Advances in all areas of breast cancer research give patients and medical staff more opportunities to detect cancer early and to better treat it after diagnosis.

Genetic testing has revolutionized medical care for those whose family health history includes multiple cancer diagnoses. Testing offers the ability to quantify the risk. While only a small percentage of breast and ovarian cancers are caused by mutations in the BRCA1 or BRCA2 genes, those who test positive for the mutations have a greatly increased risk of developing breast cancer. The mutations are also linked to cancers of the pancreas, stomach and prostate.

Next gen sequencing, a lower cost and more advanced genetic testing, allows for the detection of a fuller spectrum of gene mutations including rarer forms. The result is an improved ability to ensure patients are prescribed the most efficient therapies.

Moving Forward

"They are basically looking for typos or spelling errors in the genetic code," says Kristin Theobald, a genetic counselor with St. Elizabeth Medical Center. Those who test positive for a gene mutation must then make very personal decisions on how to proceed with the information. Options include increased screenings, taking preventive medications and prophylactic surgery.

"There is a 98 percent risk reduction for those who undergo surgery," says Theobald. "The best way to treat something is to not get it in the first place."

Genetic testing is also proving effective in determining which patients will respond well to chemotherapy.

"Personalized medicine that has come with treatment has improved survival as much or more than finding it early," says Jamie Lewis, MD, a University of Cincinnati Health surgical oncologist and assistant professor at the UC College of Medicine.

"Breast cancer isn't just one disease. It is a number of diseases and we are trying to tailor medicine to the patients. We're getting closer to making it more of a chronic disease, but I don't think we are close to a cure. I wish we were."

Great Successes

New equipment improves the odds of a proper diagnosis for those obtaining a mammogram.

Tomosynthesis, a new tool used congruently with mammography, provides a 3D image of the breast. Unlike mammography, which takes only two X-rays, tomosynthesis takes successive images at different angles. The result is a scan that can show anything that may be hidden behind fibroglandular tissue.

Becky Allen, director of imaging for Jewish Hospital — Mercy Health, compares the scans to a loaf of bread. The images from a mammogram are like that of an unsliced loaf allowing a radiologist to see only what can be viewed from the outside. The images resulting from tomosynthesis are like a sliced loaf where each individual slice can be examined.

By detecting any irregular areas early, patients improve the odds of surviving. "There is a 98 percent survival rate for those who are diagnosed early," says Allen. "We are not there in saying we have this beat, but there have been great successes."

Testing Pays Off

Self breast exams and mammography with tomosynthesis offer the best opportunity to locate cancer in its earliest stages.

The American Cancer Society recommends all women over the age of 40 receive annual breast exams from a doctor along with a mammogram. A small percentage of women, because of their family history or genetic tendency, should be screened earlier and include an MRI to their screenings.

Under the Affordable Care Act, most insurance policies cover an annual mammogram free of charge. The exam is also covered for those over 40 by Medicare. For those without insurance, options are still available. Mobile mammography vans are offered by most local hospitals.

"Some people take it for granted that they can drive up to a hospital and get a mammogram. Some people cannot," says Allen. "We never want pay to be an issue in whether a patient receives a mammogram. Thankfully, we have relationships with agencies that allow for free testing for those who cannot afford it."

Screening mammograms show potential abnormalities in 6 to 8 percent of patients. While most abnormalities aren't breast cancer, it is important for this group to be further evaluated through possible diagnostic mammograms, breast ultrasound and biopsy.

Once diagnosed, a patient can become overwhelmed with the options available for further testing, medications and surgery.

Navigating the System

"One of the things to do is provide some sort of navigation through the system," says Lewis.

"We have a nurse navigator who is a primary contact for the patient. We do a lot of that, too, as physicians. When I see a patient that is first diagnosed, I tell them they have time. I let them know we have a little bit of time to make decisions."

In addition, UC Health and most other local hospitals collaborate with outside agencies, which can place patients in touch with appropriate resources.

One of those agencies is the Cancer Support Community (formerly The Wellness Community), which offers a wide range of programs and services designed to provide support and education to anyone impacted by cancer. Among those programs is Open to Options, which helps patients prepare for medical appointments. Patients are partnered with a volunteer who helps develop a personal list of questions and concerns to share with doctors to determine the best treatment options.

Most programs at the CSC are meant to put patients at ease and reduce stress.

"We offer more of the psycho-social piece," says Kelly Schoen, program director for CSC. "Doctors are wonderful for providing treatment and medication, but we come in on the emotional side. It is our goal to help patients get through the cancer experience as well as they can."

Other programs include yoga, support groups and Healthy Steps — the Lebed Method, a movement class meant to help with lymphedema, a common issue for patients who have undergone surgery. In addition, the CSC regularly partners with other cancer care organizations including the American Cancer Society, which provides support services at the organization's Fort Mitchell and Blue Ash locations.

"We are more program focused (than other organizations)," says Shoen. "I am familiar with what's offered and I don't see a lot of duplication of services, but I do see a lot of collaboration."