HCA Midwest Physicians October 17, 2013

Dr. Stephanie L. Graff, medical oncologist

by Linda Cruse, special sections contributing writer | Paid Advertising Supplement, Kansas City Star Magazine

Women with breast cancer are reporting better outcomes thanks to improved methods of early detection combined with the physicians’ ability to genetically analyze tumors.

“Survival rates continue to improve, which reflects both earlier detection and more targeted treatments,” said Dr. Timothy Pluard, medical director of Saint Luke’s Cancer Institute.

Not only are women being treated for their specific type of breast cancer, they are also experiencing fewer side effects from that treatment, which is the result of recently improved medications, he said.

Early detection

New technologies such as breast tomosynthesis, or 3-D mammography, are improving early detection of breast cancer, said Dr. Amy

Soetaert, breast radiologist at Saint Luke’s Hospital. Starting this month, 3-D mammograms are available at all four of Saint Luke’s facilities. Soetaert said the 3-D machine takes multiple images at various angles and then creates slices of images that can be viewed by the radiologist. “The process eliminates the overlapping tissue where cancer can hide,” she said.

While the new technology is beneficial for all women, it’s especially beneficial for women with dense breast tissue, she said.

Dr. Jamie Wagner, breast cancer surgeon at The University of Kansas Hospital, said 3-D mammography is one of the early detection tools available at the Richard and Annette Bloch Cancer Care Pavilion. Another tool is the Automated Breast Ultrasound (ABUS), which is also beneficial for women with dense breast tissue.

“When ABUS is done in conjunction with mammography, we’re seeing a 60 percent increase in breast cancer detection,” she said.

3-D mammography patients

Three local patients credited 3-D mammography with detecting their breast cancer. One is Judy Junk, a nurse at Saint Luke’s Hospital. She was excited to learn that 3-D mammography was coming to Saint Luke’s and delayed her annual mammogram in order to take advantage of the new equipment.

“I have dense breast tissue and I’m often called back for additional screening,” she said, “so I was excited to try the new equipment.”

Junk, of Lenexa, is glad that she did. The new equipment detected stage 0 breast cancer. “I was thrilled it was detected so early,” she said. “It’s almost amazing how early they can detect something now.”

Duonna VanBuskirk, 53 and a mother/baby nurse at Saint Luke’s Plaza location, also decided to take advantage of the 3-D mammography at Saint Luke’s.

“I had been told by my OB/GYN that I had dense breasts and I knew the 3-D equipment could pick up smaller changes in the breast,” said VanBuskirk, of Lee’s Summit. “I credit the 3-D mammogram with finding the cancer.”

VanBuskirk had a 3-D mammography last October, followed by an ultrasound. The following Monday she received a breast cancer diagnosis. She had a partial mastectomy two days later, followed by radiation treatment.

Carol Macey, 55, had a 3-D mammography at the Richard and Annette Bloch Cancer Care Pavilion in April, followed by ultrasound. She learned after a subsequent biopsy that she had breast cancer.

Macey, of Kansas City, said she transferred to a KU physician before learning she had breast cancer. “I wanted to be at a National Cancer Institute-designated facility in case I ever had cancer,” she said. “Every step of the way has been handled well, and I have been confi dent throughout my diagnosis and treatment.”

Self-exams still important

Not all cancers are being detected solely with new technologies. Tori Burch, 40, Olathe, considers herself lucky to have detected her breast cancer before her first mammogram.

The American Cancer Society recommends yearly mammograms starting at age 40. However, Burch had not scheduled a mammogram when she began having pain in her breast. A self-exam led to discovery of a lump.

“I saw an OB/GYN at Overland Park Regional Hospital and they conducted a mammogram,” she said. “However, it’s in a difficult place and didn’t show up on the mammogram. They then did an ultrasound, which showed a tumor.”

Dr. Stephanie L. Graff, medical oncologist at Menorah Medical Center and Research Medical Center, said studies have shown that mammography misses about 17 percent of breast cancers. “Self-breast exam is extremely valuable and made all of the difference in Tori’s life,” she said. “If a woman has an abnormal self-breast exam or breast symptoms that she’s concerned about, she should always talk to her doctor or a breast health expert.”

Treatment

In addition to improvements in early detection, Pluard said breast cancer treatment is rapidly improving thanks to the ability to genetically analyze breast cancer tumors.

“We are segregating breast cancer with the goal of determining the correct treatment,” he said. “As the ability to genetically analyze breast tumor cancers increases, we expect to see much better outcomes and fewer side effects.”

Dr. Anne Kobbermann, breast surgical oncologist at Overland Park Regional Medical Center, said oncologists are “no longer taking a cookie-cutter approach to treatment. We know a lot more about the biology of individual tumors and we can tailor treatment to each specific disease.”

Wagner said understanding the genetic makeup of the tumor clarifies whether it has a low, intermediate or high risk of recurrence.

Pluard said the three main types of breast cancer tumors are estrogen dependent, HER2-positive and triple negative. He said a new drug approved this year for patients with HER2-positive late-stage breast cancer links Herceptin and chemotherapy, carrying chemotherapy directly to the cell. “In large part it’s eliminated the side effects of nausea, vomiting and hair loss,” he said, “because the chemotherapy stays attached to the Herceptin until it gets inside the cell.”

Preventive mastectomy

Kobbermann said many patients have asked her about actress Angelina Jolie’s decision to undergo a preventive double mastectomy after learning she carries a gene that increases her risk of developing breast and ovarian cancer.

“People with the genetic mutation carried by Angelina are at a much higher risk of development breast and ovarian cancer,” she said. “There are specific guidelines to determine if you should be genetically tested.”

Wagner said, “There are patients who will benefit from a prophylactic mastectomy. It’s up to us to provide the information they need to make that decision.”

Both Saint Luke’s and The University of Kansas Hospital offer genetic counseling programs designed to help women identify their genetic risks. Gene testing and counseling are provided to help women make informed choices. Both also offer a high risk breast clinic for women who have a higher than average risk of breast cancer.

Macey made the decision to have a double mastectomy because she tested positive for a BRCA1 gene mutation. She will undergo surgery at the end of September. “I’m confident this is the right step to take based on my situation,” she said. “The doctors have guided me well.”

According to the National Cancer Institute, 55 to 65 percent of women who inherit a BRCA1 mutation and around 45 percent of women who inherit a BRCA2 mutation will develop breast cancer by age 70, as compared to about 12 percent for the general population.

Together, BRCA1 and BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancers and about 5 to 10 percent of all breast cancers. They also increase the risk for ovarian and other cancers.

Reduce your risk

Kobbermann said that while some risk factors for breast cancer, such as family history, can’t be changed, other factors can be modified.

They include: not drinking more than two alcoholic drinks daily, maintaining an ideal body weight, staying physically active, avoiding a sedentary lifestyle and being cautious about hormone replacement therapy.