For this last Monday of National Breast Cancer Awareness month, Dr. Patricia Yarberry Allen has called on a colleague, Alexander J. Swistel, Associate Professor of Clinical Surgery, Weill Cornell Medical College, to give us some positive news about breast-cancer treatment. Here is his list of therapy improvements that deserve celebrating:



• Nationally accredited breast centers. Blending the various disciplines of medical, surgical, and radiologic expertise into a group model has significantly improved communication between specialties and enhanced patient care. This has led to the establishment of nationally accredited breast centers. These give patients the knowledge that their care is being delivered by the top minds within each specialty discussing the best options of care in a team setting.

• Better use of technology and guidelines. Improvements in the quality of mammograms now find cancers at a smaller size. This has a dramatic impact in the ability to provide gentler treatments and improved survival. The judicious use of sonograms and MRI in patients with dense breast tissue can identify patients with early-stage disease. Guidelines for the proper use of diagnostic imaging and needle biopsies also have made it easier to define appropriate surgery.

• Targeted therapies. Targeted therapies have changed medical and radiation oncology approaches. Medical oncologists now recognize five subtypes of breast cancer with differing treatment options and behavior patterns.  This selection of therapies has improved survival and recurrence rates while decreasing the side effects of chemotherapy. Specific targeting of tissues and partial breast irradiation in selected patients has likewise improved the outcome and spared overtreatment of patients. Blanket recommendations for postoperative radiation treatment have changed for selected breast-conserving patients. In addition, new trials have suggested that equivalent success may be obtained with intra-operative radiation during breast-conserving surgery [radiation of the tumor area at the time of surgery].

• Oncoplasty. Surgical advancements center on Oncoplastic Surgery. This specialized approach combines proper and appropriate radical techniques to remove the tumor with the use of plastic reconstructive techniques to re-contour the breast and minimize surgical defects and scars [surgeons reconstruct the breast at the time of tumor removal]. This allows the patient to not only survive her surgery but to thrive during her recovery and feel comfortable with her own body image.

These reconstructive techniques have also made a large difference in the latest surgical technique for women requiring mastectomy. Nipple-sparing mastectomies with immediate reconstruction have now become more popular as the safety of this new surgical option has been shown in long-term follow-up. This provides an excellent technique for patients selecting bilateral mastectomy [removal of breasts before they develop malignant cells] because they are at high risk based on family history or known genetic mutations. Patients in these groups can now choose nipple-sparing mastectomies knowing that for them, their odds of survival are significantly improved and this surgery preserves to a greater extent postoperative deficits in body image.

Oncoplasty techniques also can improve quality of life for patients who have problems and side effects related to large amount of breast tissue. These patients can undergo bilateral reduction surgery at the time of their lumpectomy and achieve greater margins of safety and an overall reduction in the amount of radiation therapy that might otherwise be required. Oncoplasty will continue to change surgical management of breast cancer, but the future of treatment lies in understanding tumor biology and genomics.


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