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Breast Cancer Treatment In The Breast Cancer Treatment In The 21st Century21st Century21st Century21st Century
Strategies for maintaining health and well being for Strategies for maintaining health and well being for decades of survivaldecades of survivaldecades of survivaldecades of survival
NYSPA Symposium NYSPA Symposium y py pMay 9, 2011May 9, 2011
h C C h C Sh C C h C SAnthony C. Cahan, M.D., F.A.C.S.Anthony C. Cahan, M.D., F.A.C.S.Chief, Breast Surgery DivisionChief, Breast Surgery Division
Northern Westchester HospitalNorthern Westchester HospitalNorthern Westchester Hospital,Northern Westchester Hospital,Mt Kisco, NYMt Kisco, NY
Question:Question:Question:Question:What do these 4 patients have in common?What do these 4 patients have in common?
Answer:Answer:Answer:Answer:They have all had mastectomies.They have all had mastectomies.
1974 1984
1994 2004
The Quiet The Quiet RevolutionRevolutionThe Quiet The Quiet RevolutionRevolution
1974 200476% 5 Year Survival 90% 5 Year Survival
Trends In 5 Year Breast Cancer Trends In 5 Year Breast Cancer d 5 a a ad 5 a a aSurvival Rates In The U.S.Survival Rates In The U.S.
90%
95%
80%
85%
90%
5 YearSurvival
70%
75%
80%
65%
70%
1975-77 1984-86 1996-2002
Factors Affecting Breast Cancer SurvivalFactors Affecting Breast Cancer SurvivalFactors Affecting Breast Cancer Survival Factors Affecting Breast Cancer Survival Duration and QualityDuration and Quality
Early DiagnosisEarly DiagnosisMammographyMammographySonographySonographyMRIMRI
f ( )f ( )Breast Specific Gamma Imaging (BSGI)Breast Specific Gamma Imaging (BSGI)
Risk Assesment and IdentificationRisk Assesment and IdentificationBRCA G t tBRCA G t tBRCA Gene testBRCA Gene testTissue markers of RiskTissue markers of Risk
Atypical hyperplasia lobular neoplasiaAtypical hyperplasia lobular neoplasiaAtypical hyperplasia, lobular neoplasiaAtypical hyperplasia, lobular neoplasia
Factors Affecting To Breast Cancer Factors Affecting To Breast Cancer a o g o a aa o g o a aSurvival Duration and QualitySurvival Duration and Quality
Improved Pathology AssessmentImproved Pathology AssessmentBetter educationBetter educationBetter educationBetter educationTumor MarkersTumor Markers
Estrogen/Progesterone Receptors, Her 2 Neu Estrogen/Progesterone Receptors, Her 2 Neu st oge / ogeste o e ecepto s, e eust oge / ogeste o e ecepto s, e euOncogene ExpressionOncogene Expression
Genetic ProfilingGenetic ProfilingOncotype Dx, MammaprintOncotype Dx, Mammaprint
Factors Affecting Breast Cancer Factors Affecting Breast Cancer a o g a aa o g a aSurvival Duration and QualitySurvival Duration and Quality
Locoregional Therapy: Surgery and Locoregional Therapy: Surgery and IrradiationIrradiation
Customized to individualCustomized to individualMastectomy vs. LumpectomyMastectomy vs. LumpectomyR t tiR t tiReconstructionReconstructionIntraoperative Radiation Therapy (IORT)Intraoperative Radiation Therapy (IORT)
