Transcription:
Advances in Breast Cancer Treatment

Maggie McKay: Deaths from breast cancer have declined over time. However, breast cancer is still the second leading cause of cancer death among women in the US overall, according to the Centers for Disease Control and Prevention or C D C.

But there are advances and options in treating it and new research in progress

Here to tell us more is Dr. Anu Thala, an oncologist with Comprehensive Cancer Centers of Nevada, and also with the Valley Health System. She'll talk about the latest treatments, the importance of mammograms, risk factors, and more. Welcome to Health Talk with the Valley Health System presented by The Valley. I'm Maggie McKay. Dr. Thummala, thank you so much for being here to update us on the latest in treatments for breast cancer. It's a pleasure to have you here.

Anu Thummala: Pleasure to be here. And thank you, Maggie, for inviting me for this conference.

Maggie McKay: Absolutely. To begin some basics, how crucial are yearly mammograms or screenings after a certain age? And what age is recommended that you start them now?

Anu Thummala: Screening mammograms, there's several different task forces which have put up guidelines as to when is the appropriate time for getting a screening mammogram. Mammograms do save lives because if there is early detection of breast cancer. These lesions are treated and there's high cure rate from breast cancer. But you have to talk to your provider on what best suits you because there's so many factors which go into when the screening mammogram has to start.

American Cancer Society, United States Preventive Task Force Services have all given several recommendations on when to start screening mammogram. American Cancer Society recommends around age 40 yearly and then to a maximum age of 74, unless you have a life expectancy greater than 10 years. United States Preventive Services Health Service Task Force has a little bit different recommendation. They recommend starting around age 50.

Lately, it depends on the number of risk factors you have, the preexisting conditions you have, like if you have a family history of breast cancer or you previously had an abnormal lesion in the breast and you had to undergo a biopsy. Those are exceptional cases, which may need mammograms to start sooner. If you have a strong family history, average is 10 years from the first diagnosis of cancer. So with these variables, it's always so important that you just talk to your provider and see what best suits you.

Maggie McKay: And what are some symptoms of breast cancer?

Anu Thummala: Most often, they're detected by a screening mammogram if it's a very, very early stage. If it's a little more advanced stage, patients usually feel a lump or they come in with a lump in either in the breast or in the armpit, which is called as a lymph node. About only 25% of patients do experience pain in the breast as a presenting symptom. Occasionally, we see bloody nipple discharge or discoloration of the skin. So, that's why palpating your breast and doing monthly breast exams is so important and critical in the early detection of cancer.

Maggie McKay: And what are some risk factors or causes of breast cancer and are certain ethnicities more prone to get it?

Anu Thummala: Nowadays, there's so many other genetic variables which are also causing increased risk of breast cancer. On an average, about 15% to 20% of breast cancers are caused by a genetic mutation, which the family carries. But other risk factors also include obesity, excessive use of hormonal therapy, previous chest wall radiation and history of multiple biopsies.

Now, don't quote me wrong on this one. When I say biopsies, it's not that it is causing breast cancer, but the biopsies were done because there was some abnormality in the breast like in what we call as atypical ductal hyperplasia or a pre-cancerous lesion. And those also predisposes an increased risk of breast cancer.

We all know smoking is also another added risk factor, and delayed pregnancy and also a very early onset of your period. So, the longer you have estrogen exposure without a break with pregnancy, that means women who do not have kids, they are also at an increased risk of breast cancer.

Maggie McKay: And you mentioned a few ways, I think you answered this somewhat, but are there any ways to prevent getting breast cancer? It sounds like not smoking, keeping your weight under control. What else?

Anu Thummala: I think maintaining a very healthy lifestyle, understanding your risk factors of what can get you into that situation, maintaining a healthy diet as well as exercise, prevention of obesity, vitamin D replacement, all these are important. If you do know that some of your family members are affected with breast cancer, it's very important that you talk to your providers about screening mammogram. Mammograms still save lives, and they can detect breast cancer in a very early stage.

Maggie McKay: And women aren't the only ones. Men can get breast cancer. How common is that?

Anu Thummala: You are so true, Maggie. Yes, it's a bit uncommon to see breast cancers in male. On an average, most of my patient population would be women. But yes, men are not spared from male breast cancer. And in fact, because the numbers are small, their treatment and the way we approach a male breast cancer is almost extrapolated to what a female breast cancer is.

Maggie McKay: And you're on the front lines of clinical research collaborating with other hospitals. Can you tell us what you're working on and what research you may be optimistic about in the future?

Anu Thummala: There are so many advances in the field of breast cancer, especially in the last five years. Now, the way we are looking at cancers is how different the imprint of cancer is. It's no longer a cookie cutter approach of you have breast cancer and this is the treatment. There are different subtypes of breast cancers, and all of them are treated in a very different way.

On a broad spectrum, you have breast cancers, which are estrogen-positive, estrogen-negative, HER2-positive, HER2-negative, triple-negative breast cancers when all the receptors are negative. So, each individual cancer has a special treatment order. We use many, many different agents to treat them. Again, it's a little bit different when you are treating them in the early stage breast cancer versus when you're treating them in the late stage breast cancer. There's so many immunotherapy advances and targeted therapy advances which are going on in the field of breast cancer. Especially if you look into the stage IV breast cancer, we are working on using less of chemotherapy and more of biological therapies, targeted therapies, immunotherapies, which stimulate your immune system or directly attack the cancer cells, sparing you from chemotherapy.

