Breast cancer: What you need to know

The science behind any kind of medical research can feel impersonal to your average Jane, but the news in breast cancer medicine is all about strides toward personalizing care. From emotional support for couples to groundbreaking targeted treatments, the days of one-size- fits-all are over. To mark Breast Cancer Awareness Month, here’s a look at what’s new in this quickly changing landscape.

A version of this article appeared in our October 2012 issue with the headline "Breast tests" (p.42).

You’d be hard-pressed to find a woman who didn’t understand the connection between smoking and cancer, but wine? If you knew that wine is classified as a carcinogen, then you’re among only seven percent of Canadian women, according to research by the Canadian Breast Cancer Foundation. Alcohol consumption is related to increased estrogen levels, which are associated with breast cancer. And sadly, it doesn’t take many glasses of vino to up your chances — just three glasses a week could increase your risk by 15 percent. MJ DeCoteau, executive director of Rethink Breast Cancer, says the social factor definitely plays a role in women’s drinking. “You’re not sitting around at your book club smoking cigarettes, but you’re having a glass or two.”

Chemotherapy is known for its terrible side effects as much as for its ability to trounce cancer cells. Nausea, vomiting, hair loss and exhaustion are just a few of the hazards women face when receiving the traditional treatment for breast cancer. But for women with HER2-positive cancer, there may soon be an alternative. (HER2 is an aggressive form of breast cancer,
characterized by the existence of too many human epidural growth factor receptor 2 proteins, or HER2, which promotes cancer growth. HER2-positive cancer makes up 20 percent of all breast cancers.) Researchers have discovered a way to link chemotherapy to the antibody drug trastuzumab (T-DM1). This means that the rest of the body doesn’t absorb the chemo, thus radically reducing side effects. Women who were treated with T-DM1 had their risk of the disease worsening reduced by 35 percent. The treatment must now make its way through the government approval process.

Connection and support from family and friends is essential to women who are diagnosed with breast cancer, but it’s the relationship with her spouse, if she has one, that might be most critical to a woman’s survival. A study by Nashville’s Vanderbilt University Medical Center and the Shanghai Institute of Preventive Medicine published in 2011 found that breast cancer patients who reported the highest levels of satisfaction in their marriages and families had a substantially improved prognosis. Those results would come as no surprise to Karen Fergus, a clinical psychologist at Sunnybrook’s Odette Cancer Centre and the creator of innovative new online workshop, couplelinks.ca. The six-week program guides couples through a series of exercises designed to support and improve their emotional bond as the medical phase of breast cancer treatment is winding down. While the program doesn’t look at the physical benefits of the relationship-enhancing exercises, women report being helped emotionally by them.

Much has been made in the last couple of years of the risk for false-positives as a result of mammographies. Researchers continue to look for ways to refine them. The Twente Photo-acoustic Mammoscope, a new device still in development at the University of Twente in the Netherlands, combines near infrared light and ultrasound to detect tumours. Although still in development,
it’s hoped that this new machine could work in concert with traditional mammograms to improve the accuracy of diagnoses.

In an effort to look at measures women can control in order to reduce their risk for breast cancer, the Institute of Medicine in the U.S. recently undertook a large study of environmental factors; the results were released late 2011. Researchers looked at factors ranging from environmental toxins to lifestyle choices. Being overweight (with a body mass index of 25 or higher), in particular, was linked to post-menopausal breast cancer. The excess estrogen created by extra fat cells is thought to be responsible for the growth of tumours. With nearly 52 percent of Canadians overweight or obese, the connection between excess fat and breast cancer represents a significant health issue. The good news is that by staying fit and by lowering your BMI, you can decrease your risk for the disease.