Opinion - Whatcom View

POSTED: Saturday, Oct. 24, 2009

Some good news in the long fight against breast cancer

October can overwhelm us with breast cancer awareness. We're urged to donate, participate, support, run relays, jog, race, walk and purchase a variety of pink-colored items. We buy items labeled with pink ribbons, from deodorant to automobiles. We're asked to read articles about an actress or singer who was recently diagnosed with breast cancer and is now a survivor.

It is frustrating that these requests return every year. Like migrating birds returning year after year, singing the same song that the cure is just around the corner. It's been more than 30 years since the war on cancer began. This war has become the longest war our country has ever fought and not won. When we hear of yet another person being diagnosed with breast cancer we get more disillusioned.

If national statistics weren't bad enough, it is worse in our state. Year after year, Washington state has had the highest rate of invasive breast cancer of all the 50 states. Our state is number one, 23 percent above the national average. (Whatcom County's numbers are similar to state numbers.) Yet we still don't know what causes breast cancer or why our own rate is so high.

We have a variety of suspects. It could be the rain, the clouds, the air, lack of sunshine, high fatty food intake, low exercise, emotional stress, alcohol, electromagnetic radiation, drugs, smoking, family history, lack of organic foods, not enough sleep, environmental toxins, solar radiation, low Vitamin D, excess hormone use, lack of minerals or supplements, or even other causes.

Research has looked into all of these factors, without being able to identify the single cause of breast cancer. Chances are that it's not a single cause. It is more likely a combination of several factors occurring in certain people with specific genes resulting in breast cancer. The exact cause still eludes and discourages all of us.

So, what have we done in response? If we can't identify the cause of breast cancer, our next approach would be to find it at the earliest point when it's easier to cure. This requires coordination between each woman and her doctors.

In that regard, we've been successful in Whatcom County. During the last 20 years, we have seen the mortality from breast cancer decrease by 40 percent; an average decrease of 2 percent per year, each and every year (see chart last page). This is the largest improvement in survival of any common cancer during the same time period. In addition, treatments for smaller cancers have become less invasive; lumpectomy now replaces mastectomy, one lymph node is removed instead of many, and we avoid chemotherapy more often thus avoiding the side effects.

This is, after all, the bottom line. If women diagnosed with breast cancer have a 40 percent decreased chance of dying from the disease and can be treated with less drastic methods, that is a good start. We need to continue that progress.

New research has identified many genetic types of breast cancer. Some cancers are less aggressive and can be successfully treated with minimally invasive procedures. Others can be genetically identified as having a high risk of recurrence, necessitating all our methods of treatment including targeted immune therapy and chemotherapy.

Because breast cancer treatment has become so complex, many organizations are measuring the quality of care provided. These organizations have long names and go by their acronyms such as NCBC, NAPBC, SSO, ASBD, ASBS, QOPI, QPRI, and others. Their focus is to increase the quality of breast care provided by physicians across the country.

Physicians in Whatcom County have used the team approach for breast cancer diagnosis and treatment. Working together, radiologists, surgeons, medical oncologists, radiation oncologists and reconstructive surgeons provide comprehensive breast care.

This joint effort has achieved nation-wide attention. The first nationally recognized "accredited" breast center in Washington state is in Bellingham. The physicians caring for breast cancer worked together to achieve this recognition from the National Accreditation Program for Breast Centers (accreditedbreastcenters.org).

This designation demonstrates the commitment of our physicians to comprehensive quality breast care. These physicians adhere to state-of-the-art national guidelines of care for all forms of breast cancer. There are major efforts to continuously measure the quality level of care that is provided.

Whether we find the cause of breast cancer soon or not, our community has collaborated to achieve the best results for our patients with decreasing mortality. That, alone, is a giant step forward.

Cary S. Kaufman MD, FACS, is a breast specialist and surgeon in Bellingham.