Medical advances in early detection, treatment improve outcomes
By Kristi L. Nelson, The Knoxville News-Sentinel, Tenn. | |
McClatchy-Tribune Information Services |
It's a fear most women share: finding a breast lump.
They face the anxiety of waiting to see if it's benign, the uncertainty of what needs to be done to take care of it.
It's a well-founded fear; statistics suggest one in eight women will have breast cancer sometime in her life, with the risk increasing with age.
"I think a lot of people have a fear of the word 'cancer,'" said registered nurse
With early detection, breast cancer can now sometimes be contained with a single surgery. Survival rates of early-stage breast cancer are close to 100 percent. But in order to detect and treat breast cancer early, health providers need to get women who might be fearful and anxious through the door.
Just for breast
Does it help when those doors are pretty and labeled "breast"? Providers think so. Most sizable health systems now have a center just for breast health, many with built-in boutique stores where women can buy specialty undergarments, swimsuits, prostheses and head coverings.
"I think it's important for woman to have a place that they identify as where they go to get their breast imaging," said Dr.
The independent Knoxville Comprehensive Breast Center does only breast health; founder Dr.
Dr.
Thompson's breast center has its own lobby and waiting room, and parent company
Even
"Women might be feeling anxious about a mammogram," said
Having a dedicated space for mammograms and staff trained to administer them gently can make a big difference in women's comfort level, providers said.
"The worst thing is to have someone come in, have an awful experience and then say, 'I'm done with mammograms,'" said Dr.
Better detection
Screening mammograms are still the standard of care. The
But while those standards are long-standing, the technology continues to improve.
"Our mammogram imaging has advanced," said Dr.
Among the newer advances: tomosynthesis, or "3-D mammograms," in which a machine takes an arc of photos around the breast, along with a traditional mammogram, that a computer program can put together in a three-dimensional model for radiologists to read.
In use since 2001, tomosynthesis is still not widely reimbursed by insurance; it accounts for about 17 percent of mammograms given in the U.S., and many of those women pay extra for it. Until September, a single company,
Summit and Thompson, which uses GE machines, are looking at purchasing tomosynthesis machines, and Tennova and Knoxville Comprehensive Breast Center said they may consider it as more data is available and reimbursement becomes more common. Parkwest Comprehensive Breast Center was the first in the area to start offering it, last year, and charges patients
"It's good at detecting cancer, and good at not seeing things that don't matter," a problem with the ultrasound and MRI machines sometimes used with those patients, she said. "It is more time-consuming for radiologists to read, but I think the added benefit of reducing that call-back rate, reducing that stress patients have, and detecting more cancers, I think it ends up being worth it."
But Dr.
"The only reason you don't use it to screen everyone is that it's too expensive," Margulies said.
But he's excited about a study published
Tennova's Gallaher said cost to patients -- up to several thousand dollars, if insurance won't approve it -- is her main concern with using MRI to screen breasts. She's less bothered by the fact the "super-sensitive" MRI finds things other than cancer: "In the hands of my radiologist, somebody who's expert at it and can tell when it's a false positive, it rarely misses a cancer. ... The radiologists haven't yet found that perfect tool."
That's one question debated in the medical field: As technology becomes more and more sensitive, how many women are being "overtreated" for small cancers that might not ever cause them harm?
"The problem is, how do you know? Are you willing to sit with an early cancer in your breast and take the risk that it may never cause you any harm?" Roulier said. "Who's willing to take that risk? ...
"Because when you detect cancer earlier, the treatment is minimal. If you wait too long, that's when it gets very expensive, and you need more extensive surgery, and you need more chemotherapy and radiation. If you detect it very early, sometimes it's just a matter of surgery, and you're cured."
Targeting tumors
Being able to tell which cancers would be harmful and which wouldn't -- and how to eradicate them -- through genetic profiling is the new frontier of treatment, Margulies said. Already, doctors can tell if a cancer is receptive to hormones; more than half are, and those can be treated with a type of drug that blocks the hormone receptors in the tumor. The oldest and best-known is Tamoxifen, which has been used for about 30 years and is even used for prevention in some cases.
Women whose tumors respond to hormone-blocking drugs may not need chemotherapy at all. In fact, the development of chemo drugs is actually at a standstill; treatment through genetic profiling will eventually replace it, said Dr.
That could eliminate a barrier for some women. "I have found that people are much more concerned about losing their hair with chemotherapy than they are about the surgery," Gallaher said.
Panella uses genomic tumor assessment, which can tell him what changes in DNA are allowing a cancer to grow, and allow him to target treatment to block what is aiding a tumor's growth. The next advance will be the ability to measure DNA circulating in the body to screen for different types of tumors, then target them, he said.
UTMC has a number of cancer clinical trials that use genetic profiling. Thompson and Tennova also have cancer clinical trials.
But even women who need the standard chemotherapy and radiation will benefit from advances. Newer medications help better manage chemo's side effects; radiation can be delivered in a variety ways now, over long or short periods of time, depending on the patient's needs.
"Breast cancer nowadays is a speed bump in life, not a roadblock," Ingram said. "It's something you've got to get over; you can't ignore it. But you're going to see it in the rearview mirror."
___
(c)2014 the Knoxville News-Sentinel (Knoxville, Tenn.)
Visit the Knoxville News-Sentinel (Knoxville, Tenn.) at www.knoxnews.com
Distributed by MCT Information Services
Wordcount: | 1683 |
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News