Alberta Cancer Foundation

Understanding Breast Cancer, From Screening to Metastatic Disease

By: Sean P. Young

Illustration by Laurel Dziuba.

Breast cancer is the most commonly diagnosed cancer in women, accounting for one in four new cancer cases in females in Canada. There are many facets of this progressive disease to understand for the newly diagnosed. But there are just as many reasons to have hope, as innovative treatments and research are being undertaken by experts like Dr. Jeff Cao, radiation oncologist at the Tom Baker Cancer Centre in Calgary, and Alberta Health Services Cancer Care Alberta Provincial Breast Tumour Team lead.

Here, Cao shares his insight into the breast cancer journey.

Q: The new Alberta guidelines advise screening women starting at age 45 instead of 50. Why change the guidelines?

“It should be noted that this applies to average-risk individuals, with a recommendation for digital mammography every two years, starting at 45 until 75. The decision to lower the age was based on expert consensus considering multiple factors, such as provincial participation versus cancer-detection rates, new evidence showing mortality reduction with earlier screening, and modelling using Alberta data to determine the most efficient age groups and frequency of testing.”

Q: Are there any advances in biopsies or surgical techniques showing promise?

“My multidisciplinary colleagues have developed a provincial diagnostic pathway for highly suspicious lesions to expedite biopsies, prompt early surgical referral, and provide nurse navigator support for patients to reduce their anxiety and wait times. The primary treatment of breast cancer is surgery. There are innovative localization techniques that use radioactive or magnetic seeds instead of cumbersome wires to mark the site of cancer accurately, as well as microsurgery techniques to reduce the risk of lymphedema.”

Q: How is breast cancer treatment being personalized?

“Every patient is unique, and every breast cancer is different based on its tumour features and stage of presentation. Breast cancer is generally differentiated based on its receptor status — whether it’s estrogen or progesterone hormone receptor positive, HER2 receptor positive, or triple negative. Recently, my medical oncology colleagues have used genetic testing on tumours to better understand the patient’s disease and to decide between chemotherapy or treating with anti-estrogen therapy alone. Radiation oncologists are also using these genomic tests on tumours to study whether radiation is required.”