Prepared By: S. Gautami Rao, MD, Foundation Hematology/Oncology

Breast cancer continues to be one of the most commonly reported cancers at our institution. It is the most common cancer reported in women [not counting skin cancer]. The incidence of breast cancer increases with age and is still most common in the sixth and seventh decades of life, generally. However, breast cancer can occur in the 20s or 90s as well. Incidence seems to level off a little in the 80s and 90s, most likely because of other comorbidities and causes of death.

Detection is clinical (self palpation or physical exam) or by radiological evaluation (mammograms, ultrasounds and breast MRIs). Screening mammograms have definitely decreased the incidence of higher stage disease and may have increased the detection of clinically insignificant cancers. At SNHMC, more than 45% of all 2009 breast cancer diagnoses were stage 1. The majority were classified as infiltrating ductal carcinomas. Most patients were diagnosed and treated at SNHMC.

At our hospital, screening mammograms for the average population start at age 40 and are recommended annually until determined not to be useful by patient, physician or stopped by death. Screening earlier than age 40 is based upon family history and risk factors for breast cancer.

Some highlights of the new staging system at SNHMC include MRI evaluation; specific recommendations regarding microscopic measurement of tumor as well as clinical measurement of tumor; and specific recommendations to pathology for size of the invasive cancer.

More recent treatment additions include the use of partial breast radiation in certain circumstances and possible avoidance of radiation in certain women over the age of 70. Herceptin, aromatase inhibitors and possibly the use of Avastin are in the forefront of adjuvant therapy.

Site study data also include surgical, radiation, chemotherapy, hormone therapy, immunotherapy and palliative treatment choices, presented by stage.

Download Dr. Rao's complete report here (.pdf)