By Robert J. Gottlieb, M.D.
Hematology/Oncology Physicians of Lancaster

As we enter the new millenium, it would be appropriate to assess what has been accomplished in recent years to improve the outlook in patients with breast cancer and where we have to go in the future. In recent decades, we have made substantial inroads in early detection, effective therapy, as well as now even prevention of breast cancer for American women. This disease, the most common type of cancer afflicting women, has always been associated with intense emotional and physical disability. However, much has been discovered which offer dramatic hope and encouragement not only to the women who have this disease but to women who are at risk for getting it.

The major risk factors for developing breast cancer include:

1. A strong family history of breast cancer.
2. An early age of menarche.
3. Breast biopsies.
4. Absence or a late age for first pregnancy.
5. A lesser role may be played by high dietary fat and cigarettes and use of exogenous estrogen hormones.

For those women who are at high risk, a medication called Tamoxifen has been shown to reduce this risk by up to 40 or 50 percent when it is taken for five years. This drug has only mild side effects of increased heat flashes, headaches, occasional weight gain, and rare development of blood clots or easily treatable cancer of the uterus. It is a medicine that could be considered for many women who are at high risk for breast cancer.

Early detection of breast cancer by use of regular mammography has been a vital force in helping to make the diagnosis in the very earliest stages. By doing this, the need for a mastectomy has been reduced dramatically. Most women with breast cancer can be treated by removal of the lump and possible radiation therapy and do not have to undergo the physical and emotional traumas of a mastectomy. This has been a dramatic and major advance in the treatment of breast cancer in the latter part of the 20th century.

In addition, it has been found that breast cancer in most stages is a systemic disease. The use of various medicines on a systemic basis taken either orally or intravenously has been shown to reduce the reoccurrence rate of breast cancer and significantly improve the cure rate. These medications may include a pill called Tamoxifen or the use of chemotherapy in a variety of forms. Recent studies have shown that the use of certain types of chemotherapy, including Adriamycin and the taxanes have been shown to significantly reduce the reoccurrence rate of breast cancer in those women who have involvement of a number of lymph nodes.

In the 21st century, our goal is to further refine our treatment of breast cancer and get maximum reduction in the rate of reoccurrence with the least possible side effects. In addition, the new STAR Trial has been initiated which compares the established drug Tamoxifen to the newer drug Reloxifene in order to determine whether Reloxifene is equally as effective in reducing the incidence of breast cancer and hopefully can further reduce the already low incidence of side effects. This trial, which is taking place around the world and at a number of major medical centers in the United States, is one in which the Lancaster General Hospital can offer its patients in Lancaster. Patients are randomly allocated to receive either Tamoxifen or the drug Reloxifene for five years if they meet the eligibility criteria. Patients who think they may be at increased risk for breast cancer because of breast biopsies or strong family history of breast cancer are invited to contact Becky Neal, Oncology Research Nurse at (717) 290-5965 to discuss their eligibility for this trial.

By reducing the risk of developing breast cancer as well as more effectively treating established breast cancer, we hope in the years to come to further improve our results of treatment.