THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, March 31, 1996 TAG: 9603300043
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
LENGTH: Medium: 92 lines
Doctors talk of breast cancer in terms like ``non-invasive,'' but any woman knows such a description is wrong.
Breast cancer is nothing if not invasive: It attacks silently, in a shrouded part of the body, while the medicines that combat it do their work publicly with hair loss and weight gain.
Last week we learned that this personal disease had invaded the privacy of a public figure. Virginia Beach Mayor Meyera Oberndorf announced that she would soon begin treatment for breast cancer. It was an announcement that 183,000 American women could make in any given year.
But while the disease can be devastating, even fatal, advances in treatment and research have improved the lot of its victims.
In the past, breast cancer usually meant mastectomy - removal of the entire breast. But recent studies, including one taking place at Eastern Virginia Medical School, have indicated that giving chemotherapy before surgery can shrink medium or large tumors until they can be surgically treated with lumpectomy, or partial removal of the breast.
Dr. Roger Perry, an associate professor at EVMS and a surgical oncologist, said there are two components to treatment of breast cancer.
``One facet of treatment is directed toward the local disease, the tumor in the breast,'' he said. ``It's usually a combination of some sort of surgery and radiation.
``The other component is treatment to address potential systemic disease, disease that has spread to other parts of the body. That's the role of things like chemotherapy or the anti-estrogen agent tamoxifen.''
Nearly every breast cancer patient undergoes chemotherapy, in which powerful drugs are given to kill the rapidly dividing cancer cells.
``Like anything else with breast cancer, there is a lot of controversy about what the optimal drugs are - when should they be given?'' Perry said. ``For smaller tumors, it has been traditional to give chemotherapy after surgery. But now, for medium- or larger-size tumors, there is a trend to give chemotherapy first, before surgery.''
Some women may be uncomfortable with the idea of delaying surgery, preferring instead to have the tumor removed immediately. But studies have shown that in 80 percent of women who received early chemotherapy, their tumors shrank by half, meaning less disfiguring surgery was necessary.
Perry said that chemotherapy has also improved over the years, and many breast cancer patients receive outpatient treatment.
``I've had patients who have gone to work, and many women have missed no work or just one or two days,'' he said. ``That's not to say that it's not bad. It's not the greatest thing. But I think most of them do better than they think.''
The most obvious side effect of chemotherapy is hair loss. The hair does grow back after treatment stops, Perry said. Many women also gain weight during treatment, while others may experience less obvious effects such as heart damage.
More research will improve cancer treatment even further, said Mary Jo Kahn of the Virginia Breast Cancer Foundation. ``One of the things I think has held back research in breast cancer is that one of the more poorly studied organs in the body is the normal physiology of the breast,'' she said.
Overall survival rates for breast cancer patients have also improved, from 74.3 percent in 1974-76 to 80.4 percent in 1990, according to the National Cancer Institute.
Breast cancer activists have brought the disease into the political spotlight in recent years, forcing insurance companies to cover last-ditch treatments that used to be considered experimental and garnering more money for research.
But advances in research lead to their own problems, Kahn said.
This year's General Assembly passed a bill prohibiting insurance companies from discriminating based on genetic information, which would include screening for the inherited form of breast cancer. The governor is still reviewing the bill and has not yet signed or vetoed it.
Without such a bill, ``people would be buying insurance policies that don't protect them from what they're most likely to get,'' Kahn said.
Oberndorf's personal trauma will have a positive effect on the public, Perry and Kahn agreed: More women will be inspired to get breast checkups and mammograms, and more cancer victims will be diagnosed in time for early treatment.
``Even though surgery's gotten better, chemotherapy's gotten better, radiation's gotten better, there's no question that the sooner a tumor is detected, the greater is the chance for cure,'' Perry said.
Although yearly mammograms are recommended for every woman over age 50, many do not get the screening.
``I think what she (Oberndorf) is doing is very commendable,'' Kahn said. ``If you look back over the history of rates of breast cancer, there were peak times right after Happy Rockefeller and Betty Ford and Nancy Reagan came forward.
``It does a lot of good to have high-profile women recommend that others get the medical care they may have been putting off.'' by CNB