CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
19  OCTOBER  2000
Two Million Women Survive

By: Phillip E. Hoffsten, M.D.

 One of the scariest words in the English language is cancer, and of all the various types of cancer, breast cancer is perhaps the scariest of all. Every year 180,000 women are diagnosed as having breast cancer. Due to a number of improvements in medical care, the survival of women who do develop breast cancer has improved dramatically. It is conservatively estimated that there are two million women in the United States today who have had a breast cancer diagnosed and survived. This group of women are mostly over age 50 and compromise a significant fraction of that age group. October is National Breast Cancer month and a time to consider steps to diagnose breast cancer early and appropriate steps in care once a woman has had a breast cancer.  The first point to emphasize is that cancer of the breast is one of the very few cancers in which early diagnosis clearly makes a difference. The cure rate for cancers that are found with mammography is 80%. If a woman waits until a tumor is found because it can be felt, then the cure rate is only 40%. The cure rate is doubled from 40 women per 100 cured if the tumor is first felt to 80 women per 100 if the tumor is found by mammography. Mammography is the most effective preventive medical step in all of medicine.

The recommendations for mammography depend upon the lady's family history. If a lady has a female blood relative who has had a cancer of the breast, she should have mammography done at age 40, age 44, and every two years until she is 50. At age 50, all women should have mammography done every year whether their family history is positive or not.

If a tumor is discovered, treatment is very individual and beyond the scope of this column. Suffice to say, various forms of surgery and chemotherapy are available and chosen on an individual basis depending upon the characteristics of the individuals particular tumor.  Individuals often wonder what can be done to prevent cancers. Things like cancer of the lung are prevented by discontinuation of cigarette habit but unfortunately there is no step that a woman can take that prevents a breast cancer. Continuing through the present time is the controversy of whether estrogen replacement therapy is safe. Over the years, more than 30 separate major studies have been carried out to try and determine the effect of estrogen replacement therapy on the incidence of breast cancer. The most recent data summarizing years of experience indicates that there is perhaps 1.3 cases of breast cancer developing in women on estrogen replacement therapy as compared to those who are not. The life saving benefit from prevention of fractured hips, heart disease, hypertension, mental function, and maintaining balance far outweigh the measured increase in breast cancer that occurs with estrogen replacement therapy. Be that as it may, many women are unwilling to consider estrogen replacement therapy because of this very slight increase in breast cancer.

As an alternative, there is now a safe alternative. A product called Raloxifene (Evista) is available which has all of the osteoporotic prevention effect of estrogen and in addition protects against the development of breast cancer. The down side of this product is that it does not prevent the hot flashes, sleep disturbances and headaches that often come from estrogen deficiency, and it does not have the heart disease protection that estrogen has. However, it does have the very strong osteoporotic prevention with the added benefit of cutting the rate of breast cancer substantially.  Unfortunately, Evista is somewhat more expensive than Premarin or Ogen or other estrogen replacement products.

In this month of breast cancer awareness, I urge women to consider appropriate steps for detection and treatment of this illness.  Preventive measures such as the use of Evista can also be considered for appropriate individuals. These matters can be discussed with your health care providers at your local clinic.