A Team Approach To Breast Cancer Treatment
Tran says older patients or anyone diagnosed with breast cancer can benefit from getting care at a comprehensive center, such as the one where she performs surgery: the Sullivan Breast Center at Sibley Memorial Hospital in Washington, D.C.
Our team meets weekly to discuss individual patients cases, and that helps us bring the best thinking to each persons treatment plan, Tran says. Our combined experience supports every patient.
Breast Health Services
Treating Breast Cancer In People Age 70 And Up
Older age increases the risk of several types of breast cancer. But advancements in diagnosis and highly individualized treatment plans are increasing the odds of recovery for older patients and making it possible for many to live longer, healthier lives.
Breast surgeon Hanh-Tam Tran, M.D., explains what people age 70 and older should know about being diagnosed with breast cancer and why theres reason for hope.
If I Have Invasive Breast Cancer Do I Have To Have A Mastectomy
Mastectomy is one treatment for invasive breast cancer, but it isnt required in all cases, Tran says, especially now. Which treatments your doctor recommends and the order in which theyre given depend on several factors.
For example, she says, You and your doctor may decide that the best option for you is to undergo chemotherapy first. Chemotherapy can shrink the tumor and melt part of it away, so it is small enough to be managed with a lumpectomy instead of a full mastectomy.
If surgery is the best choice for you, new advancements for breast-conserving surgery and mastectomy with reconstruction can offer alternatives that preserve your appearance and self-image, such as oncoplastic breast reduction, nipple-sparing mastectomy, aesthetic flap closure and other techniques.
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What Are The Risk Factors For Breast Cancer
A risk factor is anything that increases a person’s chance of getting a disease. Different cancers have different risk factors.
However, having a cancer risk factor, or even several of them, does not necessarily mean that a person will get cancer. Some women with one or more breast cancer risk factors never develop breastcancer, while about half of women with breast cancer have no apparent risk factors.
Significantly higher risk
- History. A woman with a history of cancer in one breast, such as ductal carcinoma in situ or invasive breast cancer, is three to four times likelier to develop a new breast cancer, unrelated to the first one, in either the other breast or in another part of the same breast. This is different than a recurrence of the previous breast cancer.
- Age. Your risk for breast cancer increases as you age. About 80% of women diagnosed with breast cancer each year are ages 45 or older, and about 43% are ages 65 or above. Consider this: In women ages 40 to 50, there is a one in 69 risk of developing breast cancer. From ages 50 to 60, that risk increases to one in 43. In the 60 to 70 age group, the risk is one in 29. In women ages 70 and older, one in 26 is at risk of developing the disease.
Moderately higher risk
Slightly higher risk
- Less lifetime exposure to endogenous estrogen. Having a pregnancy before age 18, starting menopause early, and having the ovaries removed before age 37 decreases the risk of developing breast cancer.
Understanding Your Risk Of Breast Cancer
Several breast cancer risk assessment tools have been developed to help people estimate their chance of developing breast cancer. The best studied is the Gail model, which is available on the National Cancer Institutes website at www.cancer.gov/bcrisktool. After you enter some personal and family information, including your race/ethnicity, the tool provides you with a 5-year and lifetime estimate of the risk of developing invasive breast cancer. Because it only asks for information about breast cancer in first-degree family members and does not include their ages at diagnosis, the tool works best at estimating risk in people without a strong inherited breast cancer risk. In addition, it cannot be used by patients who have a personal history of breast cancer to determine their risk of developing a new breast cancer. For people with a personal history of breast cancer or a strong family history of breast cancer, other ways of determining their risk of breast cancer may work better. People with a strong family history of breast cancer risk should consider talking to a genetic counselor.
It is important to talk with your doctor about how to estimate your personal risk of breast cancer and to discuss risk-reducing or prevention options .
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Your Personal History Of Breast Cancer
If youve been diagnosed with breast cancer in the past, you are more likely to develop a new cancer in the other breast or in another part of the same breast. This is not considered a recurrence but a new breast cancer.
What to do: Follow your cancer teams instructions on monitoring to stay on top of this risk. Ask your doctor whether you should see a genetic counselor.
What Are The Pros And Cons Of Genetic Testing For Breast Cancer
Genetic testing is not 100% accurate. If a test is negative, a person still has a chance of getting breast cancer. If the test is positive, there is still a chance of not getting breast cancer.
Genetic testing is costly, ranging from about $400 to more than $3,000, depending on the type of test. Insurance coverage varies.
The results of genetic tests won’t be available for several weeks. The length of time it takes to get results depends on the tests performed and under what circumstances they are done.
