Breast Cancer Treatment

Much of the discussion and debate about breast cancer is currently over issues like screening guidelines, risk, and prophylactic bilateral mastectomies. This focus on risk reduction and early detection can lull us into a false sense of security, suggesting that if we just do this early stuff right we can prevent all breast cancer deaths. But women and men still die from breast cancer even after screening, bilateral mastectomies, “precision medicine,” and targeted therapy! Why? Because we don’t yet know enough about metastases.

Mary-Claire King was honored on Monday with the prestigious Lasker Award for Special Achievement in Medical Science “for bold, imaginative, and diverse contributions to medical science and human rights.”

One of the aspects of cancer treatment I have become intimately aware of since my own experience with leukemia, is the collateral damage of all of the treatments patients undergo. Second cancers, heart disease, neuropathy and leukemia are often mentioned the most, but there is another pressing issue that often gets less attention: infertility.

The U.S. Preventive Services Task Force has released its draft recommendations regarding the use of medications for breast cancer risk reduction. (Note that it is a draft and you can both read and comment on it here.)

When I started out as a breast surgeon in the early 1980’s, most women diagnosed with breast cancer were told they needed to have a modified radical mastectomy—removal of the breast and all of the lymph nodes in the armpit. Many others were still being treated with a radical mastectomy—removal of the breast and lymph nodes and the pectoral (chest) muscle. Why? Surgeons strongly believed that the more they removed the lower the chance of having the breast cancer come back.

Cancer patients have been telling their doctors about the foggy thinking and forgetfulness that are often referred to as “chemobrain” for years. Initially, many doctors didn’t take these complaints seriously. But as more attention began to be paid to cancer survivors’ quality of life, cognitive functioning began to be seen as a topic that needs study.

Tamoxifen has been used for so long to treat breast cancer that most of us assumed we knew everything that we needed to know about it—including how long women should take it. But yesterday at the San Antonio Breast Cancer Symposium we all learned something new when researchers presented results from the ATLAS trial (Adjuvant Tamoxifen: Longer Against Shorter).

Lots of medical meetings are held at this time of year, which means lots of media coverage of new breast cancer research. Whenever you hear about a new study, keep in mind that any results that are presented but not published have not passed the critical peer review process and are considered preliminary.