Photo by Porch & Parish. Dr. Michael Castine, III stands in the infusion room at the Hematology Oncology Clinic at 1673 Mount Pleasant in Zachary.
Michael Castine, III, MD is Board certified in Internal Medicine, Hematology and Oncology. For 20 years, he has served Zachary and the surrounding areas, working full-time at the Hematology/ Oncology Clinic. His practice centers around the treatment of all cancer diagnoses and the diagnosis and treatment of disorders of the blood such as anemias and clotting disorders. He sat down with us for a Q&A about breast cancer, as October is Breast Cancer Awareness Month.
How is breast cancer diagnosed?
The main way breast cancer is diagnosed is through screening mammograms. The secondary way breast cancer is diagnosed is through self-diagnosis, where someone discovers a lump and brings it to the attention of their doctor. For approximately every 20 women diagnosed with breast cancer through a mammogram, one is a self-diagnosis. Diagnosis by a physician is even rarer. This generally happens when someone comes in with evidence of metastatic cancer that is traced back to the breast. Once breast cancer is located, the specific diagnosis is determined pathologically and radiographically to stage it and determine treatment. Early detection can mean the difference between a 90% cure rate over a 70% cure rate if detected later. The earlier we catch it, typically the less we have to do to cure the person.
When should women begin getting annual mammograms?
Most women are recommended to start annual screening mammograms at age 40. Depending on their family history, some women should begin to receive annual mammograms as early as their 30s. Medicare and some health insurance providers may want women to stop receiving mammograms around age 75. However, we encourage people who are high-functioning —still working and active — to continue to get mammograms.
What are some warning signs or symptoms of breast cancer?
The most important thing to look for is changes to the breast that won’t go away. If a lump is a cyst you have had diagnosed or something that waxes and wanes with menstrual cycles, that is less of a concern than something that comes up and continues to get larger or won’t go away. A woman is her own best advocate. If you bring a concern to your doctor, and the doctor does not run a test like a mammogram or ultrasound, bring it up at a higher level or get a second opinion. It may turn out to be nothing, but you are your own best advocate, and you need to carry it to a completed test result.
How is breast cancer treated?
The three main ways to treat breast cancer are surgery, radiation and medication, such as hormone blockade or chemotherapy. Treatment is determined primarily by pathology and radiology. Twenty-five years ago when I started, there were only a few ways that breast cancer treatment was determined – size, lymph nodes or metastatic status. As the study of breast cancer has increased in the last 25 years, a breast cancer can now fall into 15- 20 different sub-types, and a lot of those are based on the characteristics of the cancer. We now know that there are four main subcategories: the most aggressive is triple negative, the less aggressive ones — tumors with either estrogen receptor or progesterone receptor proteins on them that are sensitive to hormone manipulation, and, finally, HER2 positive. Metastatic is not a sub-category, because the term refers to the metastasis, or spreading, of cancer. While HER2 used to be the most aggressive breast cancer, it has now fallen to a less aggressive nature because we have better treatments. HER2 is a driver protein that makes cancer grow, but we have discovered proteins that combat HER2 and drugs that target its development.
Metastatic breast cancer is currently incurable, but very treatable. For earlier stage breast cancer, we cure approximately 87% of women – and that’s all subsets. That’s because we’re getting women into treatment earlier.
What are some noteworthy developments in the diagnosis and treatment of breast cancer?
There was a test developed a few years ago that broke the news, with many saying it would mean fewer women would need chemotherapy. The test looks at the genetics of breast cancer itself and assigns a score to it. Scientists showed they could draw a single line on the result of the test and anything below the line probably does not need chemo, and anything above the line probably does. The test has become more routine but is only geared to breast cancers with certain characteristics. My goal since I’ve been an oncologist is to give less chemo to breast cancer patients, and I prescribe a lot less than I did 20 years ago. Back then, we looked at breast cancer and said, “that might be aggressive, we’re going to treat it.” But now, we have better testing and techniques that have reduced the number of surgeries, radiation and chemo necessary to cure a patient. Those have been wonderful improvements over the last 20 years, and that’s the constant strive. We want to maintain the cure, but reduce the toxicities in the treatments we have to achieve that cure. And that’s the goal of a lot of the clinical trials that we do. I have about 30 clinical trials open, and a third of them are breast cancer trials. These trials are done in Baton Rouge and Zachary, and we’re doing them to advance medications, cure rates and decrease side effects of treatments we know work. Most of these trials involve giving patients one medication or another, both of which are already proven effective, to monitor side effects and improvements in efficacy.
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