11 May 2013

In May 2013, I was invited to give a talk with my colleague Dr. Carol Connor at the annual meeting of the American Society of Breast Surgeons.  Our topic was “Endocrine Therapy for Breast Cancer”, and we discussed the literature supporting the use of tamoxifen and aromatase inhibitors for breast cancer, as well as adverse effects and treatment of adverse effects. We were then invited to submit a manuscript which was published in the Annals of Surgical Oncology. The following is a summary of our talk and manuscript. I would like to express my appreciation to the #BCSM Community, who responded to my request for information about adverse effects  – it allowed me to discuss not only the literature, but also real patient experiences.

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10 May 2013
Angelina Jolie’s decision to undergo a prophylactic mastectomy has prompted a lot of interest in the options available for immediate reconstruction. Unfortunately, there are a lot of misconceptions regarding the extent of surgery, the recovery time needed, and the potential for complications. The following article appeared in the New York Times on 05/10/2013 and discusses the complicated issue of breast reconstructive surgery.
By RONI CARYN RABIN
A technician helps to create a silicone gel breast implant for Sebbin Laboratories in Paris.
Benoit Tessier/ReutersA technician helps to create a silicone gel breast implant for Sebbin Laboratories in Paris.

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1 March 2013

A study published in JAMA found that there is an increase in the incidence of young women (age 25-39) diagnosed with metastatic breast cancer. Metastatic breast cancer means that the cancer has already spread outside of the breast, most commonly to the lungs, liver, bone, and brain. Metastatic breast cancer is not curable, although newer treatments have improved the survival rates.

This study evaluated the SEER Database from 1973-2009. They found that while the incidence of breast cancer in young women is low, young women are more likely to have metastatic disease when first diagnosed. One criticism of the study is that we did not have the ability to detect metastatic disease in the 1970’s like we do today. So a woman diagnosed in the 1970’s might have been thought to have earlier stage disease, when in reality the cancer was already present in other areas of the body. Today, we are more likely to use a combination of blood tests and imaging scans to get better idea of the cancer stage – metastatic disease is considered Stage IV.

The following interview discussed some of the limitations of the study, as well as recommendations for young women. All women should be aware of their breasts and their bodies. While breast cancer is not common in young women, it certainly does occur. Any changes should be reported to your physician.

The Young Survival Coalition is an excellent resource and support organization for young men and women diagnosed with breast cancer, as well as their caregivers and support team. 

 

30 January 2013

A recent study in the journal Cancer compared patients with early stage breast cancer who underwent lumpectomy with radiation to patients who underwent mastectomy, and found that the patients who underwent lumpectomy had a better overall survival.

It is important to realize that this is an “observational study”, meaning the researchers went back to older data and analyzed the results – in the case of this study, they reported on patients treated between 1990-2004. There are many factors that were not accounted for, most importantly the specific subtype of cancer. It is not clear if the patients who underwent mastectomy had more aggressive tumors, which might in part explain the difference in survival rates.

Randomized clinical trials have demonstrated that the long-term survival is equivalent for patients undergoing a lumpectomy with radiation or mastectomy – in other words – you will not live any longer if the breast is removed. This is important to remember as more women are requesting mastectomy, and even removal of the healthy breast. While there are limitations to this current study, it at least reinforces the point that more surgery is not necessarily better.

The following interview discussed some of the history of breast cancer surgery as well as a discussion of the journal study: