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Achievements in Fighting Breast Cancer

While breast cancer cases have risen slightly this past year, chances of long-term survival are increasing thanks to new technologies being implemented at healthcare facilities throughout the state.

Every two minutes in the United States a woman is diagnosed with breast cancer, with approximately one in eight women developing the disease at some point in her life. Incidences of breast cancer have not subsided – about 310,000 women will be diagnosed this year, a .06% increase over 2023 – but continued breakthroughs in diagnosis, treatment, and recovery are making the process easier and increasing chances of long-term survival.

Targeted breast cancer screening, more accurate tumor marking techniques, less visible incision scars, and combining mastectomies with other surgeries are some of the rising practices being embraced by New Jersey hospitals, many of which are at the forefront of advancements that make the process more comfortable and less invasive. 

 “I’ve been treating breast cancer patients for 30 years, and it’s great to have so many improvements in the field,” says M. Michele Blackwood, MD, FASC, director of breast surgery at RWJBarnabas Health and director of women’s oncologic health at RWJBarnabas Health and Rutgers Cancer Institute of New Jersey. “We have a lot more options for patients than back in the 1980s and ‘90s. Today, it’s about thinking outside the box and having the patience and resources to treat the whole person.”

Diagnosis Marked by Targeted Screenings

In 1976, the American Cancer Society (ACS) began recommending mammograms as a screening method for breast cancer. While this is still the first line of defense for those 40 and older, women are becoming more proactive with care, including doing regular self-exams and learning more about breast density, breast health, genetic disposition and the importance of early detection. The goal is to catch the cancer early, which leads to better outcomes. For example, if breast cancer is caught in Stage 1, the five-year survival rate is 99%.

“What I’ve been seeing is more gynecologists looking at their patients’ family histories and sending them to us for risk assessment,” says Dr. Lori Timmerman, a breast oncologic surgeon at Virtua Health, South Jersey’s largest healthcare provider. “Women who come back as having a lifetime risk of 20% or higher get additional screenings – in addition to a yearly mammogram, they get a screening MRI at the six-month mark. It’s about being aware of what their risk factors are and if they need genetic testing.”

Women who have a sister or cousin with a gene mutation should also be tested for that gene mutation, or if their mother had breast cancer at age 40, they should start screening at age 30 or even younger. There has also been a greater push for supplemental screenings for women with dense breasts, which is about 50% of the population.

“Choice of supplemental imaging depends on individual breast cancer risk factors,” says Eleonora Teplinsky, MD, head of breast and gynecologic medical oncology at Valley-Mount Sinai Comprehensive Cancer Care. “There are increasing studies of contrast-enhanced mammography and using AI in breast cancer screening, which we will likely see more of in coming years.”

Treatments Are More Thorough and Less Invasive

There have been a number of improvements in breast cancer treatment in recent years – everything from how to mark the tumor in preparation for surgery, to where the incision should go for better cosmetic effect, to combining breast surgery with other procedures to make the overall experience more positive.

“In breast cancer treatment right now, there’s a major trend toward a combination of de-escalation and targeted treatment,” says Deborah Capko, MD, FACS, a breast surgeon at Memorial Sloan Kettering, which now has four New Jersey locations. “With both of those, we’re offering better options – and better tailored options.”

Along these lines, MSK breast surgeons are using data from recent clinical trials to perform fewer surgical procedures removing the lymph nodes from the armpit – particularly in post-menopausal women – to decrease lymphedema risks. Care is coordinated by disease management teams, who decide if a patient is a good candidate for a clinical trial or may benefit from limiting the amount and duration of radiation. “We perform most breast surgeries in our Middletown location, and we have the full scale of treatment options, including breast and reconstructive surgery,” Capko adds. 

According to Timmerman, lumpectomy technology has been updated from using a thin wire to guide a surgeon to the tumor on the day of surgery, to marking the breast with a metallic reflector – or Scout tag – that gives doctors a more accurate picture of where the tumor is, so they don’t have to take as much tissue. This also leads to a better cosmetic effect, as the incision is hidden in the areola line or under the mammary fold so it’s less noticeable. Once the tumor is out, the specimen goes on a Faxitron, which is like an x-ray machine, so doctors can do an immediate assessment of the tumor compared to the tissue around it to see if they need to take extra margins and prevent additional surgeries.

In addition, therapies after a lumpectomy are much more tumor directed, and whether or not the patient receives chemotherapy can be based on the genetics of the tumor. “After our oncologist is done with the tumor, the pathologist sends it to another lab to do a 21-gene assay on those tumor cells, and that information tells us how likely it is to spread,” Timmerman says. “Based on that information, you may get a short course of chemotherapy to prevent the tumor from showing up again in 10 years. And even if you’re Stage 1, you may have just caught it early, but it may be a really aggressive tumor. It’s all very specific.”

And for those who need radiation treatment, Virtua and long-time healthcare partner Penn Medicine opened a $45-million Proton Therapy Center in 2023, the first of its kind in South Jersey and one of about 50 across the US. Based in Voorhees, the facility provides the most advanced form of radiation treatment, Timmerman says, as proton therapy targets cancer with pin-point precision, avoiding damage to surrounding tissue, thereby reducing the risk of side effects.

Recovery, Quick Release and Follow-up

In the area of recovery, it seems to be about getting patients out of the hospital as quickly as possible – a trend brought on by COVID-19 when hospital beds were scarce and patients didn’t want to be around infected people during the pandemic. Lumpectomy patients as well as many mastectomy patients go home the same day with pain control, Timmerman says, adding, “We use an injectable pain mediation when the patient is asleep – it’s usually a local anesthetic, but one that lasts much longer – for three days. So, these patients come out feeling much more comfortable and using much less pain medication.”

Capko says most patients, particularly those who have had reconstructive surgery, get nerve blocks and are often ready to go home two to three hours after surgery. “It’s about reducing hospital stays, but more so about patient convenience and comfort,” she says. “Our New Jersey patients don’t have to go to Manhattan anymore. It’s all done safely, and they’re thrilled that this state-of-the-art care is right in their backyard.”

According to Teplinsky, the medical community is also paying more attention to “cancer survivorship.” Many patients experience long-term side effects beyond their active cancer treatment, including risks to their mental health, bone health, cardiovascular health, brain health, and sexual health, as well as infertility and early and premature menopause. This has led the medical community to focus on addressing these long-term side effects and supporting patients both during and beyond active cancer treatment.

“We have seen tremendous advances in breast cancer treatments in the last few years that are improving outcomes for our patients,” Teplinsky adds. “We are focusing on escalating care when necessary and de-escalating care when we can. There is an increasing focus on supporting patients beyond active treatment, focusing on survivorship and their overall well-being.” 

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