Breast Cancer Updates Patty Tenofsky, MD FACS Women’s Connection  October 11, 2011
Topics <ul><li>Breast Cancer Statistics </li></ul><ul><li>Screening for Breast Cancer </li></ul><ul><li>Treatment Options ...
Statistics <ul><li>Incidence overall </li></ul><ul><ul><li>1 in 8 (about 13%) </li></ul></ul><ul><li>In 2008  </li></ul><u...
Statistics <ul><li>Only about 20-30% of women diagnosed have a family history  —  most are spontaneous </li></ul><ul><ul><...
Screening <ul><li>Self Exams </li></ul><ul><li>Physical Examination </li></ul><ul><li>Mammograms </li></ul><ul><li>MRI </l...
Breast examination <ul><li>Self examination </li></ul><ul><ul><li>Studies have shown it does not decrease breast cancer de...
Mammograms <ul><li>10 year survival for patients with mammogram detected lesion and no mass:  95% </li></ul><ul><ul><li>Wo...
MRI <ul><li>Requires a special coil  — c annot be done on any MRI machine  </li></ul><ul><li>MRI:  Because of blood supply...
Ultrasound <ul><ul><li>Used to look at abnormalities seen on mammogram, MRI or on exam to clarify its characteristics </li...
Breast biopsy <ul><ul><li>Minimally invasive with needle </li></ul></ul><ul><ul><ul><li>Helps plan surgery, simple, small ...
Ultrasound biopsy <ul><li>Performed in either radiology department or in surgeon’s office </li></ul>
Stereotactic biopsy <ul><li>Prone table is used most often </li></ul>
<ul><ul><li>If the needle biopsy shows atypical cells, pre-cancer or cancer, the area must be removed.  </li></ul></ul><ul...
Evaluation and treatment <ul><li>Surgical choice  </li></ul><ul><ul><li>Breast conservation </li></ul></ul><ul><ul><li>Mas...
Lumpectomy
Mastectomy with or without reconstruction <ul><li>Women continue to receive a mastectomy between 30 and 70% of time </li><...
Mastectomy without reconstruction
Tissue expanders and implants <ul><li>Usually requires a staged approach </li></ul><ul><ul><li>Expander placed below the c...
Latissimus flap and implant combination <ul><li>The muscle from the back may be rotated to create a breast </li></ul><ul><...
Latissimus flap and implant Postoperative left mastectomy — left latissimus flap and implant Pre-operative view
Tram flap <ul><ul><li>More natural appearing  —  no implant needed </li></ul></ul><ul><ul><li>Does not interfere with heal...
Checking the lymph nodes <ul><ul><li>Cancer in the lymph nodes is the most important prognostic factor for a patient with ...
Sentinel node biopsy <ul><li>As cancer cells travel to the lymphatic channels, these cells lodge in the sentinel node(s) f...
Axillary node dissection <ul><li>Still utilized: </li></ul><ul><ul><li>When sentinel node is positive on the day of surger...
Z-11 Trial <ul><li>In the 1990’s and 2000’s women were placed into a trial if their sentinel node contained cancer AND the...
Radiation for breast cancer <ul><li>Patients who will need radiation </li></ul><ul><ul><li>Breast conservation </li></ul><...
Chemotherapy <ul><li>May be given before or after surgery </li></ul><ul><li>Most important prognostic factor in determinat...
Chemotherapy <ul><li>Women who will get chemo: </li></ul><ul><ul><li>Premenopausal women with positive nodes </li></ul></u...
Hormonal therapy and herceptin <ul><li>Hormonal therapy </li></ul><ul><ul><li>5 year treatment </li></ul></ul><ul><ul><li>...
Conclusion <ul><li>Breast cancer is very common </li></ul><ul><li>Importance of screening </li></ul><ul><li>Biopsies are d...
Upcoming SlideShare
Loading in...5
×

Breast Cancer: Dr. Patty Tenofsky

1,199

Published on

Dr. Patty Tenofsky of Via Christi Clinic spoke at the Via Christi Women's Connection luncheon about breast cancer statistics, screening for breast cancer, treatment options, radiation therapy and chemotherapy.

