Breast cancer survivor. It’s a term that is heard now more than ever as patients not only survive breast cancer, but go on to live happily for decades afterwards.

As advances in early detection and treatment surge forward, doctors can better focus on the quality of patients’ lives long after they leave the hospital. Surgical incisions are becoming smaller and more targeted. Side effects are more treatable. There are more and better choices for breast reconstruction. And doctors now more openly talk about the personal issues that go along with breast cancer treatment, such as forgetfulness, hair loss and the benefit of support groups.

Survivorship issues are what doctors who specialize in breast cancer in the Greater Cincinnati area are talking about these days.

“Breast cancer is not a death sentence in any way, shape or form,” says Hilary Shapiro-Wright, a doctor of osteopathic medicine and a surgical breast oncologist at Mercy Health. “Almost all of the time we are treating patients for a cure… The vast majority of women who walk through my door are treatable.”

New research hints at what may be available to patients in a few years. In the near future, women may be screened for early cancer markers by using blood tests instead of mammograms, and cancer may be treatable without removing it surgically, local doctors say.

“Breast cancer is probably one of the best treated cancers out there,” says Dr. Elizabeth Shaughnessy, a surgical breast oncologist at UC Health’s Cancer Institute.

EARLY DETECTION IS KEY

If cancer is detected at an early stage, patients have more treatment options and a better prognosis. That is why the American Cancer Society recommends yearly breast exams from a doctor and mammograms for women age 40 and older.

Doctors say they usually see larger tumors and more advanced cancer in women who did not get regular mammograms.

Shapiro-Wright recently met with a new breast cancer patient whose last mammogram was in 2011, and she had gone nearly two years without another one.

“She said to me, ‘I thought I was supposed to be getting them every other year.’ And she walked in with a small tumor,” says Shapiro-Wright. “Mammograms save lives. I truly believe that.”

For women with dense breast tissue, digital tomosynthesis may be needed for a 3-D image of the breast. This new tool increases the odds of finding lesions that may be hidden behind tissue, since small cancers and dense tissue can both look like white matter on X-rays. While a mammogram only takes two X-rays of each breast, tomosythensis takes multiple X-rays from many angles allowing a computer to create a highly focused 3-D image.

Genetic testing is another new tool being used in early detection. The publicity of actress Angelina Jolie’s preventive double mastectomy—after genetic testing revealed a mutation that put her at high risk for developing the disease—has prompted many more women to ask for the same testing.

The U.S. Preventative Task Force Services recommends that only women with a strong family history, or about 2 percent of U.S. women, be evaluated for genetic testing for BRCA1 and BRCA2 mutations. The American Cancer Society strongly recommends that anyone considering the testing talk with a genetic counselor, nurse or doctor before making a decision.

BETTER TREATMENT OPTIONS

Shapiro-Wright usually tells new patients that while breast cancer will be a tough struggle for a few years, they will get through it and go on to cancer-free, healthy lives.

“The majority of women who have breast cancer do very, very well,” she says.

Each local hospital has its own protocol for greeting new breast cancer patients, but most use a team approach led by a nurse navigator as the primary contact.

At the TriHealth Cancer Institute, doctors, nurse navigators, genetic counselors and other specialists meet to discuss new breast cancer patients at weekly tumor boards. The group talks about treatment options for each patient, whether it be surgery, chemotherapy, radiation or clinical trials, and then the team visits the patient to discuss the proposed plan.

“The patients don’t just hit the system and then leave it,” says Dr. Jose Barreau, medical director of the TriHealth Cancer Institute. “There is a coordination of care through the whole system, from the day of the abnormal mammogram, to the biopsy, to survival.”

The same multidisciplinary approach is taken at the UC Health Barrett Cancer Center, in which an entire team of specialists meets to look at each new breast cancer case.

After surgery, UC’s Shaughnessy follows her patients for months because side effects such as sharp stabbing pains or burning sensations from nerve recovery at the surgery site may not show up until later.

