Breast cancer is the most commonly diagnosed form of the disease among women in Tennessee and the second leading cause of death, according to the Tennessee Department of Health.
As a surgeon in Knoxville, Randal Graham, MD, knows he is often the first, and sometimes the last, hope for patients seeking treatment for breast cancer.
“Historically, our options for success were usually limited to surgical mastectomies,” he said.
But thanks to almost constant technological advances, Graham and other physicians can offer a myriad of options that may include surgery, radiation, chemicals, and various combinations of these, all with more success than ever before.
“There have been tremendous improvements,” he said. For decades, one of the most successful options for treating breast cancer was a mastectomy, or complete breast removal. But new procedures such as partial lumpectomies have reduced the need for total tissue removal.
Technologies such as laser energy also hold promise. Graham and his practice, Premier Surgical Associates, are currently involved in a clinical trial with Novian using laser energy to destroy benign tumors. The procedure uses a needle to deliver the laser light directly to the tumor. As of now, the Food and Drug Administration has approved testing the procedure only on benign growths.
“But it could be applied to treat malignant tumors in the future. That shows real promise,” said Graham.
Radiation therapy, often prescribed in conjunction with lumpectomies, is becoming less painful and intensive in some cases thanks to a new procedure known as partial breast radiation. In a strategy similar to a lumpectomy, a balloon catheter is used to target radiation directly on the tumor, rather than the traditional method which involves surrounding tissue. The course of treatment is usually less than a week, after which the catheter is removed.
“This option works well for patients who work or who have to travel for treatment,” said Graham. “The procedure also offers good cosmetic outcomes.”
Along with exploring new treatment options, physicians in Tennessee are also focusing more on prevention, early detection and breast cancer education.
Breast cancer screening became a hot topic in late 2009 when the U.S. Preventive Services Task Force revised its recommended guidelines for breast cancer screening. The panel suggested that women not begin routine mammograms until age 50 and that the tests be done every two years instead of yearly. The previous guideline recommended the procedures for women over 40. The group also suggested that doctors should not teach women how to do breast self-exams.
Graham doesn’t mince words over the new screening guidelines. “It’s dead wrong. There is value to self-examination.”
Physicians are also placing greater emphasis on the value of genetic testing in breast cancer prevention. A simple blood test, known as the BRCA test, can check for changes in specific genes that help determine a patient’s risk for developing breast cancer. The test is fairly expensive but can show if a patient is at greater risk for additional cancer. It can also tell if other family members are at risk.
“It seems we are seeing more young women with breast cancer,” said Graham. “We offer the BRSA test as a useful tool for them.”
Testing can also help patients decide on preventative procedures, including mastectomies. The rate of mastectomies is increasing again as more women with cancer in one breast are choosing to remove the other rather than take a chance the disease could return.
Patients at several medical facilities can make those important decisions with the help of specialists called breast navigators. At Holston Valley Medical Center and Bristol Regional Medical Center, navigators work one-on-one with patients through diagnosis, treatment and recovery.
“I determine if the patient has a surgeon, attend the consultation, hear options and help her make an informed decision about her personal treatment process,” said Mary Coon, a registered nurse and oncology breast navigator at Bristol Regional.
“Not everyone has the same needs,” said LaCosta Brown, oncology breast care coordinator at Holston Valley. “We coordinate their care around their life to our best ability.”
Navigators aid patients in coordinating office visits and treatments so all their time isn’t spent at the hospital. They also can help patients find additional funding for care, local support groups and other resources. Navigators also attend weekly multidisciplinary conferences to discuss patients’ progress along with physicians and staff members.
“It gives us all a better approach to a patient’s treatment. It gives me great confidence knowing I’m recommending the right options for my patients,” Coon said.
A similar program at Memorial Healthcare System in Chattanooga involves a Mobile Mammography Coach at the MaryEllen Locher Breast Cancer Center. The coach helps educate women about the importance of breast health and increase screening among women. The system was recently awarded a $55,000 one-year grant from the Avon Foundation Breast Care Fund. It’s the ninth straight year Memorial has received Avon funding.