September 25, 2000
Health Center Experts Debunk
Myths About Breast Cancer
Breast cancer continues to pose a significant health threat
to women, but advances in diagnosis and treatment have moderated
the effect of the once-fatal disease.
At the UConn Health Center, a multidisciplinary team has been
assembled to treat breast cancer patients. The team includes
cancer specialists, surgeons, radiologists, plastic- and reconstructive
-surgeons, advanced practitioner nurses, physical therapists,
social workers and case managers. Working together with the
patient, the team devises and initiates a treatment plan that
brings to bear the many different specialties in a coordinated
The statistics on breast cancer are unsettling:
- Breast cancer is the most common form of cancer to strike
American women. More than 200,000 cases are diagnosed annually
and more than 44,000 women will die from the disease. Connecticut
has one of the highest rates of incidence.
- Today, the risk of a woman having breast cancer is one in
eight. Thirty years ago, that number was one in 14.
- A new case of breast cancer is diagnosed in the United States
once every three minutes; a woman dies of breast cancer every
- It is the primary cause of cancer death for black American
women and it is the leading cause of death for women aged 40
Moreover, the disease can be devastating to women. It is deeply
personal, with numerous psychological aspects that may not be
present with other forms of cancer.
"Breast cancer strikes at the very essence of femininity," says
Johanna Meehan, a UConn Health Center oncology nurse practitioner.
"A woman with breast cancer struggles with issues and questions
of body image, femininity, self-esteem, sexuality, fertility,
and relationships with significant others. It can be overwhelming
and even terrifying."
But the story isn't all grim. There are more than one million
American breast cancer survivors. And yesterday's radical mastectomy
- the standard treatment for breast cancer - has been replaced
by new surgical techniques that offer effective therapies while
frequently preserving tissue. Chemotherapy and radiation offer
treatments that, when combined with surgery, expand the effectiveness
of medical management. New drugs and medicines promote healing
To mark Breast Cancer Awareness Month in October, members of
the multidisciplinary team have prepared responses that address
some of the myths surrounding the disease:
- Breast cancer will leave you mutilated and disfigured.
Not all breast cancers require removal of the breast, says Scott
Kurtzman, a surgeon and specialist in breast cancer and member
of the multidisciplinary team. Other therapies have been developed
to preserve the breast and are practiced in the northeast in
particular. For example, lumpectomy is a surgical procedure
that removes just the cancerous mass. Breast cancer treatment
depends upon the type of cancer and at what stage medical attention
is sought, Kurtzman says: "Not all cancers require surgery,
but for those that do, physicians are at pains to preserve as
much tissue as possible." Other treatment options for certain
cancers include chemotherapy, radiation therapy, hormonal therapy,
or a combination of the three.
- If you have lymph node involvement, it means the cancer has
spread and you're going to die.
Lymph node involvement means the breast cancer has spread, but
it does not mean a death sentence. It does change the course
of treatment, however. Lymph node involvement means a more rigorous
course of therapy, says Jonathan Sporn, that could include systemic
chemotherapy or hormonal therapy after the breast cancer has
been removed or successfully treated.
- The big breakthrough in breast cancer treatment is about to
This may not be as much "myth" as it is unrealistic expectation.
A tremendous breakthrough could occur tomorrow, but even if
it did, it would be months if not years before the treatment
was approved, and more importantly, proved effective. Sporn
suggests that in the short term at least, standard therapies
for breast cancer - surgery, chemotherapy and radiation, or
a combination of all three - will continue to be the norm. "In
the future standard therapies will not go away," Sporn says.
"I suspect that chemotherapy and radiation therapy will play
a role in treatment for some time to come."
- A woman is a "victim" of breast cancer.
"Breast cancer can be a transforming experience," says Meehan,
"but not in the ways you might think. Most women don't just
survive breast cancer; they derive strength from the experience
of having the disease." For some, she says, the experience helps
solidify and redefine core values and women emerge with a new
appreciation of what's important - family and friends - while
material goods become less important. "It restructures one's
perspectives and helps many to focus on the more rewarding aspects
of life," Meehan says.
- Radiation therapy will leave you scarred and is likely to
cause damage to the heart and lungs.
Permanent skin damage is very uncommon today and collateral
heart and lung damage even less so, says Robert Dowsett, a radiation
oncologist and member of the multi-disciplinary team. There
are several reasons why. Modern treatment planning simulators
allow physicians to carefully plan treatment programs. In addition,
high energy treatment machines such as linear accelerators,
offer precision in radiation-targeting and dose-distribution.
Years of refining radiation procedures and experience have contributed
to a thorough body of knowledge and expertise, Dowsett says.
"We've come a long way in knowing what is important to treat
and how to treat it."
- A pregnant woman with breast cancer has to terminate the pregnancy,
because the hormones associated with pregnancy fuel the growth
Some cancers may grow in response to hormones, but there is
no proof that the hormones of pregnancy pour "gasoline on the
fire" of cancer, according to Peter J. Deckers, dean of the
UConn School of Medicine and a specialist in breast cancer surgery.
He says one of the most important factors is what stage the
cancer is in when the woman seeks treatment: "The current thinking
is to treat the woman according to the stage in which she presents,
independent of whether she is pregnant." For example, although
chemotherapy after surgery in the first trimester can be disruptive
to the fetus and the pregnancy, that is not necessarily so in
the second or third trimesters. "The bottom line is that for
the pregnant woman beyond the first trimester," Deckers says,
"the most appropriate treatment is the same treatment that might
be offered to the non-pregnant breast cancer patient."