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Community Connection Newsletter

Winter, 2011

COVER STORY:
Young Women Ask, 'Why Me?'

No woman is prepared for a diagnosis of breast cancer—least of all, women who haven't reached 40, an age group that accounts for just 5 percent of U.S. cases. In the prime of their lives, younger breast cancer patients are faced with sudden worries over their body image, their ability to have children, the fate of their budding career, their own mortality. Even more pressing, they must sort through various treatment options and be sure they're getting exactly what they need.

New Horizons in Treatment

The stage of the cancer and the characteristics of the tumor—not the age of the patient—are what mostly affect treatment options, says Ann Wexler, M.D., a medical oncologist at Alta Bates Summit Medical Center. Providing state-of-the-art cancer care, the medical center has programs at the Carol Ann Read Breast Health Center (CARBHC) on the Summit Campus, as well as comprehensive cancer services on all our campuses.
"Breast cancer in younger women can have an excellent prognosis," explains Dr. Wexler. "But when we see younger patients, we consider the possibility of an inherited mutation in the BRCA1 and BRCA2 genes, which is the most common cause of hereditary breast cancer and is more common among younger women. There is often a concern that they have a type of cancer that's unresponsive to hormonal therapy and requires chemotherapy or other treatment."

Today's physicians can personalize breast cancer treatment with advanced diagnostic tools such as Oncotype DX and MammaPrint tests, which assess the risk of recurrence for early-stage tumors and the possible benefit of chemotherapy. Alta Bates Summit breast cancer patients also have access to the latest surgical procedures, including mastectomy (removal of the affected breast) and breast-sparing lumpectomy (removal of only the tumor plus a small margin of healthy tissue), as well as leading-edge radiation therapy, chemotherapy, hormonal therapies and other treatments.

In October, Drs. Valery Uhl and Lisa Bailey collaborated in introducing a promising new procedure at the medical center, called intraoperative radiotherapy (IORT). IORT takes place during a lumpectomy after removal of the tumor. Before the surgeon closes the incision, the radiation oncologist administers a precise, 20- to 30-minute dose of low-energy radiation in the tumor cavity—just the spot where local recurrence is most likely to occur. That "internal boost" can reduce the subsequent amount of external radiation a woman receives as treatment.

More research is needed, but "preliminary data shows that the rate of local recurrence may be less with IORT," says Dr. Bailey, a surgical oncologist and CARBHC director. "In Europe, IORT is already replacing traditional radiation," adds Dr. Uhl, medical director of Alta Bates Summit's Radiation Oncology Services. "It's the wave of the future."

Breast Cancer and Fertility

Beyond the weighty issues of their breast cancer treatments, patients of childbearing age are often concerned about their fertility, says reproductive endocrinologist Richard Chetkowski, M.D. That's because chemotherapy is toxic to ovaries, causing some women to lose the ability to produce eggs or be thrown abruptly into menopause. Also, over the course of prolonged hormonal therapy (tamoxifen), the number of healthy eggs is reduced.

It's possible for a woman's periods to return after treatment, but breast cancer patients at Alta Bates Summit can be proactive in facilitating future conception. One option is to take medication that suppresses the ovaries, which may reduce damage to them during chemotherapy. Another option is to undergo a procedure before chemotherapy that retrieves eggs so they can be fertilized and then frozen for future transfer to the patient or a surrogate. "Embryo freezing has been a safe and reliable technique for more than two decades," says Dr. Chetkowski. Newer techniques of freezing unfertilized eggs are also available and are rapidly evolving, he adds, but they're still considered experimental.

Supporting the Whole Woman

The compassionate counsel and care that breast cancer patients receive from their peers, social workers and others are as vital as the treatments offered by Alta Bates Summit physicians. For example, the COMPASS program matches its volunteers, who are at least a year out from breast cancer treatment, with newly diagnosed patients who are about to travel a similar road. On-staff breast cancer navigators are multilingual and connect Alta Bates Summit's diverse patient population with resources at the medical center and beyond.

Breast cancer support groups are held at Herrick, Markstein Cancer Education and Prevention Services, and CARBHC (for younger women). "Just to be able to recognize that you're not the only one gives women a huge sense of relief, and very strong bonds are formed," says Gale Uchiyama, a licensed clinical social worker at Alta Bates Summit and a support group facilitator. "It's always amazing and very inspirational to see how women persevere in very difficult situations. They look back and can say, 'Somehow, I made it through that, and I know I can face whatever happens in the future.' "

For more information about breast cancer services at Alta Bates Summit, please call the Carol Ann Read Breast Health Center at (510) 869-8377 or visit www.altabatessummit.org/breasthealth/.

Funding Breast Health Services for Low-Income Women

Markstein Cancer Education and Prevention Services at Alta Bates Summit recently received a grant from the San Francisco Bay Area Affiliate of Susan G. Komen for the Cure® to provide enrollment and case management for annual breast health services to low-income women who cannot obtain coverage for this service through any other means. "We are so grateful for Komen's support of this important initiative," says Leslie Paine, Markstein's manager. "This funding makes critical, potentially lifesaving breast health services available to the women in our community."