News

In battling breast cancer, Belinda Stronach joins thousands of other Canadian women who have faced the difficult choices posed by the disease. Dr. Marla Shapiro, author of Life in the Balance: My Journey with Breast Cancer and a board member of the Canadian Partnership Against Cancer, explains Ms. Stronach's type of cancer and some factors in diagnosis and treatment.

What kind of cancer does Ms. Stronach have?

Ms. Stronach, 41, was diagnosed with ductal carcinoma in situ, known as DCIS. The breast is composed of fatty tissue and sections of milk glands or lobules called lobes. Ducts connect lobules and lobes.

Most breast cancers originate in the ducts or lobes of the breast. Cancer that has not yet spread outside of the ducts is called in situ. Once it has spread outside of the ducts, it's called invasive or infiltrating cancer.

Women are being told that breast self-examinations are not effective, but Ms. Stronach is reported to have found her lump. Does that mean women should be doing the exams?

Since data show no change in survival rates among women who practice self-exams, an argument has been made against these exams because they can lead to false positive tests and unnecessary interventions.

But many women who have discovered a lump on their own argue that they owe their lives to self-detection. In my practice, I encourage women in to do exams if they are comfortable doing so. If they do feel something, it drives them into their doctor's office far faster.

Should mammogram screening start earlier than 50?

Recently, a U.S. task force estimated that screening women in their 40s every one to two years resulted in a 15-per-cent decrease in breast cancer mortality after 14 years of follow-up. But a separate Canadian study found that women in their 40s received no benefit from mammography.

It is argued that routine mammography poses potential risk to women in this age group including radiation exposure and false positive results. Women in their 40s often have dense breasts, which means that a mammogram may suggest disease when in fact there is none.

Certainly, as a woman diagnosed with breast cancer in my 40s, I disagree strongly. The best advice is to be informed of both the potential benefits and harms.

Ms. Stronach had a mastectomy even though her cancer was not invasive. Is this overly aggressive?

We don't know the reasons that Ms. Stronach had a mastectomy.

Treatment options for her kind of cancer can vary. If the disease is widespread, even if it not invasive, it may not be possible to entirely remove the cancer without removing the breast.

For many women with DCIS, a lumpectomy, which is an operation to remove the tumour, followed by radiation, is the recommended route. The risk of recurrence with this treatment is the same as with an elective mastectomy.

In situations where lumpectomy with radiation is deemed as effective as mastectomy, the decision to proceed with a mastectomy is driven by a woman's preference.

How many women in Ms. Stronach's age group get breast cancer?

Canadian statistics are that roughly 20 per cent of female breast cancer cases are diagnosed in women under the age of 50. So in 2007, of the 22,300 total breast cancer cases, 4,415 cases occurred in women younger than 50. In her 40s, a Canadian woman has a one-in-235 risk of breast cancer, whereas in her 50s, her risk increases to one in 54.

While breast cancer remains the most frequently diagnosed cancer in Canadian women, the incidence rate of new cases has stabilized since 1993. Since 1988, the death rate has dropped 19 per cent. The reasons for these trends are still unclear; it may be that early disease detection has translated into lower mortality.

Will Ms. Stronach have to be monitored still?

She will need to be examined by a doctor for recurrence on a regular basis. She will require both a clinical exam of the remaining breast and the implant as well as mammography of the remaining breast.