» Part II

By Mary O’KEEFE

Since Ancient Egypt there have been attempts to treat and cure cancer. The growing body of knowledge about breast cancer biology and improvements in surgical and medical treatments has been built over time. One of the earliest manuscripts reporting on cancer treatment was written on the Egyptian papyrus of Edwin Smith, dated 1600 BC but possibly copied from a much older document dating from 3000 to 2500 BC, according to the U.S. National Library of Medicine – National Institutes of Health.

The word “cancer” was created by the Greek physician Hippocrates. The term is derived from the word Karkinos, which is Greek for crab or crayfish. Some feel this is an analogy for the invasive behavior of the disease, which touches and invades nearby tissues. Breast cancer, and other cancers, has been studied as a disease of the body and was once considered an act of magic or of God. Removing the infected breast was the only treatment for centuries but, as medical knowledge flourished, surgical and alternative techniques were developed.

Chemotherapy evolved in the second half of the 20th century and, with the financing of cancer drug research by the U.S. National Cancer Act of 1971, more treatments were found to fight breast cancer.

Today’s precision medicine includes cancer treatments that use information about a person’s genes, proteins and environment to prevent, diagnose and treat cancer.

In addition to treatment, methods of diagnosis have changed and improved over time. X-ray imaging had been used to detect breast cancer in the early 1900s, then, in the 1960s, mammograms became a more acceptable instrument for detection. The mammogram is currently the “go-to” diagnosis tool for the detection of breast cancer. But that tool has also evolved resulting in the 3D mammogram.

3D mammography, as defined by Cedars-Sinai, is an imaging procedure in which an X-ray moves in an arc over the breast, taking multiple images from different angles. The 3D pictures are synthesized by a computer into thin, one-millimeter images, making it easier to see tumors.

“The 3D mammogram is the best tool available for [detecting] breast cancer,” said Mary Yamashita, director of the Breast Cancer Center at USC Verdugo Hills Hospital.

However not all breast centers have 3D imaging.

Yamashita said that one of the most important aspects of detecting and, if needed, treating breast cancer is the team that is at the hospital’s Breast Cancer Center.

“[It’s important] you go to a place where you have a team of multiple breast specialists to get the best treatment [and detection],” she said. “There are many types of breast cancer out there and it is really important that you get personalized care.”

She added it is important that a woman, or man, is comfortable with the breast cancer team and, if breast cancer is detected, the team will provide emotional support as well as medical support.

Yamashita said that a patient’s attitude of “I can fight this” and “I can get through this” can reflect the team that includes a breast imaging specialist, a medical oncologist and, many times, a nurse navigator who can help patients get through all the appointments.

It is also important for the medical team to know a patient’s history especially if a woman has a history of breast cancer in her immediate family.

For some patients there is another imaging detection tool that is available: magnetic resonance imaging – MRI.

“We offer an MRI to all women but MRIs are [usually] used for high risk patients,” she said.

That a patient is a woman is the first risk factor in developing breast cancer but there are other risk factors to consider as well including whether there is a history of breast cancer in the family or having been tested and found to have a type of breast cancer gene. Another consideration is the type of breast tissue the woman has.

“Having dense breast tissue on a mammogram is [sometimes difficult to see],” she said. “Breast cancer appears white on a mammogram. It is harder for us to find a small white breast cancer in dense [tissue] breast. People who have dense breast tissue are at a greater risk than those who have fatty breast tissue.”

Also taken into consideration is how long it has been since a woman ended menopause, if she used hormone replacement, how much alcohol she normally drinks and if she maintains a healthy weight and exercises.

In addition to typical mammograms and 3D mammograms there are also ultrasounds that can be used to detect breast cancer, but Yamashita said this method can be tricky because it depends on the abilities of the ultrasound technician; however, it is a helpful method for those with dense breast tissue.

Yamashita said at USC researchers continue to look at numerous new detection technologies. She is the principal investigator of a research project at USC Norris Comprehensive Cancer Center that looked at a new ultrasound device known as SoftVue. It is the world’s first 3-D whole breast ultrasound system that might better assist physicians in distinguishing normal breast tissue from cancers, according to USC Keck. This new system could better detect breast cancer in women who have dense tissue.

Over 8,000 women were involved in the project and the data is now being analyzed.

“This is technology that would only be used for breast cancer [detection]. A woman lies [face down] on a table with holes on one end of the table. The hole gets filed with warm water then a ring system circles the breast,” she explained.

A 360-degree transducer images the entire breast in a single pass within two-to-four minutes per breast without radiation exposure or compression. Unlike handheld ultrasound, SoftVue can provide multiple distinctive tissue qualities to radiologists, allowing them to differentiate possible cancers from normal to benign findings, according to USC Keck.

“It is exciting,” Yamashita said. “Some of these [new] technologies are giving us great results.”

  Mary Okeefe