SALT LAKE CITY — With breast cancer, there are choices, complete with pros and cons, and what to do depends on individual circumstances. But it's curable if the cancer's not too advanced, according to Dr. Bill Rees, a cancer surgeon, and Dr. Elizabeth Prystas, an oncologist, both of LDS Hospital.
The two are featured on Saturday's Deseret News/Intermountain Healthcare Hotline, which focuses on breast cancer. From 10 a.m. to noon, they'll take phoned-in questions about treatments, detection, screening and more. The number is toll-free, 1-800-925-8177, or from the Salt Lake area, 801-236-6061.
The first thing to consider in selecting treatment is the size of a tumor and whether lymph nodes are involved and, if so, how many, Prystas said. Cancer before menopause tends to be more aggressive than after menopause. Specialists need to know if the cancer cells respond to an estrogen receptor, because those that do may be easier to inhibit. They also look for HER2/neu, a protein linked to the aggressiveness of the disease.
The treatment plan considers all those factors. And at Intermountain, notes Rees, a large team of specialists discusses each case to consider which options appear to be the best ones.
"We say if we have a chance to cure breast cancer, it's at the beginning, right when it's diagnosed and when the least amount has spread — if any," said Prystas. "We do the most up front and hope that's enough. The prognosis is much less hopeful if it comes back."
She said with early-stage breast cancer "the vast majority of those patients can be cured." At stage 3, some are cured. When it spreads to other organs and is stage 4, it is typically not curable. That's why early treatment is aggressive.
Breast cancer can show up somewhere else in the body because errant cells migrated. If it spreads, it most often goes to the bony structure, lungs, liver and brain, but can go anywhere. It's still breast cancer, in a different location. A woman who has had breast cancer on one side has a slightly higher chance of developing it in the other breast, although it's a relatively small risk.
A small percentage of breast cancer is genetic; most of the risk factors are related to hormone levels. So risk is lower for women who have their first pregnancy when they are younger than for those who are in their mid-30s or older.
Even weight can affect risk, since women who are overweight have more estrogen. Fat cells produce it.
Both Rees and Prystas lament the suggestion by a federal guideline panel that women don't need screening mammography in their 30s and 40s.
"I still think the appropriate baseline is between 35 and 40, then regularly after that," Prystas said.
Rees said the U.S. Preventive Services Task Force recommendation was based on "bad data." The only way to pick up breast cancer early is with screening. And he's seen early detection in younger women save their lives.
Tomorrow: Diagnosed. Now what?
The Deseret News/Intermountain Healthcare Hotline will tackle breast cancer Saturday from 10 a.m. to noon, featuring surgeon Dr. Bill Rees and oncologist Dr. Elizabeth Prystas. From the Salt Lake area, call 801-236-6061. Elsewhere, the toll-free number is 1-800-925-8177.
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