The majority of cancers should be diagnosed without going to the operating room. The ability to provide a biopsy of a breast mass, either in clinic or with a radiologist, is key to the diagnosis of breast cancer. This opens discussion upfront that allows for planning partial versus complete mastectomy. If reconstruction after mastectomy is desired, a dialogue needs to happen prior to the initiation of treatment, with the help of a plastic surgeon.
Involving a radiation oncologist as part of the breast care team provides information about radiation treatment options, such as partial breast radiation. Partial breast radiation allows for treatment in five days rather than the traditional six weeks. Medical oncologists help in decision making for chemotherapy treatment prior to surgical intervention in order to help shrink the tumor and allow for breast conservation.
New research on the forefront includes new screening tools. Studies are ongoing as an adjuvant to mammography and physical examination for detecting breast cancer. At the University of Arkansas for Medical Sciences a study is looking for cancer genes in saliva. Tissue specimens from cancer patients are also collected here in Lubbock at the Texas Tech Health Sciences Center through several studies in hopes to find a cure for breast cancer.
Several tests are available through research on the DNA of breast cancer. Genetic counseling should be offered to patients with a significant family history of cancer or who have cancer themselves. The BRCA gene is associated with HBOC (Hereditary Breast and Ovarian Cancer) syndrome and is available with a simple blood test. Other genetic syndromes are associated with breast cancer, and genetic assessment should be done to discover Cowden’s or Li-Faumeni syndromes.
Genetic analysis of individual cancers is being done, also. An array of 21 genes from a patient’s specific cancer allows analysis of the need for chemotherapy. This test looks at the recurrence risk of the cancer and gives a better idea about which patients may benefit from chemotherapy.
With these advances, treatment of breast cancer patients is individualized. The cancer itself is evaluated to see what medical and surgical options are going to work best. No longer is the patient told what the regimen will be without input, rather she will be involved throughout the entire decision making process.