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Treating Breast Cancer . . . And Avoiding Chemotherapy

October 08, 2021

With regular screenings and advances in the treatment of breast cancer, some patients avoid chemotherapy altogether.

In a conversation with Hartford HealthCare’s Jocelyn Maminta, medical oncologist Dr. Richard Zelkowitz, regional medical director for the Hartford HealthCare Cancer Institute breast program at St. Vincent’s Medical Center, discussed the various treatment options based on the aggressiveness of a patient’s diagnosis.

Dr. Zelkowitz said breast cancers are typically divided into two categories: invasive and non-invasive. DCIS, or Ductal Carcinoma in Situ, is an early stage of breast cancer that is not likely to metastasize or spread to other parts of the body.

“The majority of patients have invasive breast cancer,” Dr. Zelkowitz said. “But, as we have improved as a society with emphasis on screening, we’re seeing more people with DCIS. When I think back to when I started, that was a relatively rare diagnosis. So again, it speaks to the importance of early detection and screening.”

Once a breast cancer diagnosis is made, certain tests are done on the tumor cells to determine the best course of treatment.

“I explain to patients that for noninvasive cancer, our treatment is directed at preventing the cancer from coming back in their breast,” he said. “For invasive cancer, you have two goals. You want to prevent the cancer from coming back in the breast, and you want to prevent the cancer from coming back elsewhere in the body.”

Hormone therapy, typically recommended for hormone receptor-positive cancers, can sometimes be used instead of or in combination with chemotherapy to treat breast cancer. Hormone therapy blocks cancer cells from receiving the hormones it needs to grow. While both treatments come with side effects, hormone therapy can be less severe.

“When I first went into practice, basically any tumor that was graded about three-quarters of an inch got chemotherapy,” Dr. Zelkowitz said. “And what we’ve learned is that biology really trumps anatomy or what the tumor is really like tells us how to treat it.”

Genomic testing done on certain hormone receptor-positive tumors has allowed the reduction in the amount of chemotherapy given by 30 to 40 percent, Dr. Zelkowitz said.

“That is really a game-changer for us,” he added.

Of course, the chance for the best prognosis is early detection and Dr. Zelkowitz recommends that women have yearly mammograms starting at age 40. Be sure to talk to your doctor about when you should begin to have mammograms.

“The earlier cancer is detected, the earlier the stage, the less aggressive treatments tend to be and we have a much better chance to cure people,” he said.

For more information on breast screenings at Hartford HealthCare, click here.