Beyond the headlines: Survival, breast screening, scans in metastatic breast cancer
LBBC’s July column shares our views on breast cancer news
As I wrote this month’s column, I was struck at how important it is that we identify which people need the most help when it comes to breast cancer treatment.
Despite all we’ve learned about breast cancer over the last few decades, we still have trouble figuring out which cancers are most likely to be lethal, which individuals are most vulnerable to toxic side effects, and who needs to be followed most carefully to ensure they live as long as possible with the best quality of life. The answer, of course, is everyone, but with technology and medicine becoming more and more tailored, it’s our responsibility to identify the most vulnerable — and to focus our resources on them.
Read on to learn more about early-stage survival outcomes, the use of supplemental ultrasound screenings after mammograms, disparities in second cancers, PET-CT scans for staging, and side effects, as well as a tribute to Susan Love and Mit Joyner from Jean Sachs, LBBC’s CEO.
Reasons for hope (with limitations)
The internet was abuzz after a UK-based study showed risk of death from early-stage breast cancer decreased over time. Looking at breast cancer outcomes from the early 1990s through 2015, the researchers found the 5-year risk of dying was 14.4% for women diagnosed 1993 through 1999, versus 4.9% for those diagnosed 2010 through 2015. During the more recent period, when women would have received today’s standard treatments, the risk of breast cancer death was less than 3% for nearly 63% of women. Still, 5% of women had a disproportionately high risk of death, at more than 20%.
This study has some key limitations: it only followed women for five years, and the most common type of breast cancer — hormone receptor-positive — tends to recur later. It excluded people with metastatic disease and those who got pre-surgical chemotherapy. And it contained no information about racial and ethnic background. Nevertheless, this study shows that broadly across the population, people with early-stage breast cancer are living longer, most likely because of improved screening modalities, medications, surgery, and radiation therapy. Now we must focus on those with MBC and that 20%, finding cures for those at greatest risk.
Good, clear communication about prognosis can make a vast difference to a patient's quality of life, and how they can cope with things.
- Breast cancer mortality in 500,000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study (The BMJ)
- Early invasive breast cancer now leaves mostly long-term survivors (Medpage Today)
- Changes in early breast cancer outcomes from 1993 to 2015 (Eleanora Teplinsky on Instagram)
Related LBBC content
Don’t be dense about screening
Breast cancer screening guidelines can be confusing, even to doctors. One study shows physicians may not target those at highest risk for breast cancer who could benefit from breast ultrasounds, a supplemental test given after a screening mammogram. The study compared over 825,000 people who got screening mammograms without supplemental ultrasounds to 38,000+ who got supplemental ultrasounds. They found no differences in the risk factors for the two groups: participants all had high or heterogeneously dense breast tissue. This suggests doctors should be ordering supplemental screenings based on other risk factors, like family history and past benign breast conditions. If you’ve been told you have dense breasts, talk with your doctor about a tailored assessment of your risk so you can get personalized recommendations for screening, whether it’s ultrasound, MRI, or something else.
- Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone (Cancer)
- Breast ultrasound recs may not be targeting the right women (Medpage Today)
Related LBBC content
Disparities, beyond the breast
After breast cancer treatment, appropriate screening and surveillance — for all cancers, not just breast cancer — is vital to your health. In a study of nearly 40,000 women who’d had breast cancer, the risk of death from a second, new primary cancer was 12% higher among non-Hispanic Black women and 8% higher among Hispanic women compared to non-Hispanic white women. Compared to white women, non-Hispanic Black women were less likely to be diagnosed at a local stage, and Hispanic and non-Hispanic black women were more likely to need chemotherapy for a first and second cancer, the study found. Talk with your doctors about a tailored cancer screening plan.
A multipronged approach is needed to identify biological factors, and patient-, provider- and systems-level contributors to survival outcomes among breast cancer survivors.
- Racial and ethnic disparities in mortality among breast cancer survivors after a second malignancy (Journal of the National Cancer Institute)
- Black, Hispanic breast cancer survivors have higher mortality risk after a second malignancy (News-Medical.net)
- American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline (CA: A Cancer Journal for Clinicians)
Related LBBC content
- Black with breast cancer (hub) https://www.lbbc.org/black
- Our voices, our stories (video)
- From her experience to real-life help for others: Rosemary Carrera (blog)
PET-CTs for locally advanced breast cancer?