Maggie McKay: What is biological therapy?

Anu Thummala: You know, these are agents which are directly devised to the target on the cancer cell. And they work with the way the cancer cells proliferate. Cancer cells are very smart. They escape the immune system, and they are hidden. So, you are basically using some of these agents just to stimulate back your immune system to recognize the cancer cells for better cancer kill. Now, again, these treatments differ in different types of cancers you could carry.

We at Comprehensive Cancer Centers are involved in research both for early stage, late stage breast cancer. We are looking at some of the use of these novel agents which help to prevent progression of cancer.

Maggie, I'm very proud to say that the survival, even in stage IV cancer, has significantly improved because we are incorporating these newer agents in their management.

Maggie McKay: That's great. And are there less invasive alternatives to breast cancer surgery these days, Dr. Thummala?

Anu Thummala: The scars are getting much smaller. Especially if you want to remove the lymph nodes in the axilla, previously, a decade ago, we used to take out all the lymph nodes in the armpit, and now we no longer do that. We are very selective in our approach to how many lymph nodes we remove by injecting a dye into the breast and localizing that particular lymph node, which is actually draining the breast, and where the cancer cells tend to go first. And this is what we call as a sentinel lymph node biopsy. And with this, the risk of lymphedema, which is the swelling of the arm, which happens after the breast surgery is completed or after the lymph nodes are removed, is significantly lowered. And in fact, I can say that I barely see lymphedema these days because of the expertise of the surgery.

Maggie McKay: That's great. And of all the research you're doing right now, what are you the most hopeful about? Which treatment?

Anu Thummala: My field is more focused on how I can incorporate some of these immunotherapies as well as targeted therapies in the prevention of progression of cancer, as well as improving overall survival progression, disease-free survival for these patients with minimal toxicities. The good part is my dream is to see no hair loss for women with breast cancer. And I think we are making progress towards that. We are using less and less chemotherapy.

The other important thing, Maggie, is we are also looking at genetic imprint of the cancer cells. Okay, what I mean by that is the cancer cells carry genes just the way we do carry genes, and these are very specific for the cancer cell. And the main function of these genes is to help the cancer cell grow and proliferate. So, we are trying to understand those mutations in those cancer cells and directly use medications which attack those particular mutations. You know, it's a fascinating time in breast cancer, that we are able to offer all these therapies with the best clinical advantage to the patient.

Maggie McKay: And with so many types of breast cancer like you were mentioning, are there ways to personalize screenings depending on what type you have?

Anu Thummala: As we speak, no. For a screening exam to be effective, you have to use it in a certain number of people as well as you have to have an adequate number of patients to show a benefit that this screening modality definitely saves lives, right? So, we are not at a point where we can categorize breast cancer to say, "Okay, if you have an estrogen-positive tumor, this is how you're going to be screened. If you have an estrogen-negative tumor..." Remember the screenings are to find the cancer. So, the talk is before you even find the cancer. So at this point, these are general screening exams.

Maggie McKay: And it seems like with advances, come much better survival rates compared to even a decade or two ago. Is that accurate to say?

Anu Thummala: Absolutely. Our patients are living much longer. And now, it's very important for listeners to understand that, even if you are diagnosed with advanced stage breast cancer, stage IV breast cancer, there are multiple options to improve survival. I'm proud to say that many patients in my office who have also crossed a decade with even stage IV cancer, some of them even had cancer in their brain and they're still doing very well. Thanks to research and the number of medications we have, the number of drugs we have, that it has really significantly improved their survival.

Maggie McKay: I have to ask because just this week, Dr. Thummala, I had my annual mammogram just coincidentally. And I was thinking while I was there, I was so grateful that they have screenings. But when will they redesign the machines to make them more user-friendly? Is there any talk of that happening in the near future? Because women know what I'm talking about, they are not comfortable.

Anu Thummala: Absolutely, Maggie. I'm very religious with my mammograms too. And yes, I do wince when I have to do this. I do understand the pain behind, but I always tell my patients, "Hey, five minutes of pain and agony will save a life." And that's the way I look at it. We do have alternatives like ultrasound of the breast, especially for women who have very dense breasts. MRIs are working its way up into screening especially for very high risk patients who are at risk for developing breast cancer. But MRI is cumbersome. There is also an exposure to radiation because of the technique. So, it's not an easy modality. As we speak, mammograms still stay the gold standard of screening for breast cancer.

Maggie McKay: Well, that's good to know then. It's worth it.

Anu Thummala: And I do understand. You know, many women are fearful just because of the pain from mammograms. And I say that we do so many things in our lives which are much more painful. But if something is being done to save a life, I think I would go for it.

Maggie McKay: Totally. So, is there one main takeaway that you'd like listeners to remember from this conversation?

Anu Thummala: Please be mindful, educate yourself about what your cancer risks are. Please talk to your providers. Screening is very important and early screening is pretty much cure of many cancers.

Maggie McKay: Thank you so much for your time, Dr. Thummala. It's reassuring to be informed with some optimistic news on the latest treatment options for breast cancer. Thank you.

Anu Thummala: Thank you, Maggie. Pleasure. Thank you.

Maggie McKay: To find out more, please visit valleyhealthsystemlv.com. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks again for listening to this episode of Health Talk with the Valley Health System presented by The Valley. I'm Maggie McKay. Be well.

Disclosure: Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.