Optimizing the Management of Early-stage TNBC: Symptoms, Treatments...

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Regina Hampton, MD,
FACS
Breast Surgeon

Optimizing The
Management of
Early Stage TNBC
Symptoms, Treatments and Recurrence

Triple Negative
Breast Cancer
• 10-15% of all invasive cancers
• Aggressive subtype
• Not responsive to hormone-based ther...

Hormone
Positive/Negative

Racial Disparities
• Incidence
– 12% lower in Black women
• 5-year survival
– 77% Black women vs. 90% White women
• Death/...

Who Gets TNBC?

Symptoms
• None
• Mass
– Breast
– Armpit
– painless
• Swelling
• Nipple discharge
• Assymetry
• Dimpling

3D mammogram

Breast Imaging
Ultrasound MRI

Needle Biopsy
Minimally Invasive
Stereotactic Ultrasound
Performed in an office setting with local anesthesia.
Does not re...

Pathology Report
• Type
– Invasive ductal, invasive lobular, in-situ
• Grade
– 1=well differentiated
– 2 = intermediate
– ...

New Staging-2018
• We use an app
• Tumor
– Size
– Grade
– Receptor status: ER, PR, Her2-neu
• Lymph Node
• Metastasis
• Cl...

New Cancer Staging
Example #1:
5.3cm tumor with 1 positive lymph node without metastasis,
grade 2, ER+, PR+, Her2 +
Old st...

Additional Testing

Tumor Board
• Radiologist
• Surgeon
• Pathologist
• Radiation Oncologist
• Medical Oncologist
• Plastic Surgeon
• Breast C...

Genetic Testing
• BRCA 1, BRCA 2
• BARD1, PALB2, RAD51D
• Updated guidelines
– All women, all ages with TNBC need genetic ...

Treatment Options
• Chemotherapy
– Before surgery (neoadjuvant)
– After surgery (adjuvant)
• Surgery
• Radiation Therapy

Neoadjuvant
Chemotherapy
• AC followed by paclitaxel
– Dose dense is given every 2 weeks
– Standard is every 3 weeks
– Tax...

Neoadjuvant
Chemotherapy

Response to Chemotherapy
• Clinical response
– Physical exam
– Imaging studies (mammogram, MRI, PET)
• Pathologic response...

Breast Conservation
• Partial Mastectomy
Lumpectomy
– Remove tumor and surrounding tissue
(margin)
– Leave breast intact
•...

Lumpectomy
Then & Now

Axillary Lymph Nodes
Sentinel lymph node biopsy
(2-5 nodes)
vs.
Axillary Dissection
(7-15 nodes)

Mastectomy
• Complete removal of breast
tissue
• Decrease in risk & recurrence
– Not 0%

Types of Mastectomy
• Simple/total
• Skin sparing
• Nipple sparing
• Modified radical
• Bilateral
• Prophylactic (no cance...

Nipple Sparing
Mastectomy

Breast Reconstruction
• Implant
– Saline or silicone
• Flap
– Using one’s own tissue
• Abdomen: muscle, skin, tissue
– TRA...

Breast Reconstruction
Complications/Failure
– 1 in 3 patients have complication
– 1 in 5 patients require additional surge...

Radiation Therapy
• High energy X-rays to
cause tumor death
• Effects actively dividing
cells
• Given after surgery
– Micr...

Women’s Health and Cancer
Rights Act 1998
• Federal law
• Protection for breast cancer patients
• Insurance coverage
• Bre...

Standard vs. Custom

Skin & Nipple Selections

Custom delivery

Insurance Coverage
Pocketed bras
• Medicare: 12 per year (3 every 3 months)
• Commercial: no stated limit
Silicone prosthe...

Post Treatment
Follow Up

Surveillance
• Breast Imaging
– 3D mammogram +/- MRI (if dense)
– None after mastectomy
• Physical exam
– Every 3-6 months...

Live Life After Cancer
• Make your health a priority
• Stay active
• Resume enjoyable activities
• Don’t become consumed w...

Thank You
Regina Hampton, MD, FACS
• Chief of Breast Surgery, Luminis Health
• Co-Founder, Cherry Blossom Intimates
• Co-F...

Cherry Blossom Intimates
• Bra & Intimates Boutique
• CMS/BOC accredited mastectomy facility
• Bra sizes: AA through O
• P...

Thank You
Regina Hampton, MD, FACS
• Chief of Breast Surgery, Luminis Health
• Co-Founder, Cherry Blossom Intimates
• Co-F...

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