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,199
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Breast Cancer: Dr. Patty Tenofsky

  1. 1. Breast Cancer Updates Patty Tenofsky, MD FACS Women’s Connection October 11, 2011
  2. 2. Topics <ul><li>Breast Cancer Statistics </li></ul><ul><li>Screening for Breast Cancer </li></ul><ul><li>Treatment Options </li></ul><ul><li>Radiation Therapy </li></ul><ul><li>Chemotherapy </li></ul>
  3. 3. Statistics <ul><li>Incidence overall </li></ul><ul><ul><li>1 in 8 (about 13%) </li></ul></ul><ul><li>In 2008 </li></ul><ul><ul><li>182,460 new cases of invasive cancer and 67,770 of non-invasive breast cancer </li></ul></ul><ul><ul><li>About 40,000 died of breast cancer </li></ul></ul><ul><ul><ul><li>The death rates have been decreasing since 1990 </li></ul></ul></ul><ul><ul><ul><li>There are about 2.5 million women in the U.S. who have survived breast cancer </li></ul></ul></ul>
  4. 4. Statistics <ul><li>Only about 20-30% of women diagnosed have a family history — most are spontaneous </li></ul><ul><ul><li>A first degree relative with cancer, however, does double the risk </li></ul></ul><ul><li>5-10% of breast cancers are caused by gene mutations inherited from either mother or father (BRCA1 or 2 mutation) </li></ul><ul><ul><li>80% risk of breast cancer if you have this gene, usually at a younger age </li></ul></ul><ul><ul><li>20-40% risk of ovarian cancer </li></ul></ul>
  5. 5. Screening <ul><li>Self Exams </li></ul><ul><li>Physical Examination </li></ul><ul><li>Mammograms </li></ul><ul><li>MRI </li></ul><ul><li>Sonograms </li></ul>
  6. 6. Breast examination <ul><li>Self examination </li></ul><ul><ul><li>Studies have shown it does not decrease breast cancer deaths </li></ul></ul><ul><ul><li>However, all clinicians know that patients still find their own cancers — it is often a common manner of presentation </li></ul></ul><ul><li>Physician examination </li></ul><ul><ul><li>At least once a year </li></ul></ul><ul><ul><li>Least accurate method of diagnosis, but still important </li></ul></ul>
  7. 7. Mammograms <ul><li>10 year survival for patients with mammogram detected lesion and no mass: 95% </li></ul><ul><ul><li>Women 50-69 have decreased mortality with screening (30% fewer deaths) </li></ul></ul><ul><ul><li>Women 40-49 with less benefit, but most (not all) studies show 17-24% decreased mortality </li></ul></ul><ul><li>10-15% palpable masses are NOT seen on mammogram </li></ul><ul><ul><li>Physician and patient self exams must continue </li></ul></ul>
  8. 8. MRI <ul><li>Requires a special coil — c annot be done on any MRI machine </li></ul><ul><li>MRI: Because of blood supply, breast cancers become brighter more quickly and intensely than benign tissues on MR images after IV gadolinium (a type of dye) </li></ul><ul><ul><li>Patient lies face down; takes about 45 minutes </li></ul></ul><ul><ul><li>Low false negative rate (doesn’t miss too many cancers) </li></ul></ul><ul><li>Problems </li></ul><ul><ul><li>Very expensive test </li></ul></ul><ul><ul><li>High false positive rate (overcalls too many benign things as possible cancer leading to unnecessary biopsies) </li></ul></ul>
  9. 9. Ultrasound <ul><ul><li>Used to look at abnormalities seen on mammogram, MRI or on exam to clarify its characteristics </li></ul></ul><ul><ul><li>Not really a screening tool </li></ul></ul><ul><ul><li>The easiest method used for biopsies, therefore, if the abnormality can be seen on ultrasound, that is what will be used </li></ul></ul><ul><ul><li>Does not see calcifications well </li></ul></ul><ul><ul><li>Done both by surgeons and radiologists and is community dependent </li></ul></ul>
