The second most common form of cancer in Utah affects women almost exclusively.

Breast cancer will be diagnosed in 10 percent of Utah women sometime during their lifetimes.But not all the news is bad.

If detected early, the five-year survival rate is 95 percent. And, new forms of detection and education, as well as a change in philosophy regarding the drastic surgery that once accompanied the disease, offer new hope.

Local medical specialists have heartening news for the more than 500 Utah women each year who are diagnosed as having breast cancer: they do not have to lose their breasts to the disease.

If the cancer is diagnosed in its early stages, women can now undergo a lumpectomy, with assurance that unnecessary risk is not being taken. The procedure combines surgery and radiation therapy to kill the cancer while saving the breast.

"These women are left with a good looking, functional breast they feel good about," said Dr. R. Dirk Noyes, a surgical oncologist and clinical associate professor of surgery at LDS Hospital. "Plus the survival and recurrence rates are the same as if the breast was removed."

A lumpectomy is an option to a modified mastectomy, which remains the most common operation in the nation for the treatment of early breast cancer. A modified mastectomy involves removal of the breast and lymph nodes. The muscles are left intact.

Both procedures, Noyes said, are monumental improvements over the standard radical mastectomies, which involve removal of the breast, muscles and lymph nodes. "That was a fairly debilitating operation for women in that it left them with an arm that didn't work well, was swollen and disfigured."

Noyes, an associate of the Intermountain Clinic, maintains there is no reason today for physicians to do standard radical mastectomies. Cancer victims have two other, more appealing choices.

"It's a very personal decision. All I can do is give women the facts, and the facts are that both procedures - the lumpectomy and modified mastectomy - are the same as far as long-term survival and recurrence rates among properly selected patients," Noyes said. "If you have your breasts removed for breast cancer, you can still get recurrent breast cancer. It can also re-occur if your breasts are saved."

Local recurrence rates for early breast cancer treated by lumpectomy or modified mastectomy average from 7 to 10 percent.

A lumpectomy, Noyes said, is a more complicated and expensive treatment because following surgery, the patient must undergo radiation therapy five days a week for six weeks. Because it's also a more technically difficult procedure (surgeons are operating through small holes in the breast and arm pit), it has been slow to gain popularity in the surgical community.

Noyes said initially some women viewed the procedure as "experimental" and opted for a mastectomy. Now more than 50 percent of all women to whom it's offered want their breast saved.

"Most every young (under age 60) breast cancer patient I see feels strongly about saving her breast," Noyes said. "Most elderly women feel strongly about just wanting to have it done with, that is, have a mastectomy and avoid the inconvenience of going to the hospital five days a week for six weeks for radiation therapy."

The more advanced the cancer, the less likely it can be treated successfully by either method.

If the cancer has spread throughout the breast, the woman is not a candidate for a lumpectomy. Women with large cancer or whose nipple is involved with cancer also do better with mastectomies rather than lumpectomies. Of those women who opt for a mastectomy, only a third have their breasts reconstructed.

"There is no question that plastic surgeons are doing a better job of breast reconstruction than was done 10 to 15 years ago," Noyes said. "The breasts look and feel better. But in my opinion, the reconstructed breast is not going to look or feel near as good as a breast that has been saved by the combination of radiation and therapy."

While both lumpectomies and mastectomies are equally successful in treating the cancer, Noyes said neither procedure seems to cure the psychological ills associated with breast cancer.

"We used to think that these psychological problems seen in breast cancer patients were related to the loss of a breast," he said. "But since we have been doing the lumpectomy procedure, we have discovered it has more to do with the psychology of developing cancer rather than the removal of the breast.

"It's a difficult, emotional adjustment for most families to go through."

Screening with mammography, breast self-examination, plus a breast exam by a health professional is the way women can significantly reduce breast cancer deaths for women both over and under age 50, the cancer specialist said.

Yet, according to Noyes, less than 10 percent of Utah women do breast self-examinations. He said the importance of the exams should be stressed early, even as early as junior high.

Major cancer organizations, including the National Cancer Institute, the American Cancer Society, and the American College of Radiology, now also recommend that all women ages 40-49 have a mammogram every one to two years, and that upon reaching age 50, they have one annually.

"These recommendations are based on strong evidence that mammography is effective in detecting cancer in both older and younger women and that radiation from mammograms has decreased to a point of negligible risk," Noyes said. "The problems we have had with mammograms in the past have been solved. It's a very safe, effective technique and the most accurate one we have to pick up early breast cancer."

In Utah, it's also an inexpensive test, costing as little as $35 as compared to $150 in other parts of the country.


Utah cancer cases reported in 1988

Prostate 600

Breast 500

Colon/Rectal 450

Skin Melanoma 200

Uterus 200

Leukemia 125

Oral 125

Pancreas 100

Source: American Cancer Society


Mammogram Procedure

- Make appointment

- Register

- Dress in mammography robe

- Fill out short questionnaire

- Walk to mammogram room

- Give short medical history

- Two X-rays of each breast taken; four if patient has implants.

- Film is developed

- Film taken to radiologist if problem is detected

- Film studied by physician using magnifying glass

- Call doctor in five working days for results

TIME: 10-20 minutes

COST: $35 to $50.

PAIN: Women with tender breasts may note slight discomfort during test; most women experience no pain.

RISKS: Radiation exposure to the breasts is minimal. Most physicians believe the hazards are slight - particularly when compared to the benefits of early cancer detection.