June 13, 2005
Changes in the treatment of breast cancer since 1970
I was treated for breast cancer in 1996 and I’ve been on the staff of the Ithaca Breast Cancer Alliance (IBCA) since 2000. (Yes – I am a man. Each year, some 1,600 of us are diagnosed with breast cancer).
I recently spoke with an older woman who had been treated for breast cancer in the early 1970s. Comparing her treatment with my own more recent treatment made me appreciate how much progress has been made during the past 35 years.
After that conversation, I began to wonder if some older women hesitate to get a mammogram or see a physician because they remember (and fear) breast cancer treatment as it was practiced in the 1960s and 70s.
IBCA has provided support, information, and comfort to hundreds of women undergoing breast cancer treatment since its founding in 1994. Based on that work, we wanted to outline the typical breast cancer experience of today and highlight how it differs from that of just a generation ago.
When a breast lump is found on a mammogram or during a breast exam, the doctor will want to determine if it’s cancer or a benign condition such as a cyst. In some cases, the doctor can tell it’s probably benign based on its appearance on the mammogram and your history. In other cases, a biopsy is performed to make the diagnosis. There are different types of biopsies, but they all remove a portion (or all) of the lump so it can be examined under a microscope.
Comparing today to 1970: In 1970, a woman undergoing a biopsy remained on the operating table while the lump was examined. If it was cancer, the surgeons did an immediate mastectomy. Today, the biopsy is generally done a few days or weeks before surgical treatment. This gives the woman time to come to grips with the diagnosis and to understand her treatment options. In 1970, treatment decisions were made for the woman. Today, treatment decisions are made by the woman in partnership with her physician.
About one in five breast lumps is determined to be breast cancer. If so, the surgical treatment is usually the removal of the lump and some surrounding tissue (known as a lumpectomy), or the removal of the entire breast (a mastectomy).
Comparing today to 1970: During most of the 1970s, the type of mastectomy commonly performed was a radical mastectomy. Surgeons removed not only the breast, but also the chest muscles. Today, when a mastectomy is performed, the chest muscles are generally left intact. The overall trend is towards conserving as much of the breast as possible.
Radiation therapy is routinely given following a lumpectomy and sometimes given following a mastectomy. Most often, the radiation is directed at the body by a piece of equipment that is similar to an X-Ray machine, but many times more powerful and sophisticated. In some cases, the radiation is implanted in the body for a brief period of time.
Comparing today to 1970: In the past, radiation therapy killed the cancer cells that may have remained in the breast following surgery but sometimes did damage to nearby organs, such as the lungs. Today, the treatment is far more precise, increasing the impact on the “target” and minimizing the risk to the surrounding tissue.
Chemotherapy refers to drugs used to kill cancer cells that may have spread elsewhere in the body. Many women receive chemotherapy following breast cancer surgery to reduce the risk of a recurrence.
Comparing today to 1970: Probably the most noteworthy change from the patient’s perspective is that medical practitioners now do a better job controlling the side effects associated with chemotherapy. In particular, newer medications have greatly reduced the likelihood of the nausea that was a nightmare for people who underwent chemotherapy in the 1970s. Chemo today is still no one’s idea of fun (and the side effects differ widely from person to person), but it’s a more manageable experience than it was in the past.
A new generation of breast cancer drugs specifically targets breast cancer cells with relatively few side effects. While most of these drugs are still being tested in the laboratory, one of them, Herceptin, is currently in use and is proving beneficial for some women with breast cancer. We now understand that there are many different types of breast cancer, and these newer drugs may work quite well for some types but not at all for other types. As a result, treatments will be increasingly tailored to the individual. One size does not fit all.
Comparing today to 1970: In the past, it was generally assumed that the most aggressive treatment was the best treatment. The more radical the surgery and the more awful the chemotherapy, the better it was thought to be for the patient. That belief is changing. Today’s focus is on developing treatments that selectively attack the cancer while minimizing damage to other parts of the body.
Advanced Breast CancerComparing today with 1970: A woman diagnosed with metastatic breast cancer in 1970 was essentially told there was nothing else that could be done. While it’s still not considered “curable,” women with metastatic breast cancer can now be treated and often are able to continue leading productive and fulfilling lives.
If breast cancer spreads to other parts of the body, it is known as metastatic breast cancer. Today, metastatic breast cancer is thought of as a chronic disease that can be controlled or “managed” - often for many years - with a good quality of life.
There are more than two million women in the United States who share the bond of having heard the words, “You have breast cancer.” The newly diagnosed often want to connect with other women who have had the disease. They’re seeking support and information, and find comfort in a community of others who have “been there.” That’s why IBCA was created – so no one should face breast cancer alone.
Comparing today with 1970: In the past, women often kept their breast cancer a secret. First Lady Betty Ford made headlines in1974 by openly discussing her breast cancer diagnosis and treatment. She knew that breast cancer was nothing to be ashamed of and that talking about it made more sense than keeping silent. She was right.
Breast cancer treatment today is quite different than it was just 35 years ago. By taking measure of these changes, it makes us realize – and appreciate – the progress that has been made.
Bob Riter is Associate Director of the Ithaca Breast Cancer and can be reached at firstname.lastname@example.org.