Lynn Curry's life changed two and a half years ago, when she went for a routine check-up and her doctor found a tiny lump in her left breast. "I was very nervous during the biopsy," says Curry, now 49, of Parkland. After learning she did indeed have breast cancer, Curry was faced with instantly having to make a number of choices. "There I am, sitting in an office, and I have to decide on surgery, whether to have chemotherapy, radiation, breast reconstruction," she says, "and you're doing this while you're consumed with the fear that you're going to die" .

The fact that women have so many choices nowadays is indicative of the progress being made in the fight against this disease. But keeping on top of all these changes is no small task, so we queried some of the top breast cancer specialists in our area to learn what are the current trends in fighting this disease.

Determining the best course of treatment right from the start is imperative in fighting breast cancer, says Joyce Slingerland, M.D., Ph.D, director of medicine at the Brahman Family Breast Cancer Institute at the Sylvester Comprehensive Cancer Center at the University of Miami. "Breast cancer is a sneaky cancer," she says. "On balance, we're doing considerably better than we were a decade ago. But breast cancer is one of those cancers where you need to do the right thing, right from the beginning because, if it recurs, it can be treated, but it can't be cured" .

That means that the best imaging tests are needed even before treatment, which usually involves surgery, followed by chemotherapy and/or radiation, notes Alanna Harris, M.D., chief of breast cancer diagnostics at the Aventura Hospital and Medical Center. The American Cancer Society's new recommendation calls for all newly diagnosed breast cancer patients to undergo both digital mammography and MRI imaging. The use of MRI is extremely important because it can diagnose other cancerous lesions in the breast. This way, when a woman undergoes surgery, she and her doctor know ahead of time what needs to be done-the old days of a woman waking up from surgery, to only learn then that she needed to have her breast removed, are largely a thing of the past.

Surgery is also changing, notes Margaret Thompson-Gilot, M.D., breast surgeon at the Cleveland Clinic Florida in Weston. This is true, whether the surgery involves the removal of a small tumor with a lumpectomy, or whether a mastectomy is required. When it comes to a mastectomy, the choice includes reconstruction through a saline implant or the refashioning of the breast using the woman's abdominal tissue. "This is not a new technique, but gets more refined each year," she notes. It's a good option because, she says, "it feels like breast tissue and it heals better." As a bonus, since abdominal tissue is used, "patients get a tummy tuck," Dr. Thompson-Gilot notes.

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Following surgery, most women require chemotherapy and/or radiation. When it comes to the latter, partial breast irradiation is becoming increasingly popular, says Martin Keisch, M.D, a radiation oncologist practicing at Aventura Hospital and Medical Center and the University of Miami Hospital in Miami.

According to Dr. Keisch, traditional breast cancer radiation involves the entire breast, and takes six and a half weeks. Partial breast irradiation targets one-quarter of the breast tissue and is done with two treatments a day over five days. In addition to causing less time, there is also a lower probability of both short and long-term side effects, he notes. For instance, if the treated breast is the left one, traditional radiation can affect the heart, potentially leading to a heart attack years later. However, partial breast irradiation is only indicated for women with early stage breast cancer, so this is another argument for early detection, Dr. Keisch notes.

Research trials can also play an important role in the life of breast cancer patients, says Mark Pegram, M.D., associate director of Clinical and Translational Research at the University of Miami's Sylvester Cancer Center, where, he says, there are up to 20 active clinical trials underway at any time. "Clinical trials go on at every step of cancer treatment, but one important aspect is that they can provide hope to patients who have seemingly run out of options. Sometimes the compounds work and it's clearly beneficial. But at the very least it certainly gives patients and families hope," he notes.

Another major aspect of dealing with breast cancer today is the emphasis on caring for the patient's emotional needs right from the start, notes M. Beatriz Currier, M.D., F.A.P.M., director of the Courtelis Center for Psychosocial Counseling at the Sylvester Comprehensive Cancer Center. According to her, about 45 percent of breast cancer survivors develop some significant amount of emotional distress, such as fatigue, sexual dysfunction, body image issues, depression, anxiety of disease recurrence-the list goes on. So, every patient who comes to the center is given a questionnaire, called a "distress thermometer," upon her diagnosis. If the test shows she is at risk of developing emotional problems, immediate counseling is offered, and this is done every step of the way.

Body image concerns play a major role in breast cancer treatment, notes Alejandra Perez, M.D., co-director of the breast cancer center at Memorial Healthcare Center in Hollywood and Pembroke Pines. In Pembroke Pines, there is an image recovery center, which offers services in a spa-like setting. "Cancer patients have so much stress that we can provide services that help them," including wigs, special cosmetics, even manicures and pedicures. "Our stylists know that, when you do a manicure, you can't remove the cuticle," she says, noting this can contribute to lymphedema, a cancer treatment complication.

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But even with all these treatments, the ideal situation is never to have to use them, notes Jaime Lozano M.D., a radiation oncologist at North Shore Hospital Medical Center in Miami. "You need to do mammograms and you have to do self-exams," he says. That very morning, he noted, he had treated a woman who had noticed a lump in her breast four years ago, but had done nothing. "Four years ago, that cancer was probably curable, but now it's not," he said, adding, "you can't imagine that happening these days, but it does" .

CHOOSING A BREAST CANCER FACILITY

Paula Holland De Long of Fort Lauderdale is a 10-year breast cancer survivor who runs support groups for women whose treatment is ending at Broward General Medical Center's Cancer Center and also through Gilda's Club South Florida. Here are her tips on choosing a breast cancer doctor and treatment facility.

Make sure your doctor listens to your concerns and addresses them promptly.

Make sure you're treated with respect.

Make sure the facility offers the most current treatments and technology.

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Make certain ahead of time that your health insurance is accepted.

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