According to the National Breast Cancer Foundation, breast cancer is the most common cancer diagnosed in women, and one in eight women in the United States will develop the disease in her lifetime. Most of us have been touched by this dreadful disease at some point in our lives. I’ve watched friends and family survive, but at the age of 20, I unfortunately lost a good friend who passed away from stage four breast cancer at just 22 years old. With October being National Breast Cancer Awareness month, I had the honor of interviewing Dr. Denise Yardley, senior investigator from the nationally recognized Sarah Cannon Breast Cancer Research Program in Nashville and recipient of the American Cancer Society Clinical Oncology Career Development Award about breast cancer. She discussed the most common myths and misconceptions, prevention tips, treatment options, the age women should have mammograms, male breast cancer and much more.
Candace Rose: What is breast cancer?
Dr. Denise Yardley: “Breast cancer is a growth of what started as normal breast cells from the breast tissue and had an abnormality develop where the survival of these cells continue. They come to a point where they’re just dividing and growing and lost the checks and balances that cause cells to age naturally or to have senescence. This ends up forming a group of cells that finally can be detected either by physical exam in a more advanced state or by mammographic imaging.”
Candace Rose: What are some of the most common myths and misconceptions about the disease?
Dr. Denise Yardley: “I think the most common misconception is a thought of fear and a poor prognosis related to a diagnosis of breast cancer. I would really challenge patients now facing that diagnosis that there’s every reason to have hope and to be optimistic about a diagnosis of breast cancer. We clearly have well established detection techniques through mammography, enhanced mammography with 3D imaging and Tomosynthesis, even encompassing the MRI. All of these are just tools that allow us to detect the disease in a very earlier state.
Many of these patients don’t require any additional therapy after a diagnosis of breast cancer, other than removal of the tumor through surgery. I think for patients who have the misfortune of being diagnosed at a later stage of their disease or facing disease that comes back, recurrent disease or metastatic disease or stage four disease – these patients also are living longer with their cancer. We have such directed and special therapies for these patients, we know a lot about different subtypes of breast cancer and this knowledge allows us to really develop very specific drugs. Kadcyla’s one of these new novel drugs for the 25% of patients who are HER2-positive, a feature on their tumor for which this drug is very specific for. This really allows us then to be able to approach these patients with chemotherapy, as well as these novel targeted agents to look for serious adverse events related to the treatments, such as liver and lung issues. Patients should not become pregnant while on treatment, and we always ask patients to discuss these options with their physicians to see if it’s appropriate for them and/or their disease.”
Candace Rose: How is early stage breast cancer typically treated versus other stages? Are they all treated the same?
Dr. Denise Yardley: “Early refers to stage one through three, where the disease is confined to the breast or the breast and lymph nodes. These stages are treated with surgery and the consideration of chemotherapy, radiation therapy or hormonal therapy if appropriate. These all have curative intent.
For stage four, the more advanced breast cancer or a stage four develops when disease was diagnosed in the past and comes back, these patients are treated and have multiple therapeutic treatment options but we don’t use the term cure rather than keep these patients on suppressive treatment with a variety of agents. We kind of turn their disease more into a chronic disease in patients with advanced or recurrent breast cancer. They are now living longer as well as a consequence of the developments of these novel therapies.”
Candace Rose: In recent years we’ve been hearing about women who are genetically predisposed to breast cancer getting mastectomies (actress Angelina Jolie did so as well). Is this something women at higher risk should think about doing?
Dr. Denise Yardley: “I think absolutely. I think it’s a detailed discussion with any given individual facing a family history of breast cancer or very early diagnosis of breast cancer at an extremely young age makes us think whether there may be a genetic or inherited component. I think the purpose of this is to really open the arena of treatment for patients with the guidance of some specific therapies in development in clinical trials, but also for prevention to allow these women who are at high risk but may have not had the disease to undergo risk reductions, whether it’s through medications or through surgery to decrease their chance of ever having to face a diagnosis of breast cancer.”
Candace Rose: Many people don’t know that breast cancer can hit men as well. Can you tell us about male breast cancer?
Dr. Denise Yardley: “Yes, I think male breast cancer certainly is a much less frequent entity with just several thousand cases in the United States. It’s also associated with a genetic component, particularly the BRCA2, and so that gene does confirm for an increase in male breast cancer, and so again when we look at high risk families or families that have a male member with breast cancer, we think about genetic screening for a BRCA2 mutation that may account for the development of that rare entity.
I think as far as treatments, the treatments really support what has been effective for female breast cancer has been effective for the male breast cancer, and so the treatments are largely the same and encompasses the same groups of medications.”
Candace Rose: Is there anything that we can do to help prevent breast cancer or lower our risk for the disease?
Dr. Denise Yardley: “I think there’s lots of strategies to continue to address the risk. I think some of the important ones are things that we kind of know that are inherent to good health – that is maintaining an ideal body mass index, increasing our physical activity to two to three hours of aerobic activity a week has been shown to decrease the risk of breast cancer. I think alcohol in moderation has recently really been shown to benefit patients in terms of reducing that risk of breast cancer. These are just things that individuals can do to lower their own risks.
There are some medications for patients who have enough risk who have enough risk who haven’t faced a diagnosis of breast cancer – Tamoxifen has been approved, Raloxifene, and there’s data in trials with Aromatase inhibitors to try to see if we can cut down a risk or prevent that risk that a patient may have from developing into a diagnosis of breast cancer.”
Candace Rose: At what age should women get their first mammogram?
Dr. Denise Yardley: “I think there are many different guidelines. I think the American Society of Clinical Oncology, the American Cancer Society, as well as several others really have embraced that at age 40 to begin annual mammography in the absence of any other predisposing history, a strong family history or a family member who has had a diagnosis of breast cancer at a younger age or we may start screening earlier. I think the issues are mammography tends to be a little less sensitive in the 30 year old group and so we’re looking to see if MRI may be a tool that can be used for screening in these younger patients.”
Candace Rose: How can breast cancer patients talk to their doctors about various treatment options and to get emotional support?
Dr. Denise Yardley: “I think as all we have patients really open that dialogue with their physician and really look to ask the physician what additional resources a physician may recommend. For my own patients I do suggest perhaps looking at the BreastCancer.org website or the American Cancer Society website. I challenge patients to ask their physician what they feel is very helpful resources to be provided from the physician’s office.”
Candace Rose: Do you have any additional tips or information you’d like to share with us?
Dr. Denise Yardley: “I think the important part is we’ve really gained such milestones and advances in the treatment of breast cancer through the important role of clinical trials and so for any patient who may be facing that diagnosis, I would really ask them to discuss treatment options with their physician and also to ask about clinical trial opportunities that may give them a chance at some novel treatments and all to improve outcomes in this disease.”
Candace Rose: Where can we go for more information?
Dr. Denise Yardley: “I think BreastCancer.org can give a lot of information, and as I said the American Cancer Society. And as always, touch base with the physicians that provide a wealth of resources.”