Cancer is not one disease but many, and new genomic tools are showing that tumors are more diverse than anyone anticipated. For breast cancer patients, that diversity can have a profound impact on their treatment plan and how their cancer responds.
Cancer care is a partnership between patients and their physicians, and that process begins with prevention. Women can decrease their risk by making sure they get enough vitamin D. The body manufactures this essential nutrient when exposed to sunlight, but even in Southern California, not everyone is getting enough.
“Women feel they have a good vitamin D level because they’re in the sun all the time, but that’s not always the case,” says Marin Xavier, M.D., a hematologist and oncologist at Scripps Mercy Hospital. “Ask your primary care doctor to test your vitamin D levels to make sure you’re not deficient.”
Dr. Xavier also recommends exercise, particularly weight bearing, to build bone strength, which has been shown to reduce the risk of breast and other cancers.
Choosing when to get a mammogram is extremely personal. Every woman has a different genetic profile and family history, factors that should inform this discussion.
“There are genetic cancer syndromes,” says Dr. Xavier. “If you have this family history of breast, ovarian or male breast cancer, you could be at greater risk.”
For those who have cancer in their families, genetic testing may be in order. These tests can help women determine their personal risk and choose a surveillance strategy. In addition, Dr. Xavier encourages women to express any concerns they may have to their doctors.
“If you’re doing a self-exam and find something that’s abnormal, be sure to bring it to the attention of your physician and make sure it’s looked at,” says Dr. Xavier. “Nothing trumps knowing your body and knowing what’s new and what’s changed.”
Receiving a cancer diagnosis is scary and will naturally trigger intense emotions. The first step is to listen closely before deciding on a course of action. Cancer does not grow overnight, and patients should proceed carefully.
It’s also important to remember that each breast cancer is unique, with different mutations and a different clinical path.
“People start telling their stories, and that can be frightening,” notes Dr. Xavier. “However, what you have will not be the same as anyone else’s cancer.”
New genomic technologies are really driving this home. Oncologists now routinely test tumors for HER2, estrogen and progesterone receptor mutations. The results from these diagnostics can help determine the cancer’s aggressiveness and inform treatment. For example, women who are HER2 negative, and have no disease in their lymph nodes, may not need chemotherapy. Genetic diagnostics help outline the appropriate treatments for each patient.
Cancer treatments are also a concern but, again, the stories do not always match the reality.
“A lot of women will say something like: ‘Dad had pancreatic or colon cancer, I know what chemo is like,’” notes Dr. Xavier. “But there are many different types of chemo, and even people who get the same drugs often don’t have the same reactions. Don’t take someone else’s experience and assume it will be your own.”
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