According to the NIH’s National Cancer Institute, breast cancer is the second most common cancer in women after skin cancer. It is estimated that 310,720 women in the United States will be diagnosed with breast cancer in 2024, and 42,250 women will lose their lives to the disease.

When cells in the breast grow uncontrollably, they form a tumor that can either be cancerous, i.e. malignant, or non-cancerous, i.e. benign. The breast is made up of fifteen to twenty lobes, and each lobe consists of smaller sections called lobules, which end in dozens of tiny bulbs. The lobes, lobules and bulbs are linked by thin tubes called ducts. The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma, and it is more frequently found in both breasts than other types of breast cancer.

“We continue to become more personalized in our approach to breast cancer treatment by using the characteristics of each patient and their tumor biology to personalize their treatment plan,” said Dr. Heelan. “For some patients, this means less treatment in terms of chemotherapy, surgery and radiation. Whereas, for some patients, it means more. Our goal is to continue to improve outcomes, e.g. survival and prevention of recurrence, while minimizing overall treatment and side effects.”

Alicia Heelan, MD, MS, FACS, FSSO Member, Cancer Risk, Prevention and Surveillance Research Program University of Cincinnati Cancer Center Vice Chair of Quality, Division of Surgical Oncology Assistant Professor, Department of Surgery University of Cincinnati College of Medicine

A risk factor is anything that increases the likelihood of developing a disease. However, having a risk factor doesn’t guarantee that you will get cancer, and not having risk factors doesn’t ensure that you will not get it. Risk factors for breast cancer include:

• A personal history of invasive breast cancer, ductal carcinoma in situ or lobular carcinoma in situ.
• A personal history of a biopsy with atypical breast cells.
• A family history of breast cancer in a first-degree relative, i.e. mother, daughter or sister.
• Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
• Exposure of breast tissues to estrogen made by the body, which may be caused by:
  • Menstruating at an early age.
  • Older age at first birth or never having given birth.
  • Starting menopause at a later age.
• Taking hormones such as estrogen combined with progestin for menopause symptoms.
• Treatment with radiation therapy to the breast/chest.
• Drinking alcohol.
• Obesity.

Check with your doctor if you have:

• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• A nipple turned inward into the breast.
• Fluid, other than breast milk, from the nipple, especially if it is bloody.
• Scaly, red or swollen skin or a rash on the breast, nipple or areola, i.e. the dark area of skin around the nipple.
• Dimples in the breast that look like the skin of an orange.

“Early detection leads to excellent survival rates for the vast majority of patients and can mean less treatment is needed to be cured,” explained Dr. Heelan. “That being said, routine mammograms are key in early detection as they aid in identifying cancer before it is event large enough to be felt in exams.”

In Our Community

In the University of Cincinnati Cancer Center’s ten-county catchment area, breast cancer is the most common cancer, yet the breast cancer screening rates in the area are lower than the Ohio and the United States rates. With such a significant need for education and outreach, the Cancer Center has been working to better address this challenge in the catchment area and reduce the overall burden of breast cancer.

In partnership with Paddling for Cancer Awareness, Inc., the Cancer Center’s Office of Community Outreach & Engagement attended Paint the Square Pink hosted by the American Cancer Society (ACS) on Wednesday, October 2^nd. Paint the Square Pink is an annual event that aims to provide a supportive community event for breast cancer survivors, patients, families, friends and caregivers while also bringing awareness to help create a world free of breast cancer. The event brings together numerous community partners, local healthcare organizations, nonprofits, sponsors and more to provide attendees the opportunity to enjoy live music and local food trucks while visiting community partner tents providing educational materials surrounding healthy eating, active living and tips for prevention and early detection.

In collaboration with UC Health and the 513 Relief Bus, the Office of Community Outreach & Engagement also participated in the State of Cancer Forum and Health Expo hosted by Hamilton County Commissioner Alicia Reese on Tuesday, October 15^th. The event began with a State of Cancer Forum, which included a presentation by Melinda Butsch Kovacic, PhD, MPH, the Associate Director of the Office of Community Outreach & Engagement, focused on sharing the latest regional statistics and trends as well as a panel discussion with several other regional experts, including Elizabeth Shaughnessy, MD, PhD.

Melinda Butsch Kovacic, PhD, MPH Associate Director, Community Outreach & Engagement University of Cincinnati Cancer Center Associate Dean of Research University of Cincinnati College of Allied Health Sciences

Elizabeth Shaughnessy, MD, PhD Member, Cancer Risk, Prevention and Surveillance Research Program University of Cincinnati Cancer Center Professor, Department of Surgery University of Cincinnati College of Medicine

Following the forum, a broad spectrum of community organizations united to host a health fair where attendees could gather lifesaving information, receive valuable health screenings and much more. UC Health’s mobile mammography van was present as well as graduate student Hannah Botzman, under the mentorship of Cancer Center member Seung-Yeon Lee, PhD, who shared current breast cancer research, educational resources and self-examination techniques.

In collaboration with a clinical team from UC Health, the University of Cincinnati Cancer Center provided 25 prostate cancer screenings to eligible attendees. The Cancer Center’s Office of Community Outreach & Engagement facilitated over 200 educational sessions on cancer prevention and conducted 18 lung cancer pre-screenings of which 13 resulted in referrals to UC Health’s Lung Cancer Screening and Smoking Cessation Programs. Additionally, the Cancer Center’s Survivorship & Supportive Services Program offered resources to those currently in treatment alongside the University of Cincinnati College of Medicine’s Office of Clinical Research, which connected attendees to ongoing clinical trials.

Updates on Research & Clinical Trials

“Breast cancer research leads the way in personalized cancer treatment, and many discoveries in breast cancer have led to developments in other cancer treatment,” shared Dr. Heelan. “Currently, I am focused on researching pain management after a mastectomy.”

A mastectomy is a surgical procedure to remove all or part of a breast and sometimes nearby tissues. Mastectomies are typically performed to treat breast cancer, but they can also be a preventative measure for women at high risk of breast cancer. Over 100,000 patients undergo mastectomies ever year in the United States, and 40 in 100,000 patients undergo risk-reducing mastectomies for breast cancer prevention.

The Post-Mastectomy Recovery: A Randomized Clinical Trial Comparing Preoperative PECS-II Blocks with Intraoperative Pectoral Blocks study, led by Dr. Heelan, aims to compare two different standards of care for pain management as well as two different standards of care for local numbing medicine for breast cancer patients who will have a total mastectomy.