Health Care

Breast Cancer Mortality Rates Decline in Valley

YOUNGSTOWN, Ohio — Cancer, particularly breast cancer, remains a prevalent concern for women, even as they navigate a changing landscape in terms of both detection and treatment.

The incidence rate of breast cancer is 113 per 100,000 in Mahoning County, 108 in Trumbull County and 95 in Columbiana County, compared to a statewide incidence rate of 125, reports Nancy Gantt, M.D., medical co-director of the Joanie Abdu Comprehensive Breast Care Center in Youngstown.

“We tend to have an older population in our counties, so we do see a fair amount of cancer,” Gantt says. Even so, Columbiana County is “doing much better than the state” and both Mahoning and Trumbull counties are “actually doing relatively well,” she adds.

Breast cancer typically appears in women in their 50s, but Gantt reports she recently saw a patient at age 34. “That certainly piques our interest as to whether there’s a genetic component or something else going on,” she says.

An early presence usually means a more aggressive cell type than the cancer that strikes older women, when the cells tend to be “better behaved” or a “less aggressive molecular subtype,” she continues.

“The size [of the tumor] is a snapshot. It’s not a video,” she remarks. “It really matters what the programming is that each individual tumor cell has and what its genetics are as to how it’s going to behave, whether we’ll be able to contain it with very easy measures.”

Gantt says the mortality rate for breast cancer is down, “which is wonderful.” As more screenings are done, more tumors are discovered. “But we also have some new chemotherapeutic and medical regimes that are proving incredibly effective,” she says. “That’s why it’s really important that when you get care for breast cancer it’s done in an interdisciplinary manner.”

Breast cancer is “certainly on the forefront” of women’s concerns, says Angela Kerns, chief nursing officer at the Surgical Hospital at Southwoods, Boardman. “I don’t think there’s anyone around that doesn’t know someone whose life hasn’t been touched by someone who has breast cancer,” she says.

Southwoods aims to address women’s needs expeditiously by performing mammographies and move onto next steps as warranted, whether additional testing, a biopsy or ultrasound at different modalities, she says.

Women also come to Southwoods with concerns regarding uterine and ovarian cancers, she reports. “We provide tests and procedures that would treat women that would be afflicted by those sorts of conditions,” she says.

“We have made big advances and investments in the technology but also made sure that our technology is run by, and our facilities are staffed by, the most caring and compassionate people that we find in Youngstown,” adds Steve Davenport, Southwoods’ chief operations officer.

In Mercer County, Pa., one in eight women on average will develop breast cancer, reports Tonia Skakalski, D.O., of Sharon Regional Medical Group’s women’s care practice.

In addition to coming in for their annual exams and pap screenings for cervical cancer, women are concerned about how often they should get a mammogram and find other ways to screen for breast cancer, says Tonia Skakalski, D.O., of Sharon Regional Medical Group’s women’s care practice.

“The mammogram is still our baseline for screening,” although the recommended frequency changes “depending on which society you look at,” she says.

“The problem is that some women have denser breasts and therefore it’s harder to detect these very small cancers in them, so the advent of 3-D mammograms has been enormously helpful for those women,” Skakalski says.

Women not at high risk should have a breast exam every three years, she recommends. “The success rate really goes back to the stage we find the breast cancer in,” she remarks. “Women cannot find these small breast cancers on their own. So our success rate is significantly linked to women coming in for screening.”

Since the launch of pap smears in the 1950s there has been a decrease in the incidence of cervical cancers and deaths related to the disease, “but the pre-cancers that we have to treat are still there,” she says.

In addition, physicians are seeing many other cancers, including vaginal, vulvar and anal, all related to human papillomavirus, she reports. She is increasingly counseling younger patients and parents of teenagers on the importance of HPV vaccination.

“We know that in the cervix we are seeing a significant decrease in high-grade lesions of those almost-cancer[ous] lesions in the cervix of girls that have had the vaccine. Why not do let’s do the same in the rest of those cancers?” she asks.

One major change in women’s health care is recommendations for screenings, says Paul Rich, M.D., chief medical officer at Northside Medical Center in Youngstown and director of the family medicine residency program.

“The guidelines for screening have become much different as far as the frequency with which the screening gets done, but also the types of screening that we can do,” he says. “Some of the most interesting medicine is how much genetics has crept into so much of what we do in medicine today.”

For mammograms, the consensus now is to initiate discussions about screening with only women at age 40 and then allow family history and her preference to guide whether the risk level is low enough to hold off until age 50, and perform mammograms every two years. So say the American Cancer Society and other organizations.

Women’s health is one of the more interesting realms in predictive medicine because of the ability to identify which women are likely to get breast cancer and uterine cancer.

“That really affords us an ability to screen women in a different way,” Rich says. “In the past women had mammograms once a year, pap smears once a year. Those are no longer the recommendations. In fact, the frequency with which we do those things now is quite a bit less.”

For example, breast exams are no longer recommended during every annual exam. The reason is the number of false positives generated. “We’re kind of overdoing our medicine on patients and finding more false things than we were actually looking for,” he says.

Published by The Business Journal, Youngstown, Ohio.