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Major Site Report: Breast Cancer One in every eight women will be affected by breast cancer at sometime during her lifetime. There are many risk factors for developing breast cancer, which after lung cancer is the second leading cause of cancer death among women. While the risk of developing breast cancer increases with a woman’s age, other risk factors include family history, obesity, birth control pills, hormone replacement therapy and having children after age 35. The good news is that diagnosis and treatment options have caused an overall decline in breast cancer mortality—24 percent between the years of 1990 and 2000. At FirstHealth Moore Regional Hospital, the five-year survival rate for breast cancers diagnosed between 1998 and 1999 was well above the North Carolina and American Cancer Society averages. Improved screening techniques have allowed advancement in the early detection of breast cancer. Mammogram, ultrasound and clinical exam are key to detection and evaluation; and such new modalities as breast MRI and PET scan are becoming increasingly instrumental in staging and evaluation. The stage of breast cancer at diagnosis is important for determining the selection of adjuvant therapy, and the typical stage of the breast cancers diagnosed at Moore Regional Hospital from 2000 to 2004 was on par with national averages. The vast majority of cases remain early stage (Stage O, Stage 1 and Stage II disease). While surgery is the mainstay of treatment, other modalities—including radiation treatment, hormonal treatment and chemotherapy – contribute to the improved survival and disease recurrence rates. Moore Regional’s multidisciplinary team gives patients multiple options for adjuvant therapy whose uses are comparable to state and national averages. One of the newer evaluation options is genetic testing, particularly Oncotype Dx,TM which allows for the improved selection of patients who may or may not benefit from adjuvant therapy. Oncotype diagnosis is a gene assay that helps predict the likelihood of distant breast cancer recurrence and benefit from chemotherapy. The Oncotype diagnosis gene assay looks at a panel of 21 genes to provide a recurrence score of 0-100, which helps clinicians determine the benefit of chemotherapy. Oncotype diagnosis has been validated for breast cancer patients who are newly diagnosed Stage 1 with negative nodes and positive estrogen receptors. This can help reduce overtreatment in those patients who are likely to be cured with endocrine therapy alone. At Moore Regional, 73 percent of the breast cancer cases diagnosed in 2004 were Stage I or II and a large proportion of these patients may benefit from Oncotype diagnosis for treatment selection. Although breast cancer continues to affect many women in the United States annually, we have seen progress in early detection and improved five-year survival with improved detection, treatment modalities and the multidisciplinary team approach at Moore Regional Hospital. Raymond G. Washington, M.D.
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