Although no really new preventive measures have been discovered beyond the established ones- watching one's weight, exercising regularly and minimizing alcohol consumption-women diagnosed with the disease (as well as the men who account for roughly one percent of breast cancer cases) have reason to be optimistic.

Advances in Diagnosis

Lee Cancer Care's mammography department has become the first in Lee County to have a CAD, or computer-aided detection system. Lee's breast-health educator, Laurie Fisher, describes the equipment as "almost like a spell-check for the radiologist for regular screening mammography."

Fisher estimates that as many as 10 percent of mammograms are misread without the use of the machine. "The mammogram reading is only as good as the reader," she explains. The CAD will help doctors and radiologists identify areas that may not have been spotted or that warrant a second look. Lee Cancer Care plans to obtain more of the equipment in the future for its newly renovated Riverwalk Women's Breast Center in Fort Myers. "It's going to be considered the standard of care," says Fisher.

In addition, advances in the field of gene therapy are improving treatment options. "We're figuring out the genetic properties behind breast cancer so we can target those therapies to be more effective," Fisher says. At the moment, that means doctors can use the DNA information on a particular cancer to determine the best treatment modality, and to help avoid overtreating people.

Changes in DNA can cause normal tissue to become cancerous. Some of these mutations are inherited traits, but the vast majority occur in single breast cells over a woman's lifespan. Though little progress has been made in understanding the cause of most acquired mutations, new tests can now detect the inherited gene that causes breast cancer. For this minority of breast cancer patients, preventive drug treatment is available.

While such testing is warranted only in women with a significant family history of the disease-for example, in more than one first-degree relative such as a parent or a sibling or in first-degree relatives under age 50-early detection of the gene can help lower a woman's risk for developing breast cancer.

Better Treatment Options

Naples is fortunate to be home to one of the pioneers in a new treatment method called MammoSite therapy. Dr. Jan Forszpaniak of Naples Breast Surgery Center was the first in the country to perform the surgery after its FDA approval in May 2002, and has performed more of the surgeries than any other doctor in the world.

MammoSite therapy is tumor-site-specific internal radiation. In the technique, a catheter with a balloon on the end is implanted in the tumor bed to deliver radiation treatment directly into the affected tissue. Two treatments a day are administered for three to five days, as opposed to traditional radiation therapy, which can last up to seven weeks and involve such side effects as severe scar formation, skin irritation, swelling, and ulceration and hyperpigmentation of the skin.

With the MammoSite therapy, says Forszpaniak, "those complications are very rarely seen." Treatment occurs over a much shorter period and is very well tolerated by patients, and there are almost no side effects. "There's no other way, as far as I'm concerned," he avows. Although radiation therapy has become much more precise, in most cases it is still delivered through the skin, which is the cause of many unwanted side effects. By using MammoSite therapy, "we spare the skin and we don't do anything blindly anymore. It is so meticulous," Forszpaniak says.

Naples resident Candy Gody was diagnosed with breast cancer a little over a year ago, and by the following week had undergone the new surgery with Forzspaniak, who works with a support team at 21st Century Oncology consisting of Dr. Bruce Nakfoor and Dr. Michael Hanus.

Gody researched her treatment options and selected the new MammoSite technique based on the shorter treatment period and vastly reduced chance of side effects. "When the doctor sits down and explains it to you, it makes really good sense," she says.

And in fact, she didn't experience any of the side effects common with traditional radiation therapy. "I played tennis through the whole thing," she says of her course of treatment.

Forszpaniak continues to pioneer better methods of treatment within the new therapy. He has developed his own technique of performing the surgery, which he recently presented at the World Congress for Breast Cancer in Hungary, which he calls "tunneling technique." His method involves placing the balloon in the least invasive way, offering greater comfort and range of motion for the recovering patient, as well as less scarring.

He sees MammoSite therapy as becoming the standard of treatment in breast cancer within the next three years. National trials show no significant difference in the five-year recurrence rate between MammoSite patients and those who underwent traditional radiation therapy. Advances in the technique continue as data accumulate, including a recently FDA-approved larger balloon to treat larger tumors.

"If our data is convincing, through research done throughout the world we hope that soon we'll be able to give the patient only one single treatment during the [cancer removal] surgery, after the tumor is removed," he says.

Reconstruction Innovation

"It's remarkable the difference we're able to achieve in the last 10 years," says Dr. Andrea Basile of Naples Breast and Body Surgery regarding recent advances in breast reconstructive surgery.

Most exciting, he says, is the increasing use in the last several years of endoscopic techniques using small incisions and fiber-optic instruments. Endoscopy can minimize pain and scarring in such procedures as harvesting tissue from one part of the body, for example the back or abdomen, to use in the reconstruction of the breast. A surgery that might once have left a six-inch scar along a patient's back, for instance, can now be performed endoscopically to leave only about a one-inch scar in the armpit.

Such tissue harvesting itself only became common within the last eight years or so, according to Basile. Using a combination of implants and tissue "borrowed" from a patient's own body, doctors can re-create a breast that is "more natural-appearing and more natural-feeling," Basile says, than old reconstruction techniques that used implants alone.

But implants are improving. Doctors have developed a technique to insert a deflated implant, which is then gradually inflated with saline over a period of six weeks to several months. This incremental increase in size allows the patient's tissue to stretch to accommodate a larger implant in later surgery. The temporary implant will be replaced with a permanent one of either saline or silicone, creating a breast that looks and feels more natural. What's more, says Basil, insurance companies have become more willing to cover reconstruction surgery, which used to be considered cosmetic and voluntary.

Early Detection

The huge public focus on the disease means that more women than ever are getting annual mammograms and performing breast self-examinations. That means an increased likelihood of early detection for women with breast cancer, which means better chances for survival.

"We're detecting a lot earlier," says NCH Healthcare System's surgical oncologist Dr. C. K. Chang in Naples. "Early detection is the key right now."

"Women need to be very diligent about getting mammograms," says Gody, having won her own battle with breast cancer. "You just need to go and get the mammogram every year."