The doctor says
Dr. Jonathan Tay on breast cancer treatment and survival
Dr. Jonathan Tay, a radiation oncologist at St. Mary’s Medical Center, has been treating breast cancer patients since 1998. He discusses the signs, research and prevention strategies of the disease.
What are the signs or symptoms of breast cancer?
Most breast cancers these days are diagnosed on mammography for women who get routine screening exams after the age of 40. On mammography, they’ll often find a mass or calcifications that lead to biopsies or diagnosis. Probably 20 percent of women have a palpable mass that they feel and bring to their physician. That may or may not be seen on the mammogram, which alludes to the importance of self breast examinations. Not all breast cancers are detected by mammogram. Women should self-exam once a month. Most cancers are detected early. Rarely is it detected with skin changes or pain.
So most people feel fine, but then something turns up.
And where do they go from there?
The patient is referred to a breast surgeon, who’ll biopsy the mass to make the diagnosis of breast cancer. Just because a mass is seen doesn’t mean it’s breast cancer. Most biopsies turn out to be benign.
How many doctors does a patient usually need?
The patient is usually referred by the primary care provider to the breast surgeon, who refers to the radiation or medical oncologist. A person may see four or five physicians for the management of breast cancer.
What are the survival rates like for breast cancer patients?
Survival is dependent on the stage at diagnosis. Most cancers are diagnosed at Stage 1, which means it’s a small tumor that hasn’t spread to the lymph nodes. Survival is high—about 80 percent. Once it spreads to the lymph nodes, that’s Stage 2, and generally survival is 60 to 80 percent. Stage 4 is when it’s spread to different organs or sites like bones, liver, lung, brain, and those situations are incurable. So fortunately, most women are diagnosed in Stages 1 or 2 and are found in a very curable situation.
Well, you remove it, and once the tumor is removed, it may require radiation or chemotherapy.
That sounds similar to how most cancers are treated.
Correct. These days, cancer is being treated with multi-modalities. It’s not just radiation or chemotherapy. It’s usually a combination of two or three of them.
Is there any new research or trends happening within the breast cancer field that people are excited about?
Breast cancer is usually treated with a mastectomy, but we’ve known for several decades now that women don’t need a mastectomy to cure breast cancer; they can have a partial mastectomy or a lumpectomy. Radiation also is changing; it’s traditionally given to the whole breast every day, Monday through Friday for six weeks. It’s fairly well-tolerated, but it’s very inconvenient. Now we have Accelerated Partial Breast Irradiation, in the form of mammosite. Instead of treating the whole breast over six weeks, we do 10 doses over five days after a catheter with a balloon is placed in the biopsy cavity. We put a radioactive source in the center of the balloon to deliver a dose, which takes about five minutes to do. The downside of that is lack of long-term follow-up and results, so we’re in the process of collecting that data and enrolling women in clinical trials to prove it’s as effective as whole breast radiation therapy. Another downside is not all women can have it—they have to have a small tumor with sufficient amount of normal tissue around it in order for the mammosite to be effective. But it is a lot more convenient than external radiation. It’s especially good for women in outlying areas, like Winnemucca, who can’t come in for six weeks of treatment.
I’ve heard various opinions about the value of antioxidants in terms of preventing breast cancer. What’s your take?
Antioxidants are good in general for cancer prevention. There’s not a lot of hard data, but there’s a lot of soft data out there that show antioxidants can help prevent various types of cancer. They scavenge free radicals that damage normal DNA. … Antioxidants prevent free radicals from doing their damage and therefore help prevent cancer. Antioxidants you find in leafy greens and other colorful vegetables are good for you. That’s not to say taking antioxidants prevent every type of cancer.
Do you have suggestions of things women can do to lower their chances of getting breast cancer?
Eating a good, heart-healthy diet is good in terms of cancer prevention. Doing self breast exams and getting mammograms over the age of 40, and earlier if you have a family history of it. And a physical exam—a physician should examine a woman’s breast once a year over the age of 40.
Are more younger women being diagnosed?
I think there’s an increasing awareness in younger women, but I don’t think the statistics—up to 2003, there has been an increase in breast cancer in women over 50. From the 1970s to 2003, the incidents of breast cancer increased from 80 per 100,000 to about 120 per 100,000—most seemed to be increases in noninvasive breast cancers.
Any theories on why?
There are many theories floating around out there. Some suggest it’s a Western diet high in saturated fats. In Japanese cultures, the breast cancer incident rate is much lower than it is in Western cultures, including the U.S. But when Japanese women migrate to the United States, it only takes one generation of women to have the breast cancer equivalent [rate] of U.S. whites. So the hypothesis is a Japanese diet with less saturated fat, high in fish is better than the Western red meat, high saturated fat diet.
Are there other trends or research happening within the field?
An interesting research is the use of MRIs for diagnosis of breast cancer. Some people have suggested that women at high risk for breast cancer—people with a family history, especially in a first-degree relative under the age of 50 with breast cancer—they should be screened with MRIs in addition to a mammogram because MRIs will pick up a few more breast cancers that mammograms don’t pick up. So women who would be at higher risk that should ask their doctors about MRI screening are women with the breast cancer gene in their family or who’ve had previous radiation to the chest for things like Hodgkins disease.
Are there things some women do or lifestyles they lead that help them up their survival rates?
I think survival is more based on the stage of diagnosis. Stage 1 does better than Stage 2 than does Stage 3 than does Stage 4, regardless of demographic, social issue or age. Younger women do just as well as older women stage per stage.
Going through treatments and dealing with cancer can be a frustrating, demoralizing experience. Do you have any suggestions for coping?
Liz Thomas, our social worker in radiation oncology, operates a great breast cancer support group [see “Lean on me"]. That’s probably one of the best resources we have. I think family support is important in treating breast cancer—family and social support, in addition to getting the proper medical treatment. I think just talking with other women with breast cancer, I think that all helps patients cope.