Tuesday, November 17, 2009

Breast Surgeon Talks about Therapies; New Trends

by Holly Hosler

Although breast cancer incidence is declining in the U.S. overall, it is actually increasing among residents of Baltimore city and Baltimore County, says Dawn Leonard, M.D., presenter at last week’s Alvin & Lois Lapidus Cancer Institute oncology grand rounds on “Advances in Breast Cancer: Current Therapy and New Trends.”

Leonard, fellowship-trained breast surgeon and medical director of the Herman & Walter Samuelson Breast Care Center, gave LifeBridge Health clinicians an up-to-date summary of the current standards of care for the detection and treatment of breast cancer. She also mentioned trends and technological advances that will likely shape the future of breast care.

In terms of imaging and cancer detection, mammography is the only modality that’s been shown in clinical studies to improve survival rates, says Leonard. Moreover, digital mammography has been proven 28 percent more effective than traditional mammography in detecting cancer in pre- and peri-menopausal women, women with dense breasts and women under age 50. Leonard gave the group a glimpse into the future of breast imaging with pictures of 3-D mammography/ tomosynthesis and positron electron mammography, modalities that are not yet FDA-approved but appear to be promising.

For biopsies, Leonard says she avoids excisional biopsies, and even incisional biopsies are becoming somewhat passé. Less invasive needle biopsy techniques are now standard, and core needle biopsies are preferable to fine needle aspiration because they give pathologists better cell samples from which to ascertain more information about a tumor.

Leonard stresses the importance of patients’ desires when it comes to breast surgery. There has been an increasing trend lately towards mastectomy, and she understands why many patients would want to take this prophylactic measure. However, most patients are good candidates for lumpectomy.

“Survival rates are not impacted by breast conservation when combined with indicated adjuvant therapies,” says Leonard.

If a patient elects for a lumpectomy, which conserves as much breast tissue as possible, it’s imperative that she receive radiation treatment. Patients who have lumpectomies without radiation follow-up have a 20 to 40 percent chance of breast cancer recurrence in five years. (Therefore, most patients receive full breast irradiation, which makes the lumpectomy nearly as effective as a mastectomy at preventing future cancer development.) Leonard described IMRT, partial breast irradiation (PBI) and MammoSite (a form of PBI), adding that PBI is still relatively new and at this time the body of data is small to accurately gauge its effectiveness over the long term. (The American Society of Clinical Oncology considers it investigational.)

Breast care surgery may one day see a revolution in that surgery will be replaced by ablative therapy. (Ablation uses a probe to heat or freeze tumors, effectively destroying them from the inside out.) A final trend that Leonard mentioned was the focusing of breast care in a single, multi-modal, multidisciplinary care center, such as the Herman & Walter Samuelson Breast Care Center at Northwest Hospital.

To schedule an appointment at the breast care center, call 410-601-WELL (9355).

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