Lehigh Valley doctors discuss finding, treating breast cancer

Early breast cancer detection can mean the difference between the first stage, which is highly treatable, and the fourth stage, which could be incurable, Lehigh Valley physicians say.

Dr. Lee Riley, medical director of oncology for the St. Luke's University Health Network, is passionate about finding a cure for cancer.

In his freshman year of college, he learned that mice could be immunized against cancer. It was a breakthrough moment, Riley says, noting it led him to his doctoral and post-doctoral degrees and two fellowships in cancer research. Since coming to St. Luke?s in 1997, he has worked with hundreds patients diagnosed with breast cancer.

Riley says the biggest misconception among women is that breast cancers are all the same when, in actuality, physicians look at genes that cause breast cancer itself. Researchers have determined there are at least 40 different genes causing the cancer, he says.

"The more we (oncologists) learn about breast cancer and its causes, the more we know most breast cancers are unique in their own right. In fact, breast cancer is a broad term that describes a family of cancers that start in the breast, but each cancer is different for each woman," Riley says. "It's a very complex disease that we treat based on the stages of cancer and the individual woman?s needs."

Lori Alfonse, breast surgical oncologist and medical director of breast health services at Lehigh Valley Health Network, says another misconception is all lumps self-detected are cancer when about 80 percent of the time a lump felt is not cancer.

She says it could be many things that are benign, such as a fibrocystic breast change. To be sure, women who find lumps should contact with their gynecologist or primary physician.

Battling breast cancer

The stages of breast cancer range from a situation that is most treatable to one in which oncologists need to move fast to prolong the lives of patients. The stages help determine the treatment.

• In Stage 1, considered early breast cancer, cancer cells have formed a small tumor that is contained in the breast.

• In Stage 2, the tumor is a little larger and has more of a tendency to spread to the lymph nodes.

• In Stage 3, an aggressive-growing tumor in the breast has spread to the lymph nodes.

• In Stage 4, it's a more advanced breast cancer in which the cancer cells are found in other major organs, such as the brain, lungs, bones or liver. About 2 to 3 percent of patients beat the disease entirely in Stage 4, Riley says.

"In stages 1, 2 and 3, we treat patient with the intent to cure them," Riley says. "Stage 4 may be incurable, but treatment prolongs women?s lives up to five or 10 years."

Riley notes stages 1, 2 and 3 often are subdivided into multiple sub-stages that change each year. The American Joint Committee on Cancer has a national staging committee for each type of cancer and adjusts the guidelines as new information becomes available. The first three stages, he says, are treated with a combination of surgery to remove the cancer and then radiation, hormone therapy or chemotherapy to reduce the risk of it coming back.

Surgical options include lumpectomy which involves removing the tumor and rim of normal tissue in the breast; and a mastectomy which involves removing the entire breast and some surrounding tissue. Stage 4 is treated systemically with chemotherapy or anti-hormone treatments.

But the choice is always up to his patients, Riley says.

"I look at my job as (being) an educator; I educate my patients and their families about their tumor, what the different treatments are, what options they have and what the chances are of it coming back," Riley says. "But, they need to be in the driver's seat."

Early Detection

Most people know that early detection is key. However, if the tumor, often the size of a pea, is embedded deep in the middle of the breast, a woman likely is not to find it through self-exam alone, Riley says.

Mammograms have a 85 to 90 percent chance of picking up a small or deep tumor and radiologists will find it when reviewing the mammogram images. If a finding on the mammogram looks suspicious, an ultrasound would be performed for more images and then, a biopsy follows for a sample to be studied by a pathologist. If a cancer designation is made at St. Luke?s, another pathologist will provide a second opinion. Patients diagnosed with cancer will then work with the oncologist to determine the course of treatment, Riley says.

Women should start having mammograms at age 40 or even as early as age 35 if there is a family history, but each woman should consult her doctor to know the best age to make an appointment, he says.

Alfonse says new technology is coming to Lehigh Valley Hospital - Muhlenberg that will help better image dense breast tissue. Digital Tomosynthesis, available in November, will create three-dimensional pictures of the breast using X-rays at multiple angles. Mammograms only take a single picture, across the entire breast, in two directions: top to bottom and side to side.

?It hasn?t replaced mammography, but it?s a new way to do mammography,? Alfonse says, noting the technology is good for high-risk patients. ?It?s essentially a mammogram done in fine cuts -- thin cuts that looks through the breasts a little better.?

Source: http://www.lehighvalleylive.com/breaking-news/index.ssf/2012/09/lehigh_valley_doctors_work_wit.html

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