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Breast cancer: The path traveled and road ahead

By Greg Botelho
CNN
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(CNN) -- Melissa Etheridge's powerful performance at the 2005 Grammy Awards rocked and resonated with the thousands in attendance and millions more watching on television. Her distinctive voice and hard-strummed guitar echoed throughout the hall, as did her energy.

There was just one thing missing: Etheridge's hair.

While officially a tribute to the late Janis Joplin, many saw the bald-headed Etheridge -- in her first appearance since being diagnosed with breast cancer -- as a symbol of empowerment, not only for female rock musicians, but also for the millions who have suffered from breast cancer.

"It was such a phenomenal statement: 'I may have a disease, but I am here and I am not going away,'" said Fran Visco, president of the National Breast Cancer Coalition. "Even if you have breast cancer, you are still full of life."

Such a vibrant performance by a breast cancer patient might have been unimaginable a few decades ago, when frank, exhaustive public discussion of the disease was rare.

"I remember when you couldn't even say breast, let alone breast cancer. Women did not say those words," said Visco, a survivor herself. "That has changed quite a bit."

The American Cancer Society estimates that 211,240 U.S. women (plus 1,690 men) will get invasive breast cancer this year, joining the more than 2 million women living with the disease.

Thanks, in large part, to better detection methods, doctors will likely diagnose more American women now with the disease than many years ago -- about 1 in 7 will get breast cancer sometime in their lifetime, according to the American Cancer Society.

But these patients have an increasingly better chance of surviving. Experts credit pervasive public awareness efforts touting the need for regular mammograms and self-exams as well as improved medical treatments.

"There has been enormous improvement in our ability to detect it early, and treat and cure patients," said Dr. Lawrence Solin, a professor in radiation oncology at the University of Pennsylvania School of Medicine. "We have had a dramatic reduction in mortality, and the treatments are more effective."

Progress has been across the board, including less invasive surgeries, molecular research and ample public and private funding. But while enthusiastic about the advancements, those treating patients stress the struggle is far from over.

An estimated 40,000 women are expected to die from breast cancer this year, according to the cancer society. That makes it one of the top killers of women in the United States, more than accidents, pneumonia or influenza.

"You don't want to ... make it sound like it's all fixed," said Dr. Eric Winer, director of the Dana-Farber Cancer Institute's Breast Oncology Center in Boston, Massachusetts. "It's better than it used to be, but it's still a hellacious thing ... to go through."

Psychological, physical scars

When doctors diagnosed Betty Ford with breast cancer in 1974, a few months after husband Gerald succeeded Richard Nixon as U.S. president, the disease -- although fairly common -- was rarely mentioned openly. (Gallery)

Ford took her personal battle public, significantly raising the disease's profile while pushing the value of mammograms and self-exams. The stigma associated with the disease lessened but still lingered for many years, even as recently as two decades ago, said Winer.

"Breast cancer is the disease that, for a long time, women feared the most," said Visco. "In this country, we're so focused on physical looks. We tie the issue of femininity to physical appearance, and people think primarily of breast cancer that threatens your breasts -- though those who have it realize, more significantly, that it threatens your life."

The most common treatments through much of the 1970s and 1980s were chemotherapy and a mastectomy (or, in layman's terms, surgery to remove an entire breast). These often meant extensive hospital stays and major (and sometimes dangerous) procedures.

Much of that changed in the 1990s and into the 21st century. As more high-profile figures voiced their struggles with the disease, fund raising, lobbying and support groups sprouted throughout the nation along with novel medical approaches. (Redgrave shares her survival story)

"There are now many, many support groups for patients, family members and more," said Dr. Jennifer Eng-Wong, a medical oncologist affiliated with the National Cancer Institute, noting that most hospitals offer their own support networks.

"Advocates have been vocal and very organized, and that certainly makes a big difference," she added. Funding for the NCI's breast cancer-related research, for instance, jumped from $348.6 million in 1998 to $548.7 million five years later.

Improved prognosis

While acknowledging that disadvantaged populations tend not to reap the benefits of regular mammograms and self-exams as much as others, Winer and Eng-Wong said most American women have been duly educated about their value. (Interactive: Warning signs)

The number of cases has risen significantly -- the rate was 1 in 22 as recently as the 1940s, according to the Breast Cancer Fund. Experts attribute the jump to better detection methods, longer life spans, lifestyle changes and other factors, although there is no consensus as to what exactly causes or increases the likelihood of breast cancer.

Still, survival rates have gotten appreciably better over the same period, say experts.

In recent years, drugs, radiation and chemotherapy treatments have been refined with less severe side effects and greater success against cancers. Generally, radical mastectomies are no longer patients' main option, with Solin noting that lumpectomies -- surgeries targeting the tumor without removing the breast -- can be just as effective.

"That particular advance is an enormous benefit because of the improved quality of life and improved self-image," said Solin, who has treated breast cancer patients for the last 20 years. "There are better outcomes all the way around."

Tailoring treatments

In the mid-1990s, scientists linked two genes -- BRCA1 and BRCA2 -- with an increased risk of breast cancer. While such genetic mutations account for a mere 5 percent to 10 percent of diagnoses, notes Eng-Wong, this research has helped doctors target high-risk populations with drugs and other treatments aimed at preventing breast cancer.

Molecular research's greatest contribution -- something that has recently begun, and experts say could boom in the next few years or decades -- may be helping doctors tailor treatments to specific breast cancer strains and specific patients.

"We are learning how one woman's cancer is different from another, so we'll no longer give everyone the same chemotherapy [or other treatment] hoping for the same benefits," said Dr. Winer. "My hope is that we will get to a point that breast cancer can be treated as easily as a strep throat."

Still, for all the progress made, much about breast cancer remains unknown -- particularly how to prevent it and how to beat it, in all cases. Genes, obesity, fitness, hormone therapies, diet, age of first pregnancy all have been cited as tied, in some way, to incidences of breast cancer. But even then, most cases cannot be attributed to any one factor.

The proliferation of pink ribbons "to some extent puts a happy face on breast cancer," said Visco. "We think breast cancer is taken care of, but that is so very far from the truth."

"This is still killing tens of thousands of [U.S.] women each year," she said. "We're far, far from a cure."


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Early detection and better tests have contributed to a rise in breast cancer cases, experts say.

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