Breast Cancer: Awareness and Alternative Treatments

Breast cancer, which affects mostly women and about one percent of men, has become a common disease that transcends geographical boundaries, with approximately 1.7 million new cases diagnosed each year. In today's world and the age of technology, efforts to raise awareness about this disease have intensified, and this month, October, has been designated as awareness month for breast cancer. In the past week, Time magazine posed a question on its cover that seems to reflect a woman with breast cancer asking herself, 'What if I decide to do nothing?' This question relates to an article discussing a group of doctors who believe that unconventional methods should be employed to treat a specific type of breast cancer. One of these doctors is Mahra Golshan, an Iranian-American physician and researcher at the Dana-Farber Cancer Institute in Boston, who has answered questions from Radio Farda regarding this topic. This interview takes place in October, which is breast cancer awareness month. Dr. Golshan, due to your work, you encounter many individuals, especially women, who come to you because of breast cancer. How would you assess their level of awareness? Are they informed about their condition, or do they feel like the world has come to an end with no options left? Mahra Golshan: Well, it depends on the individual and how they perceive the options available to them. However, for many women, this is very difficult, and their world collapses around them. They ask how and why this happened to them. For a portion of the population, about 7 to 10 percent, we know there is a hereditary risk for breast cancer, known as BRCA, as in the case of Angelina Jolie, the Hollywood actress. For these individuals, more extensive surgery is required. Nevertheless, for the average women diagnosed with breast cancer, whether in the U.S., Europe, or Iran, there is a significant emphasis on the breast, and when we encounter a patient, there is a great need for information and education. This discussion occurs after your work and that of your colleagues appeared on the cover of Time magazine with the question that seems to reflect a woman with breast cancer asking, 'What if I decide to do nothing?' Could you explain a bit about your work? Women should always be vigilant about any changes; if they notice any discharge from their breasts or if someone in their family had breast cancer, ovarian cancer, or prostate cancer at a young age. You see, the majority of breast cancers in the U.S. and the world are of the invasive type, meaning the cancerous tissue has formed in the breast ducts and has also spread beyond them. However, there is another type where the cancer is still within these ducts, and this is before the cancerous tissues become invasive and have not yet spread to other parts of the body. For this second type, we attack it very aggressively, treating it similarly to the first type. It can choose another path because, in the second type, the chance of recovery is over ninety percent, meaning women survive. Most of the time, this cancer is treated with surgery, often lumpectomy, removing the cancerous tissues, followed by radiotherapy or partial mastectomy. However, we know that this type of cancer does not always end up being an invasive cancer, and we are looking for ways that involve less therapy. The reason my work is important is that I am a surgeon, and this is my income, but for a surgeon to say that we should do less surgery, I think that is very significant. A patient has encountered a lump in their body, and now the doctor tells them, 'You don't need to do anything about it.' What is the patients' reaction to this? This is a very good question. When you tell a patient they have a cancerous lump in their body, they want it removed quickly and not remain in their body because they think it will spread to other parts. However, the natural history of DCIS, or the second type I explained, has shown that it does not always turn into invasive breast cancer. In fact, it is often the case. The problem is that we have not conducted major studies in this area to confront this phenomenon, using less instead of more. Most treatment methods in medicine focus on discovering better drugs or more effective surgeries or therapies, not on over-treatment. And it is very difficult for a patient to face this approach and say, 'Doctor, how can you tell me to do less treatment instead of more?' Our job is to counsel women and their families and clarify what their disease is and what options and outcomes they have ahead of them. We are trying to challenge the standards that have been in place for a long time, and now there are numerous studies indicating that we should do less. What I am saying does not mean that all women with invasive breast cancer or even a type of DCIS should not be treated; it pertains only to a limited group. Why have you now decided to conduct research in this area? I mean, an approach with less invasive treatment for this specific type of breast cancer? The average age of breast cancer diagnosis in Iran is ten years younger than in the U.S., and thus there is a need for more studies and research to understand why this happens and what differences exist in tumor biology. In the case of DCIS breast cancer in the 1980s, only 7,000 cases were seen in the U.S., but now we are approaching sixty thousand. It has not yet become an epidemic because screening methods have improved significantly. In the U.S., women who reach 40 years old, which is my recommendation for Iran as well, should be examined by a doctor and undergo mammography. Imaging has improved significantly, and we can detect cancerous tissues at early stages, allowing us to provide better treatment options. However, breast cancer in Iran is different from that in the U.S., Saudi Arabia, or the Czech Republic. The average age of breast cancer diagnosis in Iran is ten years younger than in the U.S., and thus there is a need for more studies and research to understand why this happens and what differences exist in tumor biology. As a result, we need to slightly distance ourselves from standard treatment methods, and we say for every type of cancer that we should define a treatment path specific to each patient. Now that it is breast cancer awareness month, it would be good to focus more on screening methods and what options are available for those who need monitoring? Mammography, which is breast imaging, has advanced significantly in recent decades. We have moved from two-dimensional images to digital, and now, alongside doctors and radiologists, computer programs also review and diagnose test results. We also have MRI and three-dimensional mammography and many other technologies. All of these allow us to detect cancerous tissues earlier. However, these are expensive technologies, and we must ensure that everyone has access to them. The point is that one mammogram does not mean you no longer need it; it should be done every year. Women should always be vigilant about any changes, whether in their breasts or if they notice any discharge from their breasts or if there has been a change in the family with someone developing breast cancer, ovarian cancer, or prostate cancer at a young age. This is a field that is constantly evolving, and regarding breast cancer, compared to other diseases and cancers, there has been very good research done, but we are still learning, and there are many things that need to change. When we were talking, you mentioned Iran and said that there the age of breast cancer diagnosis is ten years younger than in the U.S. Is there a reason for this, or is there a lack of research in Iran? Honestly, this is not only in Iran but also applies to most countries in the Middle East and North Africa; most of the research conducted in this area regarding breast cancer has been in Western countries or the U.S. Breast cancer is a global disease and is not limited to one part of the world. There are numerous issues that can be addressed using research in this area from the U.S., but there is certainly a need for research, whether in prevention, early identification of the disease, or its treatment. There are very good centers in this area, and I have many dear colleagues in Iran, but I believe they need more support and backing for research in this area, whether from the government, foundations, or philanthropists who have faced this disease themselves or have family members who have. This is how we succeed in this area. I repeat that breast cancer knows no borders, but there are types of it that differ in regions like the Middle East and North Africa from what we see in the U.S.