By Dan Murphy
World Cancer Day is marked on 4 February to raise awareness of cancer and to encourage its prevention, detection, and treatment. Dr. Ashley Tsang, from Mount Sinai Doctors-Westchester, spoke with us to explain the different types of breast cancer and to encourage women to stay on top of their yearly screenings and mammograms.
“A common misconception is that all breast cancer is the same. Many of my patients come in with preconceptions of what their treatment will be based on what they may have read or what a friend or relative has personally experienced. I often explain that there are different types of breast cancer, and depending on their type and stage, we will determine the treatment algorithm” said Dr. Tsang.
Different breast cancer types are identified based on evaluating three tumor markers: 1) Estrogen receptor 2) Progesterone receptor and 3) HER2-neu. The simplest way to approach treatment is by separating into these three types:
1- Estrogen receptor and progesterone receptor-positive, HER2 negative. “This is the most common type of breast cancer that we see, and can often be treated by surgery first, as long as we find it in the early stages,” said Dr. Tsang. “Eventually after surgery, this type of breast cancer is controlled with a hormone blocking pill.”
2. HER2 – positive. About 1 out of every 5 breast cancers tests positive for HER2 (human epidermal growth factor receptor 2.) “This type of breast cancer is more aggressive, and patients often need chemotherapy and HER2 targeted therapy before surgery. The good news for this breast cancer type is that up to 80% of patients have positive clinical outcomes-or good response to treatment,” said Dr. Tsang.
3. Triple negative (or estrogen receptor negative, progesterone receptor negative, HER2 neu negative). Around 15% of breast cancers are this type. “Triple negative breast cancer is harder to treat and is the most aggressive form. Patients often need chemotherapy before surgery. Those who respond completely to treatment have very good prognosis and survival.”
Dr. Tsang said the first question most patients ask is whether they will require chemotherapy. “I cannot stress enough the importance of screening because if caught early, at Stage 0, patients will not need any chemotherapy at all. Early detection with annual mammography is key in being able to identify stage 0 cancer, which is where the cancer cells remain within the wall of the milk ducts. Once the cancer cells invade through the wall of the milk ducts, it can spread to other parts of the body. When cancer has already spread to other parts of the body, surgery is often not part of the treatment algorithm.”
After two years of COVID-19 and with some patients falling behind on their routine checkups and care, Dr. Tsang said now is the time to catch up and keep up on your healthcare. “Some women have been diagnosed at a later stage because the pandemic has delayed their annual screenings. Early diagnosis of breast cancer greatly increases the chance of cure and survival from the disease, and accurate early diagnosis of breast cancer is critical in the management of the disease. While the number of women (1 in 8) who get breast cancer hasn’t changed over the years, the survival rates have improved because of early detection, and improved treatments. My message during February, which is Cancer Prevention Month, on World Cancer Day, is that breast cancer is a treatable and curable disease, and if it is caught early, can save your life.” said Dr. Tsang.
Ashley T. Tsang, MD is a board certified, fellowship-trained breast surgeon from Stanford School of Medicine, specializing in the treatment of benign and malignant diseases of the breast and management of patients at high risk for breast cancer. Dr. Tsang is Assistant Professor of Surgery at Icahn School of Medicine at Mount Sinai, a Diplomate of the American Board of Surgery, and a member of the Society of Surgical Oncology and the American Society of Breast Surgeons.
Dr. Tsang has offices at Mount Sinai Doctors-Westchester in Scarsdale, 341 Central Park Avenue, (914)-370-5000. Visit https://www.mountsinai.org/locations/westchester for more information.
