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Good News About Breast Cancer Deaths Gives Women Hope


Sep. 30, 2009 – There’s good news in the breast cancer fight. Deaths from the disease have declined steadily over the past few years. In this episode of Cancer Connection, Siteman Cancer Center surgeon Julie Margenthaler, MD, discusses the trend and credits early detection of breast cancer as a key factor.

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On this edition of Cancer Connection, we’ll talk about breast cancer, including the role early diagnosis plays in treatment and who is most at risk.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes- Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill. According to new data from the American Cancer Society, deaths from breast cancer have dropped more than 2 percent each year since 1990. A part of that reason is greater awareness. To talk with us about breast cancer is Julie Margenthaler. Dr. Margenthaler is a breast surgeon at the Siteman Cancer Center. Dr Margenthaler, thank you for joining us.

Margenthaler: Thanks for having me.

Host: Breast cancer isn’t a death sentence, is it?

Margenthaler: No, of course not. Breast cancer is the most common cancer in women, but we have ways to detect breast cancer at a very early stage. And if we can detect it at an early stage, it’s entirely curable, and it’s very treatable.

Host: So how is breast cancer best detected early?

Margenthaler: Well, we promote breast self-examinations, and we do believe that those are very important. But the No. 1 way to detect breast cancer at its earliest stages is to have a screening mammogram on a yearly basis. All women who are over the age of 40 should have mammograms every year. If you’re a high-risk patient -- meaning that you have a family history of breast cancer or you have a known hereditary cancer syndrome -- you should be screened at a much earlier stage, and you should really consult your physician as to those particular recommendations. But in general, every woman over the age of 40 should have a yearly mammogram.

Host: What makes a person a high-risk patient?

Margenthaler: High-risk patients are determined by several factors. The most common ones are family risk factors. So in other words, if you have a first-degree relative -- such as a mother or a sister or a daughter -- who has had breast cancer, that puts you at higher risk of getting breast cancer as well. There are also patients who have extremely high-risk families to the point that they actually have a specific mutation that can cause their breast cancer, and these are the BRCA mutations that we hear a lot about in the media. Those are very rare. Only about 5 percent of all women with breast cancer have a hereditary cancer syndrome. But again, these are the types of situations if you have multiple breast and/or ovarian cancers in your family, you should consult your physician about having further testing and evaluation.

Host: How does a person find out if they have the BRCA mutation?

Margenthaler: Well, we have some models that can help us estimate whether a woman has a BRCA mutation, but there are several red flags. The biggest ones are if you have multiple women in your family who have breast cancer, specifically at young ages or in both breasts at the same time or over a number of years. If you have women who have had ovarian cancer, male breast cancer is actually a very high risk factor. And then also looking at other factors such as Jewish ancestry. All of those are red flags for possibly harboring a BRCA mutation and should alert your physician to investigate further and consider genetic consultation and testing.

Host: Now if somebody is diagnosed, what is the typical course of treatment?

Margenthaler: For a woman who is diagnosed with breast cancer, we’re generally going to talk about a combination of three possible treatments, and those will include surgical therapy, chemotherapy and radiation therapy. In addition, we also discuss treatments called endocrine therapy, which are anti-estrogen treatments. Now it doesn’t mean that every woman requires all of those treatments. It really depends on the stage of diagnosis. For the very earliest forms of breast cancer, many women can be treated with surgery and radiation alone. For the more advanced disease, we do have to include a combination of therapies, and typically chemotherapy is included in that. But for most women, if we can diagnose breast cancer at an early stage, we can treat them with local treatment, which includes surgery and radiation. And for patients with high-risk types of tumors, we may have to include chemotherapy as well.

Host: Awareness is really higher for breast cancer, it seems, than any other disease that exists. How big a role have things like the Komen Race for the Cure and other efforts played in catching breast cancer at an earlier state?

Margenthaler: It’s really very difficult to measure the immense impact that those organizations have had on breast cancer awareness. We know that it’s significant. I will also say that I think that the patients themselves are empowered by their diagnosis, and they are the biggest proponents for early screening, prevention, detection and treatment of breast cancer. All of those factors make it really such a thrill to be in this field because we do have such awareness for our patients.

Host: Overall, what’s the message you want to get out to women about breast cancer?

Margenthaler: I think what we would like to say is that breast cancer is a very treatable disease. Almost everyone can tell you that they’ve had either a personal impact from breast cancer or they know someone who has been impacted by breast cancer, and it’s a frightening disease. But we have so much knowledge about breast cancer and research initiatives and support from the community and organizations that we can effectively treat it. Our overwhelming message would be: Have your screening mammograms and have your clinical breast examinations on a yearly basis so that we can detect it early when it’s at a stage that we can really provide the best treatment that will impact your life overall the least.

Host: Dr. Margenthaler, thank you for joining us.

Margenthaler: Thanks again for having me.

Host: For more information about breast cancer, visit the Siteman Cancer Center online at, or to check out your own risk for breast cancer, go to Thanks for downloading. Until next time, I’m Jason Merrill.