  10. 10. Breast biopsy <ul><ul><li>Minimally invasive with needle </li></ul></ul><ul><ul><ul><li>Helps plan surgery, simple, small scar </li></ul></ul></ul><ul><ul><ul><li>Minimal disruption of lymphatic channels which helps with checking the lymph nodes later on in the treatment stage </li></ul></ul></ul><ul><ul><li>Consensus Conference, 2005 (ACS) — breast biopsy is an outpatient procedure performed with a needle </li></ul></ul><ul><ul><li>Most biopsies can be done in a surgeon’s office or in the radiology department either with ultrasound or a mammogram machine to map the location </li></ul></ul>
  11. 11. Ultrasound biopsy <ul><li>Performed in either radiology department or in surgeon’s office </li></ul>
  12. 12. Stereotactic biopsy <ul><li>Prone table is used most often </li></ul>
  13. 13. <ul><ul><li>If the needle biopsy shows atypical cells, pre-cancer or cancer, the area must be removed. </li></ul></ul><ul><ul><li>A wire is inserted by radiology. </li></ul></ul><ul><ul><li>The surgeon follows the wire to the lesion. </li></ul></ul><ul><ul><li>A follow-up film is taken to make sure the lesion was removed appropriately. </li></ul></ul>Needle localized breast biopsy (lumpectomy)
  14. 14. Evaluation and treatment <ul><li>Surgical choice </li></ul><ul><ul><li>Breast conservation </li></ul></ul><ul><ul><li>Mastectomy with reconstruction </li></ul></ul><ul><ul><li>Mastectomy without reconstruction or delayed reconstruction </li></ul></ul><ul><li>Postoperative treatment </li></ul><ul><ul><li>Radiation </li></ul></ul><ul><ul><li>Chemotherapy and herceptin </li></ul></ul><ul><ul><li>Hormonal therapy </li></ul></ul>
  15. 15. Lumpectomy
  16. 16. Mastectomy with or without reconstruction <ul><li>Women continue to receive a mastectomy between 30 and 70% of time </li></ul><ul><ul><li>Based on geographic location, age of patient, cancer fear and surgeon’s influence </li></ul></ul><ul><ul><li>Midwest patients have a higher incidence of mastectomy </li></ul></ul>
  17. 17. Mastectomy without reconstruction
  18. 18. Tissue expanders and implants <ul><li>Usually requires a staged approach </li></ul><ul><ul><li>Expander placed below the chest muscles at the time of mastectomy or delayed </li></ul></ul><ul><ul><li>Serial visits to plastic surgeon for expansion </li></ul></ul><ul><ul><li>Final procedure to place the implant (silicone or saline) </li></ul></ul><ul><li>Cosmetically not as good if radiation to be used, due to contractures </li></ul>
  19. 19. Latissimus flap and implant combination <ul><li>The muscle from the back may be rotated to create a breast </li></ul><ul><ul><li>Not usually large enough on its own </li></ul></ul><ul><ul><li>Implant is often added </li></ul></ul><ul><ul><li>Helps protect the implant </li></ul></ul>
  20. 20. Latissimus flap and implant Postoperative left mastectomy — left latissimus flap and implant Pre-operative view
  21. 21. Tram flap <ul><ul><li>More natural appearing — no implant needed </li></ul></ul><ul><ul><li>Does not interfere with healing, does not decrease survival or ability to find local recurrence </li></ul></ul><ul><ul><li>Much better if radiation has been used in the past </li></ul></ul><ul><ul><li>Longer, more difficult procedure </li></ul></ul>
  22. 22. Checking the lymph nodes <ul><ul><li>Cancer in the lymph nodes is the most important prognostic factor for a patient with breast cancer </li></ul></ul><ul><ul><li>Part of the surgical procedure is to check the nodes </li></ul></ul><ul><ul><li>5 year survival with surgery only: </li></ul></ul><ul><ul><ul><li>Node negative: 82% </li></ul></ul></ul><ul><ul><ul><li>1-3 positive nodes: 35% </li></ul></ul></ul><ul><ul><li>Methods to check the axilla: </li></ul></ul><ul><ul><ul><li>Sentinel node biopsy </li></ul></ul></ul><ul><ul><ul><li>Axillary node dissection </li></ul></ul></ul>
  23. 23. Sentinel node biopsy <ul><li>As cancer cells travel to the lymphatic channels, these cells lodge in the sentinel node(s) first. </li></ul><ul><ul><li>Travel to other nodes occurs as a secondary event </li></ul></ul><ul><ul><li>If the sentinel node is positive, the patient has the potential to have other positive nodes, and currently would receive a complete axillary node dissection in many cases </li></ul></ul><ul><ul><li>If the node is negative then no other treatment is required </li></ul></ul>Sentinel node (drum major) Other nodes (band members)
