Some heartening statistics were reported last year by the Journal of the National Cancer Institute: the mortality rate for breast cancer dropped nearly five percent between 1989 and 1992, the Largest decline since 1950. The numbers were even more dramatic for young women: between 1987 and 1992, the mortality rate plummeted nearly 18 percent among white women younger than 40.
But discouraging news also surfaced: the mortality rate among black women has gone up, and the number of reported breast cancer cases is rising as well. Twenty years ago a woman’s lifetime risk of breast cancer was one in 12; now it’s one in eight.
Nevertheless, we’re on the verge of a revolution in treating this disease. Researchers now have a clear picture of how a cancer cell becomes a tumor -- and how cells break free from a tumor and glide through the bloodstream to seed a new one in another part of the body. And they better understand how the female hormone estrogen makes breast cancer cells grow. "I think we’re going to get this disease licked in my lifetime, "says Dr. Susan M. Love, director of the Revlon/ U. C. L. A. Breast Cancer Center in Los Angeles.
Until that time, information is a woman’s most powerful tool. "A cancer diagnosis isn’t an emergency." Dr. Love says. "A patient should take time to educate herself and find out what the options are. "Most of all, a woman needs to remember that breast cancer is not death sentence, and that more than half of all women who develop it will live at least 15 years after their diagnosis.
Much of today’s good news centers on refining old therapies. Here’s where we stand in treating breast cancer.
Surgery and Radiation. The most dramatic change in breast cancer treatment in the past 20 years is that mastectomy -- removal of the entire breast and often part of the underlying chest muscle -- is no longer considered the only safe course. The chances of survival are no greater after a mastectomy that after the less disfiguring lumpectomy -- in which just the tumor is removed and the breast is left intact--followed by radiation. "There are good reasons to choose mastectomy," says Dr. Larry Norton, chief of breast cancer medicine Manhattan’s Memorial Sloan-kettring Cancer Center. "But if you’re a good candidate for lumpectomy, increasing your chances of a cure isn’t one of those reasons."
For about 30 percent of women, mastectomy is the only reasonable choice -- for example, a woman with small breasts and a large tumor, or one whose tumor is disseminated throughout the breast. But concerns about which procedure to choose often have more to do with life-style and attitudes. A lumpectomy requires radiation following surgery to kill any remaining cancer cells, which can mean outpatient visits five days a week for five to seven weeks. Scheduling could be a problem. Nancy Reagan, for instance, decided to have a mastectomy because radiation treatments would have taken too much time.
Many women, however, choose mastectomy out of fear and lack of information. Some patients are terrified of radiation and need to understand what it’s really all about, says Carol Fred, a clinical social worker at U. C. L. A’s Rhonda Fleming Mann Resource Center for Women with Cancer.
After a lumpectomy the machine that administers the treatment aims radioactive particles at the affected breast only. The treatments make most women tired and can sometimes leave the skin feeling sunburned. But the breast is not left radioactive.
Which statement does not agree with the text().
A. Mastectomy is the only reasonable choice for a woman with small breast and a large tumor.
B. Life-style and attitudes also play a role in the choice.
C. Many women make an improper decision in the treatment out of fear and lack of informa tion.
D. Women are more likely to feel tired if they accept mastectomy.
