During the 1990’s, it is estimated that approximately 2.5 million new cases of breast cancer alone have been diagnosed. It is currently the second leading cause of cancer-deaths among women, ranking only behind lung cancer. Yet, despite the increase in the number of cases seen each year, the risk of dying of this disease (mortality rate) has remained unchanged over the last thirty years. These numbers appear to be changing, however, due to numerous advances in the past years in the prevention, detection, and treatment of breast cancer. These advances include improved screening for earlier detection, improved surgical techniques, newer medicines, and behavior modifications for the chemo prevention of breast cancer.

Early mammography in women with an increased risk of breast cancer has led to earlier diagnosis of the disease. Roughly thirty percent of all newly diagnosed breast cancer is ductal carcinoma in-situ (DCIS). This is a form of breast cancer that is non-invasive, has a very low risk for lymph node/distant metastasis, and a much better overall survival rate. Furthermore, DCIS is treated with less radical surgical techniques. Another advance in early diagnosis is stereotactic breast biopsy. This invasive, non-surgical technique allows us to diagnose mammographic abnormalities that have not yet progressed to palpable lesions without the need for surgery.

The diagnosis of invasive breast cancer is one of the most devastating physical and emotional agonizing events that a woman can experience. Not only is there the diagnosis of cancer, but until recently, the permanent physical disfigurement that accompanies the treatment of breast cancer. In the most current study by the National Cancer Database including 96,000 women, breast conservation therapy (lumpectomy and radiation therapy) was comparable to mastectomy in regard to overall survival. Moreover, there have been vastly improved reconstructive technique that have made a significant impact in the management of breast cancer in the 1990’s. Another development in the surgical treatment of breast cancer is Sentinal Lymph Node Biopsy. Breast cancer spreads to the axillary (underarm) lymphatics via lymph channels in the breast. Until now, all lymphatics are removed (axillary dissection) in the treatment of breast cancer leaving the patient at an increased risk for swelling and lymphedema of the involved arm. Yet, if we remove only the first node to which the cancer spreads, test it for the presence of metastasis, we may avoid axillary dissections in a certain number of patients without compromising survival rates.

The most promising advances in breast cancer, however, may be in "chemo prevention". This includes or will include genetic screening, dietary modification, and hormonal therapy. An example of this is the landmark study just completed by the National Surgical Adjuvant Breast Project (NSABP) which revealed that women with a high risk of breast cancer decreased their chance of developing the disease by 45% by taking the drug Tamoxifen for a period of five years. Another interesting aspect is the link between dietary fat and the risk of breast cancer. No definitive proof has been demonstrated, but further testing is currently ongoing.

As one can see, there have been many advances in the management of breast cancer in the past five years. The key remains to follow your doctor’s recommendations for early screening and early detection. If these practical guidelines are followed by the general population, we are certain to see a decrease in the mortality rate of breast cancer over the next thirty years.