  24. 24. Axillary node dissection <ul><li>Still utilized: </li></ul><ul><ul><li>When sentinel node is positive on the day of surgery, but this is changing with lumpectomies </li></ul></ul><ul><ul><li>To determine the number of nodes that are involved and to remove the cancerous nodes </li></ul></ul><ul><li>Dreaded complication: lymphedema </li></ul>
  25. 25. Z-11 Trial <ul><li>In the 1990’s and 2000’s women were placed into a trial if their sentinel node contained cancer AND they were getting a lumpectomy </li></ul><ul><ul><li>1/2 of the patients received an axillary node dissection, chemo and radiation </li></ul></ul><ul><ul><li>1/2 the patients did NOT receive an axillary node dissection, but had chemo and radiation </li></ul></ul><ul><ul><li>NO difference in those two groups — therefore an axillary node dissection is probably not necessary in lumpectomy patients </li></ul></ul><ul><ul><li>Not certain if this can be applied to mastectomy patients </li></ul></ul><ul><ul><li>A huge step forward to decrease lymphedema rates </li></ul></ul>
  26. 26. Radiation for breast cancer <ul><li>Patients who will need radiation </li></ul><ul><ul><li>Breast conservation </li></ul></ul><ul><ul><li>Mastectomy if there is a tumor >5cm or there is 4 or more positive lymph nodes or margins are close </li></ul></ul><ul><ul><li>Inflammatory breast cancer </li></ul></ul><ul><li>Contraindications to radiation: </li></ul><ul><ul><li>Previous radiation (lymphoma patients) </li></ul></ul><ul><ul><li>Certain autoimmune diseases such as lupus & scleroderma </li></ul></ul><ul><li>Typically lasts for six weeks </li></ul>
  27. 27. Chemotherapy <ul><li>May be given before or after surgery </li></ul><ul><li>Most important prognostic factor in determination of treatment beyond surgery </li></ul><ul><ul><li>Lymph node status </li></ul></ul><ul><li>If lymph nodes are negative the most important factors: </li></ul><ul><ul><li>Tumor size </li></ul></ul><ul><ul><li>Tumor characteristics </li></ul></ul>
  28. 28. Chemotherapy <ul><li>Women who will get chemo: </li></ul><ul><ul><li>Premenopausal women with positive nodes </li></ul></ul><ul><ul><li>Postmenopausal women with positive nodes up to age 70 and then controversial </li></ul></ul><ul><ul><li>Pre- and postmenopausal women with negative nodes and increased risk factors: Based on the biology of the cancer </li></ul></ul><ul><ul><li>Women with very large tumors (locally advanced tumors) prior to surgery — chemo may shrink the cancer and allow breast preservation </li></ul></ul><ul><li>Women who probably won’t get chemo: </li></ul><ul><ul><li>Small tumors (<1cm) with positive hormone receptors and no other significant risk factors </li></ul></ul><ul><li>Oncotype Dx : </li></ul><ul><ul><li>A new DNA test on hormone positive tumors — it can help determine if a patient requires chemotherapy. </li></ul></ul>
  29. 29. Hormonal therapy and herceptin <ul><li>Hormonal therapy </li></ul><ul><ul><li>5 year treatment </li></ul></ul><ul><ul><li>Pre-menopausal: usually tamoxifen </li></ul></ul><ul><ul><li>Post-menopausal: usually an aromatase inhibitor (AI) such as arimidex </li></ul></ul><ul><ul><ul><li>Has been shown to be superior to tamoxifen </li></ul></ul></ul><ul><ul><ul><li>Not given to patients with ovarian function </li></ul></ul></ul><ul><li>Herceptin </li></ul><ul><ul><li>Given to most patients with Her 2/Neu positive tumors along with chemotherapy </li></ul></ul>
  30. 30. Conclusion <ul><li>Breast cancer is very common </li></ul><ul><li>Importance of screening </li></ul><ul><li>Biopsies are done with a small needle </li></ul><ul><li>Surgery: breast conservation or mastectomy </li></ul><ul><li>Chemotherapy and radiation </li></ul>

×