The Many Forms of Breast Cancer

I knew my friend Sybil had breast cancer, but it was still stunning to see her arrive at lunch wearing a cap covering her bald head. She had been diagnosed many months earlier, and, although she had already gone through months of chemotherapy to shrink the cancer, she was far from finished with the treatment. Her life had changed dramatically, but she was upbeat, laughing and happy to be alive.

“I never cried or asked ‘why me?’” she told me. Always strong in character and devout in her faith, Sybil has accepted that this is just a chapter in her life story.

Breast cancer is perhaps the scariest phrase a woman can hear. It’s a breathtaking diagnosis, one that is life-altering. The most common type of breast cancer – about 80 percent – is invasive ductal carcinoma. This is a disease that will strike about 180,000 women – and some men – this year. But breast cancer is not just one disease, and one cure does not fit all.

Many breast cancers are now treatable with new therapies, including hormonal therapy, which can target hormone receptors. But, for women like Sybil, who has been diagnosed with triple negative breast cancer (most breast cancers are driven by hormones) the journey to wellness is more difficult. Because her cancer tested negative for estrogen and progesterone, newer treatments such as Tamoxifen do not work. The standard therapy for triple negative is several months of chemotherapy followed by surgery, then several weeks of radiation.

Because there are so many types of the disease and because each woman is different, breast cancer therapies can vary quite a bit. According to Dr. Jennifer Beatty and Dr. Jennifer Fiorini, cancer specialists at The Breast Place, “The focus is on understanding the biology of each patient’s tumor.”

“We used to focus only on grade and stage of breast cancer, but, through scientific advances, we know more about the disease on a genomic level,” Dr. Beatty said. “This allows us to predict what types of treatment a woman’s tumor will respond best to and, often, this is not chemotherapy.”

The doctors designed The Breast Place with a woman’s view in mind. Their mission is to “empower patients with knowledge and choices, recognize beauty and provide hope through compassionate care.”

“We approach every patient as if they were our best friend or sister,” Dr. Fiorini said. “We are a private practice so we are able to be flexible because we can work with any of the hospital systems, physicians and imaging centers our patients choose.”

But beyond surgery, which is the specialty at The Breast Place, the doctors help with all aspects of breast care, from initial work-ups to aftercare. Because they are a high-risk breast center, their patients include those with a family history of the disease, women with dense breast tissue and those who need genetic testing.

High-risk cancers include recurrent or metastatic tumors. These are cancers that have returned to the same site or have spread to the lymph system and beyond. About 30 percent of early-stage cancers will recur, and there is a chance that the tumor will have “adapted.” For example, a cancer that originally tested positive for hormone receptors may become hormone receptor negative.

Triple negative cancer tends to be high risk, as well. It does not respond to hormonal therapies or Herceptin, it tends to be diagnosed at a higher grade and it is more aggressive. Some studies seem to indicate that a course of chemotherapy before surgery may lead to better results. New treatments on the horizon include PARP inhibitors (poly ADP-ribose polymerase), which fix the DNA damage in cells; VEGF (vascular endothelial growth factor) inhibitors, which prevent the tumors from creating new blood vessels to further their growth; and EGFR (epidermal growth factor receptor)-targeted therapies, which target a protein that encourages tumor growth.

Inflammatory breast cancer is another cancer that requires multifaceted treatment. Rather than a lump, it usually appears as a red patch and may be accompanied by swelling, pain, warmth and skin changes. Chemo is the first therapy of choice followed by radiation, surgery and hormonal therapy.

Whether the cancer is small and local or invading the body, if you’re one of the thousands of women who hears “you have breast cancer,” it is important to remember the new therapies and the rise in survival rates. Build a team of professionals, including radiologists, surgeons, oncologists, plastic surgeons and a nurse navigator who will be invaluable as you begin the journey to wellness.

A positive attitude and belief that you can be cured play an important role in recovery.

By Barbara Millen Patrick