October is Breast Cancer Awareness Month. According to the American Cancer Society, the chance of a woman getting breast cancer is one in eight over her lifetime. More than 280,000 new cases are diagnosed each year. Nearly 40,000 die of the disease – the second leading cause of cancer death among women after lung cancer.
This month, we are featuring two leading area oncologists from El Camino Hospital’s Cancer Center talking about developments in the prevention, diagnosis and treatment of breast cancer.
Shane Dormady, MD, PhD, medical oncologist
(Dr. Dormady, a board certified hematologist and oncologist, received his MD from New York University School of Medicine. He completed his internship and residency in internal medicine at Duke University Medical Center, and completed a fellowship in hematology/medical oncology at Stanford Medical Center. )
My practice at the Cancer Center includes many breast cancer patients, most of whom, regardless of what they have heard about new treatments and positive survival rates, are still anxious and afraid.
This is understandable. Breast cancer is still a formidable foe. However, what I am able to tell my patients now is that cure rates for breast cancer that is detected in its earlier stages are climbing steadily, which gives me overwhelming hope. In addition, women with advanced or metastatic breast cancer are now living for years and in some cases decades, with their disease controlled and wonderful quality of life due to advances in our various forms of systemic treatment.
Credit for this goes to increased awareness among women here in this country of the importance of screening mammograms, diagnostic methods that can deliver extremely accurate results, and an array of treatments, including surgery, radiation and chemotherapy that can be highly personalized to a woman’s type and stage of cancer.
Let me emphasize that regardless of sophisticated treatments, our best defense against breast cancer – any kind of cancer – is to catch it as early as possible. I am pleased to say that thanks to awareness and screening we are now seeing thousands more cases at the early stage which I’m sure is contributing to positive survival rates.
We are now able to better detect cancers in the earliest stages due to sophisticated diagnostic tools such as digital mammography, breast ultrasound and breast MRI. For women with dense breasts which make it hard to locate tumors in their earliest stages, we now have special software programs that identify this kind of tissue so that the physician can evaluate whether the woman needs a follow up view with 3-D ultrasound.
Depending on the stage, size and type of a woman’s breast tumor, treatment options will likely include surgery, radiation therapy or chemotherapy, or a combination of all, At the Cancer Center, a special Breast Tumor Board reviews all breast cancer cases after which we meet with the patient and family to discuss the best course of treatment targeted to her type of cancer.
Among the most exciting developments in the fight against cancer is the discovery of a link between our genetic makeup and certain types of cancers. We are now able to better determine whether a certain drug or treatment will be effective against a particular kind of tumor. Research is still in the early stages, but for one of my patients, a young South Asian woman, using genetic information to decide her course of treatment saved her life and the life of her baby. She came to us with a large tumor in her breast with the additional complication of being pregnant. It was too late to terminate the pregnancy and too soon to deliver the baby. Because of her type of cancer -- triple negative, with the BRCA2 gene mutation -- we were able to decide on a precise type of chemotherapy that would not harm the unborn child. After four cycles of chemotherapy, the tumor had disappeared, with no evidence of cancer cells even under the microscope. Later, after undergoing genetic counseling, she chose to have a bi-lateral mastectomy and her ovaries removed so that she would be secure and cancer free in her future.
Shyamali Singhal, MD, PhD, surgical oncologist
(Dr. Singhal is a board certified surgical oncologist and medical director of the El Camino Hospital Cancer Center. She received her MD and a PhD in molecular pharmacology at Albert Einstein School of Medicine in New York. She completed her surgical residency at the University of Washington and a three year fellowship in Surgical Oncology at the City of Hope National Medical Center in Southern California.)
Both Dr. Dormady and I agree that with the many diagnostic and treatment tools and options we have today, we have a better chance than ever before of successfully treating breast cancer. I’d like to take this opportunity during Breast Cancer Awareness Month, however, to focus on what we can do to reduce our risk of getting the disease in the first place. With one in eight women affected by the disease, I believe this is a timely and important message.
In a recent study from the University of Calgary, evidence shows that by undergoing certain amount of physical activity -- just 45 minutes a day or 225 minutes a week -- and keeping your body mass index (BMI) at 25 or lower, you can reduce your risk of getting breast cancer by up to 21%. One of the reasons is that physical activity keeps estrogen, a known contributor to breast cancer, circulating throughout the body so it isn’t as likely to be stored in our fat tissues, including breast tissue.
What I like about this study is that what counts as physical activity is not only recreational activity like tennis or swimming, but also the exercise we get on the job, doing housework and walking or cycling. With a little effort, it’s possible to get to that level so we can live our busy lives and still get this benefit. For example, you can get those daily 45 minutes in by parking your car farther away from the store and walking there, or by doing your housework a little more vigorously.
I also want to urge women to know your family history of breast cancer, especially if you are under 50 and if there has been breast cancer in your family for two generations or more. A good time to find out about your family history is when everyone is gathered together; at your family’s Diwali celebration in November for example. Depending on what you learn, you can then talk to your physician about whether you should seek genetic counseling in addition to having your regular screenings.
I would like to encourage women of all ages to belong to the “225” club” -- 225 minutes of activity per week. Do it for yourself!
Daily prayers sustain breast cancer survivor
Datta Shah, Campbell, has no trouble counting her blessings: married for 44 years, a mother of three, grandmother of six, child care teacher for 21 years, a U.S. citizen for 38.
One of the most important numbers in her life now is three. That’s how long it’s been since she had a lumpectomy to excise a malignant tumor in her left breast. The surgery was followed by a short course of radiation therapy.
“I was so scared when I found out,” she says. “I am the first woman in five generations in my family to get breast cancer. Everyone back in India was shocked. I must have received 20 calls a day, asking if it were true.”
Today, Datta is cancer free. She has a mammogram every six months and checks in often with her physicians, Dr. Dormady, Dr. Singhal and radiation oncologist Dr. Rakesh Patel.
“My doctors and all those who took such good care of me – they feel like family now,” she says.
Although she had had a mammogram regularly for 20 years, she got busy and didn’t have one for 3 years. “That was careless of me,” she says. “No matter how busy you are and involved with family, you have to take care of yourself.”
Datta will be celebrating her 70th birthday next year and plans to stay active with her children and grandchildren. What gives her comfort as well are the spiritual practices, including hours of daily prayer, that have become an important part of her life in her later years.
“For me, it’s simple,” she says. “The prayers go up, the blessings come down.”
South Asian Heart Center
The South Asian Heart Center at El Camino Hospital is the first major non-profit response to the growing epidemic of coronary artery disease (CAD) and diabetes among people from the Indian sub-continent. Men and women in this population are at four times the risk of coronary artery disease and diabetes compared to other ethnicities - despite often being vegetarian, non-smoking, and lacking other traditional risk factors. The Center has developed the AIM to Prevent methodology (Assessment, Intervention, and Management) to address the unmet clinical need for aggressive screening and risk factor modification in this high-risk community, while educating participants and physicians in the process. The mission of the South Asian Heart Center is to reduce the high incidence of heart disease through a comprehensive, culturally appropriate program that raises awareness through education, evaluates risk factors for heart disease with advanced screening, and facilitates lifestyle changes with supportive heart-health coaching. The Center aims to be a global center of excellence, to help address the worldwide heart disease epidemic through outreach, education, research, and cardiovascular risk factor screening.