Frederick M. Ilgenfritz, MD, FACS
Bitterroot General & Vascular Surgery
1150 Westwood Drive, Suite C
Hamilton, MT 59840
Breast Cancer, the 75 year perspective
In the era of "The Greatest Generation", the 1940's, only
72% of women diagnosed with Breast Cancer lived for five years. Today
the five-year survival is 97%. This remarkable improvement in the results
of treatment has several causes. Of significant importance is the education
of women to pay attention to themselves. Regular self-examination of the
breasts by women was previously strongly encouraged, but large studies
have questioned the value of self-exam. It appears to result in more surgery
with no influence on cancer mortality. A more modest goal of increased
breast self-awareness has gained support recently. This personal awareness,
along with increased public awareness of the issue has helped significantly.
A second reason for the improved statistics is the routine use of mammography.
The American Cancer Society has recommended all women have a mammogram
every year starting at age 45 and then every other year after age 55.
This use of mammography means that the average size of the tumor detected
is a fraction of what it was 50 years ago. These small tumors are much
more easily treated.
The third reason for the improvement in Breast Cancer statistics is the
treatment available to patients today. In the first half of the twentieth
century the treatment for breast cancer was to remove the entire breast,
the underlying muscles and all the lymph nodes in the armpit. The resulting
wound was both ugly and in many cases disabling.
These women had difficulty using the arm afterward and often skin grafts
were needed to close the large incisions. The patients were then treated
with high doses of both radiation and chemotherapy, often with severe
and unpleasant side effects. Since the 1980's, due to the small size
of the tumors, many patients do not have the breast removed. Studies have
shown that equal results can be obtained with simple removal of the cancer
with a rim of normal tissue, followed by radiation of the remaining breast.
A sample of the lymph glands in the armpit is removed to determine if
the cancer has spread outside the breast. Instead of the 5 to 7 day hospital
stays of years gone by, the typical patient stays one night or less. Chemotherapy
is still used but the improvements are remarkable. The drugs are far more
specific for the tumor and the doses are adjusted to be effective without
making the patient so ill. One, less toxic, treatment is an anti-estrogen
drug such as Tamoxifen. These drugs block the female hormones that stimulate
breast cancer growth, and are well tolerated even by elderly patients.
The future of breast cancer treatment may eventually lead away from surgery
altogether. The development of specific medical treatment to kill or turn
off cancer cells while leaving normal cells alone is the goal of many
research efforts. The genetic mechanisms that change a normal cell into
a cancer cell are becoming better understood and newer therapies designed
to prevent that change may make breast cancer a rare problem someday.
For the present Breast Cancer remains a significant health problem. There
are nearly 250,000 new cases in the United States every year. One out
of every 8 women in Montana will develop breast cancer in her lifetime.
Breast self-awareness and timely mammography remain the best hope for
an early diagnosis. New developments in breast cancer treatment will aid
in successful control of this common medical problem.
Women who have noticed a change in their breast or who haven't had
a mammogram recently are encouraged to contact their personal doctor to
have a mammogram ordered or to be seen.
Questions or comments can be addressed to Frederick M. Ilgenfritz, MD,
FACS, c/o Bitterroot General & Vascular Surgery, 1150 Westwood Drive,
Suite C, Hamilton, MT 59840 or visit