In an intriguing study of about 370 people, half the participants got standard screens to stage the cancer: bone scan and CT with contrast of the chest, abdomen, and pelvis. The other half did whole-body PET-CT, a different staging method. Among those with locally advanced disease, the PET-CT found more distant metastases than standard scans. This led to fewer people in the PET-CT group receiving multimodality therapy, or the combination of neoadjuvant chemotherapy, surgery, and radiation that is more common in non-metastatic cancers. We don’t yet know whether “upstaging” cancers leads to better survival, but we are excited for research to address this important question.
The study raises the question of ‘is finding something on PET and not on CT and bone scan clinically impactful’ and warrants further study. A significant limitation of this study is that most patients upstaged did not have a biopsy and, as such, there may have been false positive PET/CT readings.
- Systemic staging of locally advanced breast cancer: How hard to look? (Journal of Clinical Oncology)
- Impact of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography versus conventional staging in patients with locally advanced breast cancer (Journal of Clinical Oncology)
- PET-CT superior to conventional scans for spotting distant breast cancer mets (Medpage Today)
Related LBBC content:
Side effects: The struggle is real
We continue to see growing interest in tackling side effects of breast cancer treatment. An article on chemo brain, the brain fog and difficulty thinking many people experience during and after treatment, shares research on how cognitive behavioral therapy (CBT), exercise, and stress reduction help people regain focus and improve sleep. And a blog from Patti McGee focuses on the choice to stop anti-estrogen therapy because of side effects like hot flashes, vaginal dryness, mood changes, joint pain, and bone loss. Read LBBC’s recent story on this topic to learn about tools you can use to plan with your doctor and manage anti-estrogen side effects.
I knew that stopping the drugs increased the risk of cancer recurrence, but I also knew that I couldn't continue living with the emotional and physical toll they were taking on me.
- ‘Chemo brain’ is real, but there are ways to ease it (The Washington Post; gift link)
- My difficult decision to stop hormone therapy after breast cancer (Cure Today)
Related LBBC content
Mourning powerful voices
Cancer stole two inspiring women this month. They touched millions of lives, including mine. Early in my career I was fortunate to work with and learn from Dr. Susan Love in the young days of the National Breast Cancer Coalition. Susan was accessible, determined, honest, and compassionate. Her goal was to stop breast cancer forever, as well as to reduce the toxic side effects of treatment. After joining LBBC in 1996, I had the pleasure of working with Mit Joyner, LBBC’s second board chair and a past president of the National Association of Social Workers. A breast cancer survivor herself, Mit dedicated her career to furthering health equity. Today, we honor both women, and we pledge that their legacy will live on through the work we do. —Jean Sachs
Susan Love’s work made a significant difference for those diagnosed with breast cancer. LBBC is honored to be part of continuing her legacy.
- Dr. Susan Love, Surgeon and Breast Health Advocate, Dies at 75 (New York Times; gift link)
- Remembering Susan Love, surgeon and advocate for breast cancer patients (NPR)
- NASW Mourns Loss of Past President Mildred “Mit” Joyner (National Association of Social Workers)
(Our) people are talking
- Hear My Voice graduate Lynda Weatherby hosted an episode of SHARE’s Our MBC Life podcast featuring LBBC Medical Advisory Board member Ginger Borges, MD, on the important topic of the rising rates of breast cancer and metastatic breast cancer in young women.
- Young Advocate grad Tova Parker was featured in conversation with For the Breast of Us ambassador and LBBC support services coordinator Keneene Lewis, MA, Ed, BSM, on FTBOU’s website.
- Ann Partridge, MD, PhD, a member of our Medical Advisory Board, hosted a podcast on ways for doctors to better support people and families through a breast cancer diagnosis and beyond.
- The rising rates of BC and MBC in young women, including pregnancy and post-partum diagnoses (Our MBC Life podcast)
- 100% Authentic: Living life out loud, in technicolor, and unapologetically (For The Breast of Us)
- Living with and beyond cancer: Psychosocial and psychological support for patients from diagnosis Through Survivorship (Medscape)
Related LBBC content
Thank you to consulting medical editor Claire Nixon for her help with this month’s column.
Beyond the headlines is on extended summer hiatus. Visit Breast cancer news and follow Living Beyond Breast Cancer on social to stay up-to-date on the latest conversations in our community.
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