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With focus on prevention and detection, fewer women dying of breast cancer

Gazette (Colorado Springs, CO)


Oct. 01--Breast cancer is a disease that can confound what seems like basic logic.

"Every day I see women in my clinic who say, 'I did everything right, I exercised, I ate right; what did I do wrong?'" said Dr. Uchenna O. Njiaju, an oncology specialist with Memorial Hospital. "I tell them, 'You're a woman.' That's the single biggest risk factor."

Each year in the U.S. more than 200,000 cases of breast cancer are diagnosed among women and about 2,000 cases among men. It's estimated that one in eight American women will develop breast cancer during her lifetime. Of those, one in 36 will die from the disease.

Breast cancer likely has existed as long as humanity. The father of Western medicine, Hippocrates, wrote about it in 460 B.C. as a systemic disorder of the humors, a theory that held until the Age of Enlightenment, when it was proposed that the disease was localized in tumors that could be removed surgically. Through the mid-20th century, radical mastectomy was the preferred treatment, but by 1995 only one in 10 women were undergoing this procedure.

While there's still no cure, modern treatments are more individually tailored and less brutal to the body. With the evolution of radiation and chemotherapy, as well as advancements in detection, drugs and breast-conserving surgery, a breast cancer diagnosis no longer means death, disfigurement or even necessarily prolonged discomfort. The focus today is on awareness, prevention and management.

"Gone are the days when every single person through the door got a whole panel of chemotherapy that made her sick," Njiaju said. "Most people who end up with breast cancer can go through therapy with some comfort, with a relatively decent quality of life and with their dignity intact.

"We've also gotten very good at supportive care. Nobody should be at home all day throwing up alone. Rest assured, such things are not the norm."

In the past decade, intensified research and clinical studies have led to a wealth of information about the genetics of the disease, which manifests in multiple iterations of varying aggression, and revealed risk factors, or "markers," that appear to predispose certain populations. Doctors are now able to identify inherited gene mutations that exponentially increase a woman's odds of developing the disease.

As for firm answers, though, there are few. Data from clinical studies often exist without the context necessary for true scientific insight. And, while mortality rates in the U.S. continue to drop and women are living longer and better with the disease, the number of cases diagnosed annually is rising.

According to a study by researchers at the University of Washington, between 1980 and 2010 the number of new breast cancer cases jumped from 640,000 a year to more than 1.6 million worldwide.

"Without a doubt, incidents have increased over time," Njiaju said. "That may have to do with better screening and detecting, but it may have to do with lifestyle."

Part of the blame lies with Americans' increasing life span. Approximately one in 200 women younger than 40 develop the disease. That ratio leaps to one in 27 between the ages of 40 and 59.

Some studies suggest that a youthful diet high in animal fats can increase risk. Other research has found that women taller than 5-foot-9 face a 20 percent greater risk of developing the disease than those 6 inches shorter. Women who start their periods at a young age and those who are older than 35 at the time of their first pregnancy might face increased risks, as might women who've never carried a pregnancy to term.

Add to that the usual suspects -- family history, alcohol, tobacco, bad diet -- and it's no wonder many are left wondering what doesn't represent a potential risk factor.

"It's just a lot of associations but no clear causations," Njiaju said. "That's the first step, to find what's associated and then see if there's a secondary association."

The hope is that, eventually, all those threads will lead researchers to something concrete that can be used to battle the disease.

Njiaju acknowledges that the constant influx of information, studies and recommendations can seem overwhelming. It's still effective ammunition.

"This actually gives a woman a chance to do something about certain things, like cutting back alcohol intake. Or, if you want to have a child and you can have the good fortune to be able to have a child early, then have a child early. If you're going to have a child and breastfeed, then breastfeed for a longer time," she said. "I think that to be informed is to be empowered, and being empowered helps defray fear."


(c)2013 The Gazette (Colorado Springs, Colo.)

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