Legislation has been enacted to protect people who may have a documented genetic risk of cancer from employment or insurance problems. The best thing you can do is to become involved with an established genetic registry that can counsel people who have a genetic risk for cancer.
But for some people, genetic testing may help you make informed medical and lifestyle decisions while easing the anxiety of not knowing your genetic background. You can also make a decision regarding prevention, with both medications and prophylactic surgery. In addition, many people take part in medical research that, in the long run, may lower their risk of death from breast cancer.
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Can I Do Genetic Testing At Home
Yes. There are several options for genetic testing that can be done on your own. Companies like Veritas Genetics and Color Genomics offer testing kits that look for BRCA1 and BRCA2. You will need a doctorâs approval to order the kits. Both companies can connect you with a health care provider to get the necessary approval and help explain the results. These tests are usually more affordable than tests ordered through a hospital but can miss key mutations that could clue doctors into a possible breast cancer diagnosis.
What Are Dense Breasts
Breasts contain glandular tissue, fibrous connective tissue, and fatty breast tissue. Breast density is a term that describes the relative amount of these different types of breast tissue as seen on a mammogram. Dense breasts have relatively high amounts of glandular tissue and fibrous connective tissue and relatively low amounts of fatty breast tissue.
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How Does Age Affect A Womans Risk Of Breast Cancer And What Can She Do About It
City Of Hope Orange CountyWade Smith, M.D.Linda Buck, N.PWhy are older women more at risk for breast cancer? Smith:Are there lifestyle changes or preventive steps that older women can take to reduce their breast cancer risk?Buck:Does breast density affect breast cancer risk? Smith:Do breast cancer screening recommendations change based on age?Smith:
- Self-check. A monthly self-exam of your breasts can help you identify concerning changes.
- Clinical exam. For most women starting at age 20, your physician will perform a physical exam of your breasts once a year during your well woman visit.
- Ultrasound. Breast ultrasound uses sound waves to produce images of the structure of the breast. It can be used as an alternative to or in conjunction with a mammogram.
- MRI. An MRI creates images of the breast using a magnetic field, and like an ultrasound it can be used instead of or in addition to a mammogram to screen for breast cancer.
- Genetic testing. If you have a family history of breast cancer, your doctor may recommend genetic testing. This will help determine if you have a genetic mutation that elevates the risk of breast cancer.
Hope is growing at . Our new in Huntington Beach, Newport Beach Lido and Irvine Sand Canyon join City of Hope Newport Beach Fashion Island to form a four-location network of highly specialized cancer care. To make an appointment at any of our four Orange County locations, or call:
What Does It Mean To Have Dense Breasts
What does it mean to have dense breasts? Dr. Temeika Fairley explains in this video.
A mammogram shows how dense your breasts are. When you get the results of your mammogram, you may also be told if your breasts have low or high density. Women with dense breasts have a higher risk of getting breast cancer.
Factors That Affect Breast Cancer Risk
According to the Centers for Disease Control and Prevention , youre more likely to develop breast cancer at a young age if:
- You have close relatives who received a diagnosis of breast cancer at a young age or a diagnosis of ovarian cancer at any age.
- You have changes in the genes BRCA1 or BRCA2 or other breast cancer genes, or you have close relatives with changes in those genes but you havent been tested yourself.
- You have Ashkenazi Jewish heritage.
- You received radiation therapy to your breast or chest when you were a child or young adult.
- Youve had other breast conditions in the past.
- Your doctor has told you that you have dense breast tissue.
Talk with your doctor about your personal and family medical history. They can help you assess and manage your risk of breast cancer.
The following factors about your personal health and lifestyle might affect premenopausal breast cancer risk, per a 2017 World Cancer Research Fund report:
Younger adults tend to develop forms of breast cancer that are more aggressive or harder to treat than those that typically affect older adults.
For example, younger adults are more likely to develop:
- estrogen receptor -negative breast cancer
- progesterone receptor -negative breast cancer
- breast cancer with high levels of human epidermal growth factor receptor 2
Early detection and treatment are important for improving breast cancer survival at any age.
Screening And Breast Density
Screening is not routinely performed in women under 50 years.
Dense breast tissue looks solid and white on a mammogram . You cannot see through it. This makes the mammogram more difficult to read.
It means lumps or areas of abnormal tissue are harder to spot. This is why screening using mammograms is less effective for women with dense breasts.
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What Are Screening Options For Breast Cancer
Breast cancer survival rates are highest when detected at an early stage. Screening options for breast cancer include the following:
- Mammograms: Can detect breast cancer at an early stage and enhance overall survival
- Breast ultrasound: Sometimes used as a screening test although it is most beneficial as a follow-up test following a clinical examination or mammography.