Going forward, doctors will rely less on surgery and more on the cancer’s biology to treat tumors. A small sample from a tumor taken by needle can be studied so that doctors understand its makeup and can find a specific way to attack it instead of using garden-variety treatments, Shapiro-Wright says.

“Today we are using therapies targeted specifically at the patient’s individual cancer,” she says. “No two patients are the same, and no two cancers at the same.”

Shapiro-Wright performs a relatively new surgery called a ductoscopy, which uses a micro endoscope to find and remove a ductal legion that may be causing suspicious bloody nipple discharge. She believes that she is the only doctor in the region to perform this surgery, which removes a legion through a small incision, removing tissue no larger than an M&M, without causing any damage to the breast.

Just 10 years ago, a surgery like that would have caused a much larger incision and resulted in potential nipple loss or loss of sensation to the nipple and cosmetic deformity.

“It’s a good testament to how far breast surgery has come,” she says.

POST SURGERY

Medical advances also offer women a wider range of choices for breast reconstruction if a mastectomy is needed.

Dr. Minh Doan Nguyen, a reconstructive plastic surgeon at UC Health, is the only surgeon in the Greater Cincinnati area, and one of several hundred nationwide, who is trained in the new DIEP flap procedure, which uses stomach tissue to reconstruct breasts with less damage to the core abdominal muscles.

During the lengthy surgery, Nguyen harvests skin and tissue from the stomach and reattaches the tiny blood vessels to the chest wall. But she leaves the core stomach muscle intact, which spares the patient from bulges and stomach weakness that may come after a traditional TRAM (transverse rectus abdominis muscle) surgery.

“It’s just a really good option for the right patient,” Nguyen says. Her patients are usually younger women who don’t want implants and will live with reconstructed breasts for 30 to 40 years. But Nguyen has done the procedure on women who are 70 and have done very well.

Other options are using breast implants, or constructing a breast mound from tissue or muscle from the back, buttocks or thighs. And researchers are trying to figure out a way to remove fat from one part of the body and inject it into the breast area.

Reconstruction is very important to women who have lost their breasts to cancer. Nguyen’s patients tell her that after surgery, they can finally look in a mirror without being constantly reminded of their cancer.

“It’s not cosmetic. We’re trying to restore the norm as much as possible,” says Nguyen.

EMOTIONAL CARE

After breast cancer treatment ends, patients often still deal with the aftershocks: fatigue, weight gain or loss, depression, sexual dysfunction and sleep issues. More doctors say they talk openly with patients about these issues and refer them to resources that can help.

Over the past year, Kelly Schoen, program director for Cancer Support Community, has seen a drastic increase in the number of referrals from doctors. She had 35 percent more clients this July than last year.

“We’ve seen a huge influx of new people coming into our programs,” Schoen says. “It is very grounding. They realize when they come in that they are not alone.”

About 70 percent of CSC’s clients come for their support groups. But each month CSC offers 250 free programs at their Blue Ash and Northern Kentucky locations and off-site spots, from yoga to lectures. It also offers Healthy Steps - the Lebed Method, an exercise class that helps to reduce lymphedema, a side effect in patients who have undergone surgery to remove lymph nodes.

Diane Kabakoff, aquatics director at Mercy Health in Fairfield, teaches an aquatic cancer recovery class that also helps relieve swelling in the lymph nodes. She likens the 80-minute class to a tiny water massage that improves circulation and decreases stress on joints.

She would like to expand the class and perhaps offer additional classes for cancer survivors.

“It’s a great opportunity to talk to other people who are in the same position as you are. It’s a great support group,” Kabakoff says.

Doctors and Schoen all believe that friendships and bonds with other cancer survivors, as well as staying physically active, can only help in recovery.

“Good cancer care can’t just be medical treatment, it has to include the psycho-social element,” Schoen says.