidex. So if cancer responds to hormones, it is Estrogen or progesterone positive and therefore would respond to these drugs that specifically work to slow down and impede tumor growth and spread. These long term "chemo pills" are generally used for 5 years. This anti-hormonal therapy can prevent breast cancer re-occurrence.

HER2 is a protein that when present can cause cell growth and survival. Being HER2 positive opens up the possibility of treatment with Herceptin or Perjeta. HER2 presence is considered, according to Brown, as a "foot on the gas. It is go-go. The treatment modalities of Herceptin and Perjeta put on the brakes and slow or stop the growth of the tumor cells.”

According to the CDC, if cancer is the "house" the 3 markers are "keys" that can help treatment get inside and destroy or slow down the cancer cell. If the "house" doesn't have any one of the 3 keys, it is called "triple-negative.”Triple-negative breast cancers, or those that don't respond to anti-hormonal treatment, make up less than 20% of all breast cancers. Along with surgery, the treatments include chemotherapy.³

Immunotherapy for breast cancer is also a growing field and one where promising research is being done.

The new methods of precision evaluation breast cancer include genetic profiling of the tumor specimen and are much more specific and helpful in terms of specifying treatment options and helping patients decide how to proceed.

New Treatment Options

In years past, radical mastectomies were the treatment of choice for most breast cancers. As medical knowledge and treatment options have developed in recent years, more women are able to get simple lumpectomies and follow that up with the appropriate treatment given their staging. They may be able to have sentinel node identified at the surgery for biopsy instead of removing all the axillary nodes, reducing the problem of lymphedema of the arm after surgery.

My friend and I met for lunch and talked at length about her plans for surgery and follow up treatment. Along with the technical and medical conversation, we reconnected with each other's lives, offering one another emotional and spiritual support, realizing that as important as all of the staging and drugs and treatment info is, so also is the support we offer one another when going through diagnosis and treatment.

References

American Cancer Society- https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
Mayo Clinic - Breast Cancer Prevention: How to Reduce Your Risk - https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676
Centers for Disease Control and Prevention: Triple-Negative Breast Cancer https://www.CDC.gov/cancer/breast/triple-negative.htm