But a new approach to treatment might help some post menopausal women avoid a mastectomy and also may let many skip chemotherapy.
The novel therapy is giving hope to a Chicago-area teacher.
Gayle Goldstein has a passion for teaching. Her 5th grade Chicago students are a priority. So when she was blind-sided with a diagnosis of Stage 2 breast cancer in 2006, she was determined not to let it interfere with her classroom commitments.
"I felt that I wanted to continue doing what i love to do. I love my children. And I couldn't image going to them telling them i couldn't be here anymore," said Goldstein.
The University of Chicago Medical Center offered a treatment that made sense to Goldstein: estrogen-lowering drugs to help shrink the tumors and allow her the chance to fight the cancer without chemotherapy and drastic surgery.
"What we are trying to do is tailor the treatment to the tumor and to the patient," said Dr. Nora Jaskowiak, surgical oncologist, University of Chicago Medical Center.
Estrogen-fueled breast cancer accounts for roughly 70 percent of all breast cancers. Newer hormone blockers called aromatase inhibitors can shrink certain tumors much like chemo but are considered to have fewer side effects.
"We are frequently using these aromatase inhibitor medications in the pre-operative setting before you have surgery," said Dr. Jaskowiak. "It's not the first thing that comes to mind for many doctors because it's not so dramatic of an response. But I think it's a great thing for women to be aware of."
In a national study, more than 50 percent of women with Stage 2 and 3 cancers were able to avoid mastectomy by taking an estrogen-lowering drug first. The drugs are also an indicator for whether chemo will work or not.
"The obvious benefit of saving the breast for the patient herself is huge," said Dr. Julie Margenthaler, surgical oncologist, Washington University School of Medicine.
But this tumor-shrinking approach takes time. On average it means delaying surgery for about 16 weeks. Doctors carefully monitor the tumor and how it is responding. When it stops shrinking, surgery is then performed. Many women can then have a lumpectomy.
Goldstein says some friends and family were concerned she just didn't get the cancer removed immediately. But she did her own research and was confident with her decision, and ultimately her tumors responded to the medication. She had a lumpectomy followed by radiation. And during all of the treatments she kept teaching.
So far there is no sign of cancer.
"It is no longer one size fits all where it used to be surgery, chemotherapy, radiation. Now they are open to all these new things, and I think it's worth a try if your doctor thinks it might be right for you," said Goldstein.
"I'm going to be out of a job as a breast surgeon, in the next decade or two because we are going to be able to targeted appropriate treatment to the appropriate tumors and maybe make surgery obsolete," said Dr. Nora Jaskowiak.
This therapy will not work in women whose tumors don't respond to estrogen. And even then it may not be effective for everyone.
Goldstein continues to take her aromatase inhibitor and she ultimately ended up taking part in the national study of this treatment through Barnes Jewish Hospital and Washington University.
Judy Martin
Washington Univ. School of Medicine
St. Louis, Month
Matinju@wustl.edu
Dr. Nora Jskowiak
University of Chicago Breast Center
5758 S. Maryland Ave.
Chicago, Ill.
60637
773-834-3524
njaskowi@surgery.bsd.uchicago.edu
