Comprehensive Cancer Control Plan

The Cherokee Nation Comprehensive Cancer Control (CNCCC) Project assists in the development of networks and collaboration that produce an infrastructure for a comprehensive approach to cancer within the Cherokee Nation. Since 2003, coalition members and partners have come together to discuss the burden of cancer in Cherokee Nation. Coalition members and partners include local, regional, state and national representatives committed to identifying areas of cancer concern, planning interventions, prioritizing greatest areas of identified need, and then implementing identified strategies and/or providing needed resources. This is the second edition of the Cherokee Nation Comprehensive Cancer Control Plan and will serve, like the first, as an information resource for health care professionals and community members, as well as a tool for the Cherokee Nation Comprehensive Cancer Control Coalition and its respective entities. The coalition is committed to the process of enhancing infrastructure for comprehensive cancer control in the Cherokee Nation with the ultimate goal of reducing morbidity and mortality among the Cherokee community.

Treatment

 There are many factors that play a role in deciding which kind of treatment is best for a patient with breast cancer. Therapy may include any combination of surgery, radiotherapy, chemotherapy, and hormone therapy. If caught at an early stage, mastectomy or conservative resection of the tumor, followed by radiotherapy, is the preferred treatment for most patients.

 
The following factors influence the course of treatment, as well as the outcome:
·         Stage of cancer at time of diagnosis
·         Type of cancer and characteristics of cells
·         Levels of estrogen-receptor and progesterone receptor in the tissue mass
·         Menopausal status of the patient
·         Age of patient
·         Patient health
·         Newly diagnosed or recurring cancer
·         Patient preference
 
Treatment Options by Stage:
Stage I – breast cancer has not invaded any surrounding tissue, and all nodes are negative. A procedure is performed to either remove the mass (lumpectomy) or the patient may undergo a partial resection of the breast with dissection of axillary nodes, followed by radiotherapy. Hormonal therapy with tamoxifen is given if the tumor is estrogen receptor positive.
 
Stage II– tumor has invaded surrounding tissue by direct extension; local infiltration of dermal lymphatic tissue is present. Excisional biopsy to remove the tumor is performed. This may include axillary node dissection and radiation to the breast. Chemotherapy and hormonal therapy are usually prescribed.
 
Stage III – tumor is present in regional lymph nodes. Mastectomy is usually performed if feasible, with either pre-operative or post-operative radiation and chemotherapy. Chemotherapy and endocrine therapy are administered. 
 
Stage IV – tumor is present in regional lymph nodes and tumor has spread to surrounding tissue by direct extension. A biopsy is usually performed, followed by radiotherapy to primary site or mastectomy in order to control local disease. Hormonal therapy may be administered, along with chemotherapy (44).
The current standard of care in hormonal therapy for breast cancer is tamoxifen given for five years to all women with estrogen receptor positive tumors that are stages I-II (44). 
 
A new class of drugs called aromatase inhibitors may soon change the current standard of care, however. Aromatase inhibitors block the production of estrogen in tissues outside of the ovaries. Recent studies have shown an improved survival benefit in women who receive the aromatase inhibitor, letrozole, after five years of tamoxifen therapy (46), and another study showed improved survival when women were switched from tamoxifen to an aromatase inhibitor after 2-3 years (47).