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The latest on breast cancer research and detection in Hall
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Northeast Georgia Medical Center's Angie Persyn, RN, works Tuesday, Oct. 25, 2022, inside the hospital's infusion unit. - photo by Scott Rogers

The pink ribbons are flying for breast cancer awareness month. 

October is a time when many women are reminded of the unsettling odds that the pink ribbon may one day take on a more personal significance. 

Women account for 99% of breast cancer diagnoses and deaths, and 1 in 8 women will develop breast cancer in their lifetime. Breast cancer is the second-most common cancer among American women, second only to skin cancer. Every year, nearly 280,000 women are diagnosed with breast cancer, and more than 43,000 die from it.

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Tracie Giles, PCT, watches a blood pressure machine Tuesday, Oct. 25, 2022, while working with a patient inside the Northeast Georgia Medical Center infusion room. - photo by Scott Rogers

Fortunately, improvements in treatment and diagnostic capabilities have enabled clinicians to detect breast cancer earlier and improve the odds of survival. 

“It is, most of the time, a very treatable cancer,” said Emily Black, a general surgeon with the Northeast Georgia Physicians Group who performs about a quarter of her surgeries on breast cancer patients. 

The average survival rate for breast cancer patients is 90%, and it reaches 99% when a tumor is detected in its early stages before it has spread beyond the breast tissue. 

“I think early detection is the biggest key,” said Geoffrey Weidner, medical director for radiation oncology at the Northeast Georgia Health System. “Making sure women are getting their mammograms when they're supposed to doesn't prevent breast cancer, but that helps catch it when it's in an earlier, curable stage.” 

Screening allows women to catch breast cancer early and stop it in its tracks, but is there anything they can do to prevent it in the first place? Some researchers say yes. 

“Lifestyle factors are very important for lowering risk of breast cancer,” Marji McCullough, senior scientific director of epidemiology research for the American Cancer Society, said over email. “It’s estimated that approximately 29% of breast cancers could be prevented by maintaining a healthy weight, avoiding alcohol consumption and being physically active.” 

Eating a healthy diet rich in fruits and vegetables is also associated with a lower risk, she said. In particular, soy foods such as tofu, soy milk and edamame may lower the risk of breast cancer recurrence, though more research is needed. The American Cancer Society recommends against soy supplements. 

Black said improvements in imaging technology have allowed clinicians to detect breast cancer sooner. “We’re certainly diagnosing it earlier and earlier because our imaging has gotten that much better,” she said. 

She said mammograms that offer 3D imaging have led to a decrease in the number of unnecessary biopsies and an increase in the number of true diagnoses. 

“Not only does it decrease the false positives, but it also increases the true positives,” she said. Whereas with 2D imaging, “if you have dense breasts, overlapping tissues can kind of confuse the mammographer and can look like a mass when there's not really one there.” 

But Charles Nash, medical director of oncology services and research at the NGHS, said the jury is still out on whether 3D imaging is actually better than its 2D counterpart. 

He said more than 240 patients at NGHS are participating in a national trial, called TMIST, involving more than 165,000 women to determine whether 3D imaging outperforms 2D imaging in the detection and treatment of breast cancer.

“A lot of radiologists have begun to adopt this (3D) technology, but in cancer medicine we are determined to have data behind whatever we finally recommend to our patients,” Nash said of the TMIST study. 

He said there is a tendency to favor the “newer, flashier model,” but until the data are in, clinicians won’t know whether the 3D imaging is actually more effective or whether it’s worth the extra cost. Nevertheless, he added, “diagnostic efficacy has improved.” 

“And we also now have computer-assisted diagnosis where the radiologists’ read can be enhanced by a separate computer read of what they're seeing on the mammogram,” he said. “You put all that together, you're going to get a more complete diagnostic picture, and that's one of the things where the radiologists are really happy with some of the new technologies that are coming out.” 

Regardless of which type of mammogram wins out, experts agree that any mammogram tends to be better than no mammogram. 

“You can catch the cancer before it's even large enough for you to feel it,” Black said. “So before you ever even have a true lump, you find it when it's just calcifications or something that's only a couple millimeters in size, which you would never have known about without the mammogram.” 

Nevertheless, there is a problem called “overdiagnosis,” whereby a benign tumor is detected during a mammogram and treated on the assumption that it is malignant. 

The most recent study, published earlier this year in the Annals of Internal Medicine, estimates that about 15% of breast cancer cases identified during screening turned out to be overdiagnosed. In these cases, the cure can be worse than the disease. Patients may undergo a cascade of aggressive treatments — surgery, radiation and chemotherapy — on a tumor that would have otherwise remained harmless. Still, the benefits of mammograms are believed to outweigh the risks. 

Black recommends that women start getting mammograms once they reach the age of 40. However, women with a family history of breast cancer should consider screening even earlier. 

“The typical rule there is that if you have a first-degree relative with breast cancer, your screening should start 10 years younger than however old they were when they were diagnosed,” she said. For these women, she recommends 3D imaging because it is better at detecting tumors in dense breast tissue, which is more typical of younger women. 

Women can also talk to their doctors about genetic testing. It is estimated that about 5% to 10% of breast cancer cases are hereditary. People who inherit mutations of the BRCA1 or BRCA2 gene, for example, can have a lifetime breast cancer risk of 80%. 

“Those are the patients that we actually talk about risk reduction surgery, so basically having a mastectomy before you have cancer to prevent getting it in the first place,” Black said. 

But women without these predispositions should not be lulled into a false sense of security, she said, because most breast cancers occur in women without any family history. 

“Just because you don't have a family history does not mean you don't need screening,” she said. “Screening works best when we do it in patients who can't feel anything in their breast. If you wait until you can feel a mass, then you're actually waiting until it's at a more advanced stage.”

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Northeast Georgia Medical Center's Kim Meeks, RN, works Tuesday, Oct. 25, 2022, inside the hospital's infusion unit. - photo by Scott Rogers