Breast Cancer Awareness Month: What You Need to Know

October is Breast Cancer Awareness Month, which recognizes a leading cause of cancer death in women in the United States, according to the American Cancer Society.

Breast cancer experts at New Jersey’s only NCI-designated Comprehensive Cancer Center, Rutgers Cancer Institute of New Jersey – Nancy Chan, assistant professor of medicine at Rutgers Robert Wood Johnson Medical School; Adana Llanos, assistant professor of epidemiology at Rutgers School of Public Health, Antoinette Stroup, associate professor of epidemiology at Rutgers School of Public Health and Bruce Haffty, chair of radiation and oncology at Rutgers’ Cancer Institute of New Jersey – discuss what is new in research, clinical guidelines and myths surrounding male breast cancer.

What recent breast cancer research has come out of Rutgers Cancer Institute?

Chan: Two recent studies to come out of Rutgers Cancer Institute involve the Trial Assigning Individualized Options for Treatment (Rx) or TAILORx trial, a national study published in June in The New England Journal of Medicine, and a study that looked at breast cancer subtype among women in NJ, which was published in the July issue of Cancer Health Disparities.

Would you explain the findings and implications of these studies?

Chan: TAILORx was a national study supported by the National Cancer Institute (NCI). The study found that for women with stage 1 hormone receptor positive breast cancer, if their Oncotype Dx (a genomic test that can help determine how a cancer is likely to respond to treatment) score is 25 or less, treatment with chemotherapy and hormone therapy after surgery isn’t more beneficial than treatment with hormone therapy alone. This is great news for women whose breast cancers fit these parameters.

Llanos: In the breast cancer subtypes study, we looked at breast cancers diagnosed among women in New Jersey to determine differences and disparities in subtypes by age, race and Hispanic-origin. Our findings indicated that in New Jersey, non-Hispanic Black women and women between the ages of 20 to 39 have higher rates of triple-negative breast cancer compared to women of other races/ethnicities and women aged 50 to 64. Triple-negative breast cancer is an aggressive form of the disease marked by estrogen (ER) and progesterone (PR) hormone receptor and human epidermal growth factor receptor (HER2) negative status. 

Stroup: The findings highlight the importance of considering enhanced education and earlier screening for some groups of women in New Jersey who might be at higher risk for triple-negative breast cancer. The disparities found in New Jersey echo decades of breast cancer studies at the national level, and so our findings also underscore the need to invest in research studies that use multidisciplinary approaches to examine biological, genetic, social and other contextual factors that influence disease risk and survival among minority women and women under the age of 50.

Information surrounding screening and treatment of breast cancer is constantly changing.  How have clinical guidelines changed recently?

Haffty: Earlier this year, the American Society for Radiation Oncology issued new clinical guidelines surrounding the use of whole breast radiation therapy for breast cancer. The new guidelines, the first update since 2011, expand the number of patients recommended to receive a form of radiation treatment known as hypofractionated therapy, which delivers larger doses of radiation over the course of fewer treatment sessions over a shorter time period.

What does this change mean for women who have or may be diagnosed with breast cancer?

Haffty:  With this change, many more women will undergo radiation after breast conserving surgery over a period of 3-4 weeks as opposed to 5-7 weeks.  The shorter period of time will allow women to get back to their daily routine sooner. Studies have now clearly shown that the shorter course of treatment is equally effective as the longer courses of therapy. 

Stroup: Data that is now available through cancer registries across the country are also providing data-driven support for a prognostic test call “OncotypeDx”.  OncotypeDx is a genomic test that can provide information about how a patient’s cancer is likely to respond to treatment or chance that the cancer will reoccur. The test is currently most helpful for women with early-stage, estrogen-receptor-positive breast cancer or Ductal Carcinoma In Situ breast cancer. Results of the OncoptyeDx test may play a significant role in treatment decisions for women with some forms of breast cancer.

Have any guidelines changed surrounding screening and early detection?

Haffty:  Guidelines for screening and early detection have not changed significantly recently, but they are always being re-assessed as new data comes in. In general, women are recommended to have screening mammograms annually beginning at age 40. The screening guidelines are different for the small subset of women with known inherited genetic mutations such as BRCA1 or BRCA1.

How common is breast cancer in men?

Chan: It is rare for men -- the lifetime risk of getting breast cancer is approximately 1 in 833, and male breast cancer comprises less than one percent of all breast cancer cases in the United States, according to the American Cancer Society. Men with breast cancer should undergo genetic testing, though, as they are at a higher risk if they have a family history of breast cancer in both males and females. Other factors that may increase a man’s chance in developing breast cancer include Klinefelter syndrome, radiation exposure and other lifestyle factors such as alcohol use and obesity.

Are the screening guidelines the same for men as women for early detection?

Chan: Men have much less breast tissue and are not routinely screened for breast cancer.  Breast cancer screening is only recommended for some men with an inherited gene mutation or a strong family history of breast cancer.

How is male breast cancer treated?

Chan: Male breast cancer should be treated similarly as female breast cancer with a multidisciplinary approach that may entail surgery, radiation and systemic therapy (with either chemotherapy or hormonal therapy) based on the specific stage and subtype of breast cancer.