Earlier this year, new data presented to the American Association for Cancer Research revealed a bit of—if you can believe it—good news about breast cancer. Between 2010 and 2020, deaths from the disease were down across the board, even as rates of breast cancer went up. While breast cancer is of course a scary, world-altering diagnosis, this trajectory is hugely encouraging for patients and the physicians who treat them. “There’s so much good happening in this space,” explains Gilda Boroumand, M.D., a board-certified radiologist at Connecticut Breast Imaging. “There’s a lot to be optimistic about.” In honor of breast cancer awareness month, Westport Lifestyle spoke with top local physicians o break down some of the reasons for this important shift.
Better, more comprehensive screenings
You’ve probably heard that early detection is the key to saving lives, but early detection itself has become more effective in recent years thanks to improvements in both parts of that phrase: identifying specific high-risk patients younger and keeping a close eye on them, and better technology for their screenings. “Right now, the accepted guidelines are to start [mammograms] at age 40 if you’re of average risk,” explains Shieva Ghofrany, M.D., FACOG, a board-certified ob-gyn in Stamford and cofounder of health and wellness platform Tribe Called V. But the American College of Radiology now also recommend a risk assessment, done by age 25, to give a rough estimate of your lifetime risk of breast cancer. These questionnaires ask for information like whether you have a family history of cancers, how old you were when you had your first period, your age if and when you had children, and more. (At Connecticut Breast Imaging, every patient is offered one of these assessments.) This information can help inform the types of screenings you should get, and when. “A family history of breast cancer in an 80-year-old grandmother is very different from a family history of breast cancer in a 40-year-old sister,” explains Dr. Boroumand. “Some patients who think they may be high-risk may actually not need to start screening until 40. (And for those patients, a risk assessment would likely help alleviate their anxiety regarding breast cancer!) Others may benefit from starting screening before 40, and they may want to also consider MRI. It can be a very individualized approach, as the issue becomes quite nuanced.” The assessment results can also help docs determine whether you’re a good candidate for genetic testing. While only about 10-15 percent of breast cancers are linked to one of the known genes, having a full genetic picture can be hugely helpful towards making sure you’re taking the best possible steps to catch any potential cancers early. Bottom line: getting a risk assessment done, and done early, helps doctors tailor your care.
It’s worth noting that imaging tools, too, are improving: 3-D mammograms now offer complete views of the breast, says Dr. Boroumand. And while it’s still in development, another potential new tool is contrast-enhanced mammography, which looks at blood flow in the breast, similar to an MRI. “The theory is it might be able to find things that are missed on a regular mammogram,” explains Dr. Boroumand. “So far, it’s promising.
Care that’s individualized
Ultimately, risk assessments and genetic testing are useful because they give doctors more information about you as a person, and that helps them provide what’s known as “precision medicine.” “Every field of medicine is evolving to become more individualized,” explains Dr. Boroumand, and breast cancer care is no exception. “Because there’s so much research about breast cancer, there’s an impetus to find treatments that are tailored to the unique individual sitting in front of the doctor,” she says. “Precision medicine, really, is what’s supposed to happen in medicine,” adds Dr. Ghofrany. “We’re trying to look at the whole person.” So that might look like annual MRIs for a 34-year-old with a family history of premenopausal breast cancer and who has dense breasts, it might look like targeted immunotherapy for a triple-negative tumor (more on that below), or it might look like taking a patient’s lifestyle into account when making recommendations. For example, says Dr. Ghofrany, alcohol is not recommended for people at higher risk of breast cancer, because we don’t know how much, if any, is safe. But encouraging someone to cut out alcohol when they are drinking three to five nights a week because they’re stressed at work is different from someone who savors an occasional glass of Sauvignon Blanc because it compliments their grilled branzino. “It’s not cookie-cutter,” Dr. Ghofrany says. “The only hard part is that precision medicine is, sadly, a privilege for people who have time with their doctor.”
Improved treatments
Breast cancer is complex. There are many different types, and science can now hone in on the distinctions between them to help doctors choose the most effective treatment options. “Every breast cancer is analyzed at the molecular level to determine what the best treatment plan might be for the patient,” says Dr. Boroumand. Doctors can now actually test the cells of a tumor to see how they might respond to different treatments. “It gets really detailed.” This level of understanding, coupled with new drugs constantly in development, is leading to better outcomes for everyone diagnosed. “What gives me the most hope is that the majority of breast cancers are cured,” Dr. Boroumand says.
Hope for the future
All of this progress really boils down to one thing: staying on top of your annual screenings is key. “If we can diagnose a cancer sooner, there are so many more and better options for treatment,” says Dr. Boroumand. “So even though it’s scary, being proactive is really helpful in the long run.” Dr. Ghofrany agrees, and offers a reframe: “Let’s stop saying we’re scared,” says Dr. Ghofrany, especially given the statistics that "early stage” breast cancers confer a five-year survival rate of 99 percent. “Let’s be proactive, not paranoid, and do all the things we need to do so that if we find it, we find it early.”
“Because there’s so much research about breast cancer, there’s an impetus to find treatments that are really tailored to the unique individual sitting in front of the doctor,” explains Dr. Gilda Boroumand