Less morbidityLess morbidityLess morbidityLess morbiditySentinel lymph node biopsySentinel lymph node biopsySkin/nipple preserving mastectomySkin/nipple preserving mastectomy
Factors Affecting Breast Cancer Factors Affecting Breast Cancer a o g a aa o g a aSurvival Duration and QualitySurvival Duration and Quality
Systemic therapy: Systemic therapy: Treating the cells that Treating the cells that might have escaped.might have escaped.g pg p
ChemotherapyChemotherapypypyTaxol, Adriamycin, Cytoxan, HerceptinTaxol, Adriamycin, Cytoxan, Herceptin
HormonalHormonalTamoxifen, anastrozole, letrozole, exemestaneTamoxifen, anastrozole, letrozole, exemestane
Factors Affecting Breast Cancer Factors Affecting Breast Cancer a o g a aa o g a aSurvival Duration and QualitySurvival Duration and Quality
Post Treatment Management:Post Treatment Management:MedicalMedicalMedicalMedical
Weight, BP, cholesterol, blood sugar, bone density, Weight, BP, cholesterol, blood sugar, bone density, bone /muscle pain, neuropathybone /muscle pain, neuropathy
PsychosocialPsychosocialExercise, menopause, depression, cognitive Exercise, menopause, depression, cognitive changes, sex, divorce, deathchanges, sex, divorce, death
The Breast Cancer Treatment TeamThe Breast Cancer Treatment Team19741974
SurgeonSurgeonPathologistPathologistPathologistPathologistMedical Oncologist (maybe)Medical Oncologist (maybe)R di ti O l i t ( b )R di ti O l i t ( b )Radiation Oncologist (maybe)Radiation Oncologist (maybe)
The Breast Cancer Treatment TeamThe Breast Cancer Treatment TeamThe Breast Cancer Treatment TeamThe Breast Cancer Treatment Team20112011
Aesthetic OncologistsAesthetic OncologistsOncologic SurgeonsOncologic SurgeonsPlastic and Reconstructive SurgeonsPlastic and Reconstructive SurgeonsPlastic and Reconstructive SurgeonsPlastic and Reconstructive Surgeons
RadiologistsRadiologistsDiagnosticDiagnosticDiagnosticDiagnosticInterventionalInterventional
PathologistsPathologistsMedical OncologistsMedical OncologistsRadiation OncologistsRadiation OncologistsCancer GeneticistCancer Geneticist
The Breast Cancer Treatment TeamThe Breast Cancer Treatment Teama a a aa a a a20112011 (continued)(continued)
Primary Care PhysicianPrimary Care PhysicianEndocrinologistEndocrinologistGynecologistGynecologistComplementary Care SpecialistComplementary Care SpecialistAnesthesiologistsAnesthesiologistsNursingNursing
ORORORORFloorFloor
Physical TherapistsPhysical TherapistsPhysical TherapistsPhysical Therapists
Breast Cancer Treatment InBreast Cancer Treatment InTh 21 t C tTh 21 t C tThe 21st CenturyThe 21st Century
The Quiet The Quiet RevolutionRevolution::The Quiet The Quiet RevolutionRevolution::
Dramatic changes in the surgical Dramatic changes in the surgical management of breast cancermanagement of breast cancer
“Doing less is more”“Doing less is more”
Lymphatic Mapping and Sentinel Node BiopsyLymphatic Mapping and Sentinel Node Biopsy
The “sentinel” node is the firstnode to receive lymphaticdrainage from a primary tumordrainage from a primary tumor.Thus, it is the first node to whicha tumor will metastasize.
