It’s been years, even decades since breast cancer was considered a death sentence, and advancements occurring at virtually every stage of its detection and treatment frequently generate more welcome news.

“We’ve gotten to the point where outcomes are really good, where survival rates are very good,” said Dr. Meena Moran, director of the Yale Medicine Breast Radiotherapy Program and a professor of therapeutic radiology at Yale University School of Medicine. “There are so many new drugs that were unavailable before. We also have learned so much about individual cancers. We can ‘subtype’ patients and target their treatment.”

While surgical techniques have changed little in the last 10 to 15 years, breast cancer surgeries are less “radical” than they once were, said Dr. Christy Stanat, a breast surgeon with the Hartford HealthCare Medical Group who sees patients in Norwich and Waterford.

“The most important change has been the de-escalation of treatment,” she said. “Nowadays, there’s so much effort, science and money going into research. ... We do a really good job of preserving breasts.”

Interviewed in connection with National Breast Cancer Awareness Month — an October designation begun in 1985 — the doctors separately expressed similar views of the importance of annual mammograms for women, starting at 40 years of age. Surprisingly, the topic has sparked some controversy in recent years. In 2016, the U.S. Preventive Services Task Force, an independent panel of medical experts, recommended biennial mammograms for women between 50 and 74.

“While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger,” the task force reported.

Moran said the recommendation stemmed from “more of a cost analysis” than medical insight, and that “as a treating physician, every gynecologist, primary care physician, patient and friend I know starts having mammograms at 40.”

Most radiologists, breast surgeons and oncologists agree that women should have annual mammograms starting at age 40, Stanat said, and women whose breast examinations find dense breast tissue should have yearly breast ultrasound exams, as well. In addition, she said, women with a family history of breast cancer may want to consider having Magnetic Resonance Imaging, or MRI, scans, too.

Women who put off scheduled mammograms during the height of the COVID-19 pandemic are urged to have the test, which can detect cancer one to four years before a woman feels a lump in her breast, according to Dr. Niamey Wilson, a Hartford HealthCare Medical Group breast surgery division group leader quoted in a Hartford HealthCare publication.

Physicians are less certain about the value of breast self-examinations, but both Moran and Stanat said they can be useful, though not substitutes for mammograms.

“If a patient is going to do it, I recommend once a month,” Stanat said. “If you feel something one month that wasn’t there the month before, you should tell somebody." 

For women considered to be at average risk for breast cancer, annual clinical breast examinations are recommended between the ages of 25 and 40. For women at above-average risk, including those with a family history of breast cancer in a parent, sibling or child, Memorial Sloan Kettering Cancer Center physicians recommend a clinical exam every six months, starting no later than 10 years before the age of the earliest diagnosis in the family.

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Breast cancer, which affects one in eight women, is the most common cancer diagnosed in women. In 2017, the latest year for which data are available, 250,520 new cases of the disease were reported among women in the U.S., according to the Centers for Disease Control and Prevention. Some 42,000 women died of the disease. For every 100,000 women, 125 new cases were reported and 20 women died.

While Connecticut’s breast cancer rate of 137 cases per 100,000 women is among the highest of any state in the country, its age-adjusted mortality rate is lower than the national average, in part because the state’s screening rate is high, according to the Connecticut Breast Health Initiative, a nonprofit that supports education and research.

It estimated that 430 women died of breast cancer last year in Connecticut. 

Physicians in eastern Connecticut are screening more patients than ever before, detecting more cases, detecting them earlier and having greater success in treating them, Moran said. Some cases are being detected while in a precancerous state in which abnormal cells are confined to the milk ducts.

“Some believe it’s a precursor” of invasive breast cancer, she said. “Some think we’re screening so early, we’re overtreating. But in the U.S., that’s why we have the best outcomes in the world. We’re not considering the general costs; it’s more about taking care of individual patients.”

Moran, who has worked to standardize breast cancer radiotherapy treatment at Yale's Smilow Cancer Hospital Care Centers across the state, said radiation can be delivered more precisely than in the past, with treatments tailored to the specific circumstances of each patient. Typically used following a lumpectomy — a procedure involving the removal of a tumor and some surrounding tissue as opposed to the surgical removal of an entire breast in a mastectomy — radiation reduces the likelihood of the disease recurring.

While a course of radiation treatment used to take six or seven weeks, it now can be completed in three to four weeks, Moran said.

The shortened course of radiation has fast become the new standard of care for lumpectomy patients, Dr. Andrew Salner, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, said in an interview Hartford HealthCare posted on Facebook.

Without radiation, the rate of recurrence is 30%-40%, he said. With it, the rate is less than 5%.

b.hallenbeck@thedaycom