- Breast magnetic resonance imaging scan: Used to screen women younger than 50 who are at a high risk of breast cancer.
- Self-examinations: Involves regularly checking your breasts for lumps, which can help with early detection.
- Blood chemistry study: Blood sample is examined to determine the levels of certain chemicals produced in the blood by certain organs and tissues.
- Biopsy: Involves removing cells or tissues to check for signs of malignancy.
- Genetic testing: May be an option if you have a family history of breast cancer.
Having Had Radiation Therapy
This risk varies with age and is highest in people who were in their teens when they had radiation treatment. According to the
A number of lifestyle factors can increase someones risk of breast cancer. Being aware of these factors can help them reduce their breast cancer risk.
These lifestyle factors include:
- Being inactive: Physical inactivity increases a persons risk of breast cancer. Getting regular exercise may help reduce this risk.
- Taking hormones: Some types of hormone replacement therapy and hormonal birth control may increase the risk of breast cancer. Finding nonhormonal alternatives may reduce a persons chance of developing breast cancer.
- Being overweight after menopause: After menopause, people who are overweight are more likely to develop breast cancer. Maintaining a healthy weight may help reduce breast cancer risk.
- Drinking alcohol: According to the
What You Need To Know
- According to the National Cancer Institute, women 70 and older have a 1 in 24 chance of developing breast cancer at some point in their lives. Men can also get breast cancer.
- Treatment which could include surgery, hormone-blocking pills, targeted radiation or a combination of these therapies depends on the characteristics of the tumor. Chemotherapy is used occasionally.
- Healthy, active, independent patients have the best chance of a good outcome.
Health Disparities In Young African Americans
In addition to these unique issues, research has shown that young African American women face even greater challenges.
- African American women under age 35 have rates of breast cancer two times higher than caucasian women under age 35.14
- African Americans under age 35 die from breast cancer three times as often as caucasian women of the same age.14
- Researchers believe that access to healthcare and the quality of healthcare available may explain these disparities. But scientists continue to investigate.
- Research also shows that young African Americans are more likely to get aggressive forms of breast cancer than anyone else.14
Is Breast Cancer Hereditary
If you have breast cancer, chances are itâs not caused by a faulty gene you were born with. Most of the time, genes that lead to the disease mutate sometime during your life and arenât an inherited problem.
But in about 5% to 10% of cases, the cause is hereditary. This means that the cancer is due to a gene change, called a âmutation,â thatâs passed down from a parent.
Researchers have identified hundreds of genes linked to breast cancer, but some seem to play more of a role than others.
Just because you have an inherited gene mutation doesnât mean youâll definitely get breast cancer. It only means you have a greater chance of it happening.
What Happens During Genetic Testing
The genetic counselor will do a family pedigree to detect high-risk patterns. A family pedigree is a chart that shows the genetic makeup of a person’s relatives. Itâs used to analyze traits or diseases that are passed down through a family.
Then, youâll have a blood test to learn whether you have a breast cancer gene. Keep in mind that the vast majority of breast cancer cases are not linked to a breast cancer gene. In addition, scientists do not know all of the genes that can cause breast cancer, so they can test you only for the known genes.
When someone with a cancer diagnosis and a family history of the disease is found to have an altered BRCA1 or BRCA2 gene, the family is said to have a “known mutation.” If thereâs a link between the development of breast cancer and a breast cancer gene, then all family members willing to have genetic testing are asked to give a sample of blood. For many people, knowing their test results is important because this information may help to guide health care decisions for themselves and their families.
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What Is The Best Breast Cancer Treatment For Older Patients
In gauging which treatment might be best for an individual, Tran looks at the characteristics of the tumor. This can help identify tumors that are likely to respond to hormone-blocking therapy alone and those that may respond to other modes of treatment.
Genomic breast cancer tests can map the genome of the cancer cells and help reveal their sensitivity to hormone-blocking treatment, chemotherapy or both. Though Tran says oncotype tests are not appropriate for every patient, for some people with invasive cancers that are larger than 0.5 centimeters and estrogen positive, the tests can provide information on how likely a particular cancer is to return after therapy.
Tran says that in late 2019 and early 2020, genomic tests for breast cancer were improved, and they can now yield clues on more advanced breast cancers, even those that have infiltrated the lymph nodes. Using these data, your doctor is better prepared than ever to recommend a treatment plan to bring breast cancer under control.
Having Radiation To Your Chest
Women who were treated with radiation therapy to the chest for another cancer when they were younger have a significantly higher risk for breast cancer. This risk depends on their age when they got radiation. The risk is highest for women who had radiation as a teen or young adult, when the breasts were still developing. Radiation treatment in older women does not seem to increase breast cancer risk.
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