If the sentinel node is negativefor metastatic disease, theremaining nodes in thelymphatic basin are also likely tobe negative.g
Sentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsyRadioactive Tracer InjectionRadioactive Tracer Injection
Sentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsyPrePre--Op LymphoscintigramOp Lymphoscintigram
Sentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node BiopsySentinel Lymph Node RemovedSentinel Lymph Node Removed
Sentinel L mph Node BiopsSentinel L mph Node BiopsSentinel Lymph Node BiopsySentinel Lymph Node Biopsy
Incidence of LymphedemaIncidence of LymphedemaAxillary Dissection: 20%Axillary Dissection: 20%Axillary Dissection: 20%Axillary Dissection: 20%Sentinel Lymph Node Biopsy: <2%Sentinel Lymph Node Biopsy: <2%
Nerve injury significantly reducedNerve injury significantly reducedNerve injury significantly reducedNerve injury significantly reducedSame or more clinical information Same or more clinical information obtainedobtainedobtainedobtained
Breast Cancer Treatment InBreast Cancer Treatment InTh 21 t C tTh 21 t C tThe 21st CenturyThe 21st Century
Aesthetic OncologyAesthetic Oncology
The preservation or enhancement of body The preservation or enhancement of body form following cancer surgeryform following cancer surgeryform following cancer surgeryform following cancer surgery
Breast Cancer Treatment InBreast Cancer Treatment InTh 21 t C tTh 21 t C tThe 21st CenturyThe 21st Century
Aesthetic Oncological Procedures For Aesthetic Oncological Procedures For Breast CancerBreast Cancer
Minimal scar lumpectomyMinimal scar lumpectomyLumpectomy with oncoplastic reconstructionLumpectomy with oncoplastic reconstructionLumpectomy with oncoplastic reconstructionLumpectomy with oncoplastic reconstructionSkin sparing mastectomy with Immediate Skin sparing mastectomy with Immediate ReconstructionReconstructioneco st uct oeco st uct oNipple Sparing Mastectomy with Immediate Nipple Sparing Mastectomy with Immediate ReconstructionReconstruction
Breast Cancer Treatment InBreast Cancer Treatment Ina a aa a aThe 21st CenturyThe 21st Century
Minimal scar lumpectomyMinimal scar lumpectomy
Breast Cancer Treatment InBreast Cancer Treatment Ina a aa a aThe 21st CenturyThe 21st Century
Lumpectomy with oncoplastic Lumpectomy with oncoplastic reconstructionreconstruction
Breast Cancer Treatment InBreast Cancer Treatment InTh 21 t C tTh 21 t C tThe 21st CenturyThe 21st Century
Skin Sparing MastectomySkin Sparing MastectomyIncision is within areolar diameterIncision is within areolar diameterIncision is within areolar diameterIncision is within areolar diameter
Skin NOT involved or close to cancerSkin NOT involved or close to cancerS O o ed o c ose to ca ceS O o ed o c ose to ca cePatient is not candidate for lumpectomy or desires Patient is not candidate for lumpectomy or desires mastectomymastectomy
Breast Cancer Treatment InBreast Cancer Treatment Ina a aa a aThe 21st CenturyThe 21st Century
Nipple Sparing Mastectomy with Nipple Sparing Mastectomy with Immediate ReconstructionImmediate Reconstruction
Performed in prophylactic settingPerformed in prophylactic settingBRCA mutationBRCA mutationHigh risk breast secondary to atypiaHigh risk breast secondary to atypiaPatient desirePatient desire
Controversial in patients with breast cancerControversial in patients with breast cancer
Breast Cancer Treatment InBreast Cancer Treatment Ina a aa a aThe 21st CenturyThe 21st Century
After treatment for breast cancer, what After treatment for breast cancer, what next?next?
Remember the whole personRemember the whole personExerciseExerciseWeight managementWeight managementVitamins/SupplementsVitamins/Supplements
Calcium and Vitamin DCalcium and Vitamin D
Hormones?Hormones?
Breast Cancer Treatment InBreast Cancer Treatment Ina a aa a aThe 21st CenturyThe 21st Century
Conclusion:Conclusion:Increasingly, women diagnosed with breast cancer will live Increasingly, women diagnosed with breast cancer will live
long lives following their diagnosislong lives following their diagnosislong lives following their diagnosis.long lives following their diagnosis.Preserving a sense of well being and body image following Preserving a sense of well being and body image following
treatment is more important than ever.treatment is more important than ever.To achieve this, careful consideration of the individual’s To achieve this, careful consideration of the individual’s
needs, selective use of chemo/hormonal therapy and needs, selective use of chemo/hormonal therapy and adherence to aesthetic oncologic techniques are adherence to aesthetic oncologic techniques are essential.essential.
Overall health should never be forgotten. Overall health should never be forgotten.