News > Beyond the headlines: Survival, breast screening, scans in metastatic breast cancer

Beyond the headlines: Survival, breast screening, scans in metastatic breast cancer

LBBC’s July column shares our views on breast cancer news

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Despite all we’ve learned about breast cancer over the last few decades, we still have trouble figuring out which cancers are most likely to be lethal, which individuals are most vulnerable to toxic side effects, and who needs to be followed most carefully to ensure they live as long as possible with the best quality of life. The answer, of course, is everyone, but with technology and medicine becoming more and more tailored, it’s our responsibility to identify the most vulnerable — and to focus our resources on them.

Read on to learn more about early-stage survival outcomes, the use of supplemental ultrasound screenings after mammograms, disparities in second cancers, PET-CT scans for staging, and side effects, as well as a tribute to Susan Love and Mit Joyner from Jean Sachs, LBBC’s CEO.

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Reasons for hope (with limitations)

The internet was abuzz after a UK-based study showed risk of death from early-stage breast cancer decreased over time. Looking at breast cancer outcomes from the early 1990s through 2015, the researchers found the 5-year risk of dying was 14.4% for women diagnosed 1993 through 1999, versus 4.9% for those diagnosed 2010 through 2015. During the more recent period, when women would have received today’s standard treatments, the risk of breast cancer death was less than 3% for nearly 63% of women. Still, 5% of women had a disproportionately high risk of death, at more than 20%.

This study has some key limitations: it only followed women for five years, and the most common type of breast cancer — hormone receptor-positive — tends to recur later. It excluded people with metastatic disease and those who got pre-surgical chemotherapy. And it contained no information about racial and ethnic background. Nevertheless, this study shows that broadly across the population, people with early-stage breast cancer are living longer, most likely because of improved screening modalities, medications, surgery, and radiation therapy. Now we must focus on those with MBC and that 20%, finding cures for those at greatest risk.

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Good, clear communication about prognosis can make a vast difference to a patient's quality of life, and how they can cope with things.

Dr. Carolyn Taylor, in The BMJ

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Don’t be dense about screening

Breast cancer screening guidelines can be confusing, even to doctors. One study shows physicians may not target those at highest risk for breast cancer who could benefit from breast ultrasounds, a supplemental test given after a screening mammogram. The study compared over 825,000 people who got screening mammograms without supplemental ultrasounds to 38,000+ who got supplemental ultrasounds. They found no differences in the risk factors for the two groups: participants all had high or heterogeneously dense breast tissue. This suggests doctors should be ordering supplemental screenings based on other risk factors, like family history and past benign breast conditions. If you’ve been told you have dense breasts, talk with your doctor about a tailored assessment of your risk so you can get personalized recommendations for screening, whether it’s ultrasound, MRI, or something else.

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Black female nurse speaks with young Black woman with headscarf
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Disparities, beyond the breast

After breast cancer treatment, appropriate screening and surveillance — for all cancers, not just breast cancer — is vital to your health. In a study of nearly 40,000 women who’d had breast cancer, the risk of death from a second, new primary cancer was 12% higher among non-Hispanic Black women and 8% higher among Hispanic women compared to non-Hispanic white women. Compared to white women, non-Hispanic Black women were less likely to be diagnosed at a local stage, and Hispanic and non-Hispanic black women were more likely to need chemotherapy for a first and second cancer, the study found. Talk with your doctors about a tailored cancer screening plan.

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A multipronged approach is needed to identify biological factors, and patient-, provider- and systems-level contributors to survival outcomes among breast cancer survivors.

Kala Visvanathan, MD, MHS, on News-Medical.net

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PET-CTs for locally advanced breast cancer?

In an intriguing study of about 370 people, half the participants got standard screens to stage the cancer: bone scan and CT with contrast of the chest, abdomen, and pelvis. The other half did whole-body PET-CT, a different staging method. Among those with locally advanced disease, the PET-CT found more distant metastases than standard scans. This led to fewer people in the PET-CT group receiving multimodality therapy, or the combination of neoadjuvant chemotherapy, surgery, and radiation that is more common in non-metastatic cancers. We don’t yet know whether “upstaging” cancers leads to better survival, but we are excited for research to address this important question.

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The study raises the question of ‘is finding something on PET and not on CT and bone scan clinically impactful’ and warrants further study. A significant limitation of this study is that most patients upstaged did not have a biopsy and, as such, there may have been false positive PET/CT readings.

Eleonora Teplinsky MD, July guest reviewer

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Side effects: The struggle is real

We continue to see growing interest in tackling side effects of breast cancer treatment. An article on chemo brain, the brain fog and difficulty thinking many people experience during and after treatment, shares research on how cognitive behavioral therapy (CBT), exercise, and stress reduction help people regain focus and improve sleep. And a blog from Patti McGee focuses on the choice to stop anti-estrogen therapy because of side effects like hot flashes, vaginal dryness, mood changes, joint pain, and bone loss. Read LBBC’s recent story on this topic to learn about tools you can use to plan with your doctor and manage anti-estrogen side effects.

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I knew that stopping the drugs increased the risk of cancer recurrence, but I also knew that I couldn't continue living with the emotional and physical toll they were taking on me.

Patti McGee, in Cure

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Dr. Susan Love
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L: Dr. Susan Love (source); R: Mit Joyner (source)

Mourning powerful voices

Cancer stole two inspiring women this month. They touched millions of lives, including mine. Early in my career I was fortunate to work with and learn from Dr. Susan Love in the young days of the National Breast Cancer Coalition. Susan was accessible, determined, honest, and compassionate. Her goal was to stop breast cancer forever, as well as to reduce the toxic side effects of treatment. After joining LBBC in 1996, I had the pleasure of working with Mit Joyner, LBBC’s second board chair and a past president of the National Association of Social Workers. A breast cancer survivor herself, Mit dedicated her career to furthering health equity. Today, we honor both women, and we pledge that their legacy will live on through the work we do. —Jean Sachs

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Susan Love’s work made a significant difference for those diagnosed with breast cancer. LBBC is honored to be part of continuing her legacy.

Jean Sachs, LBBC’s CEO

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(Our) people are talking

  • Hear My Voice graduate Lynda Weatherby hosted an episode of SHARE’s Our MBC Life podcast featuring LBBC Medical Advisory Board member Ginger Borges, MD, on the important topic of the rising rates of breast cancer and metastatic breast cancer in young women.
  • Young Advocate grad Tova Parker was featured in conversation with For the Breast of Us ambassador and LBBC support services coordinator Keneene Lewis, MA, Ed, BSM, on FTBOU’s website.
  • Ann Partridge, MD, PhD, a member of our Medical Advisory Board, hosted a podcast on ways for doctors to better support people and families through a breast cancer diagnosis and beyond.

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Thank you to consulting medical editor Claire Nixon for her help with this month’s column.

Beyond the headlines is on extended summer hiatus. Visit Breast cancer news and follow Living Beyond Breast Cancer on social to stay up-to-date on the latest conversations in our community.

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