(Oct 2021) - Dr. Jorge Diaz, a hematologist and oncologist at Clearview Cancer Institute in Huntsville says the best news on the subject of breast cancer is that it can usually be cured.  Early screening by mammography and ultrasound have improved the chances of surviving cancer by leaps and bounds, Diaz said.

 “Most of the time, patients are diagnosed at an early stage,” he said. “We are able to diagnose patients when they can be cured.”

Diaz, a native of Peru who completed residency at the University of Alabama in Birmingham and a medical oncology fellowship at the University of Louisville, has been at Clearview for more than four years.

He said regular mammograms continue to be the first line of defense against terminal breast cancer.

 Today, imaging technology allows doctors to find cancer when in the past it would be undetectable. Patients can be called back for more imaging and/or a biopsy, allowing the diagnosis to be made and a treatment plan to be developed with great speed.

There is also a better understanding now of which patients should be referred immediately to a surgeon, Diaz said. The treatment of early-stage breast cancer is surgical, but a multidisciplinary approach involving a medical oncologist, radiation oncologist and breast radiologist is crucial to determine the best treatment for each individual patient.

Treatment plans at Clearview are developed for each patient through a team called the “breast cancer alliance,” comprised of the surgeon, medical oncologist, radiation oncologist and breast radiologist, as well as clinical geneticists and social workers. The team meets weekly to confer on next steps.  Due to COVID-19, those meetings that once took place in person now happen via Zoom meetings.

The decision must be made whether to remove a tumor first or proceed first with chemotherapy in an attempt to shrink the tumor before surgery.

“Ultimately, the treatment is going to be some kind of surgery,” either a lumpectomy or mastectomy, Diaz said. “This is not a one-size-fits-all.”

Clearview patients also have the option to meet with a clinical geneticist, which can have an impact on which surgery is performed, he said. Those at a high risk due to their genetics, such as those with a strong family history of breast cancer, or those who are diagnosed at an unusually young age may be likelier candidates for genetic testing and potentially mastectomy, if an abnormal gene is found, Diaz said.

“We see what’s going to be the best way of managing (the cancer),” he said, while reassuring most candidates that “in all likelihood, they are going to be cured.”

If cancer is caught before it has spread to the lymph nodes, it is considered at the early stage. Advanced cancer is characterized by presence in the lymph nodes and/or metastatic disease, meaning it has spread to other organs.

But even some advanced cancer is curable, Diaz said. Every case is different.

Some forms of cancer are fed by estrogen or progesterone, while others are driven by the HER2+ protein, which grows considerably faster, but “very responsive to targeted agents,” Diaz said.

“We are able to shrink the tumor” in more than half such cases, he added.

In summary, Diaz said the rate of cancer survival continues to improve due to several factors:

 

  • Early diagnosis and “fine-tuning” decisions about chemotherapy, eliminating that step for patients who don’t need it.
  • Incorporating targeted medicines. Genomic panels provide doctors with information about the biology of tumors, allowing them to “look into the genes of cancer” and incorporate immune therapy.
  • Regular mammography for all women at a certain age. While the age varies for different societies, it is generally considered good medicine to get a baseline screening at 40, with a regular mammography each year or every other year thereafter at age 50.

 

“De-escalating therapy, that’s a big step forward.”“It makes the prognosis much better,” Diaz said.

Those with a genetic predisposition or otherwise at high risk should start screening even earlier and also benefit from other imaging, such as breast MRI, Diaz said.

Clearview Cancer Institute is at 3601 CCI Drive Northwest in Huntsville. It is North Alabama’s largest community-based cancer clinic.

 

Originally published in the Redstone Rocket Oct. 6, 2021