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The New Treatment Paradigm for Early-Stage Breast Cancer

Web Exclusives — October 29, 2015
Dennis L. Citrin, MB ChB, PhD
Medical Oncologist, Cancer Treatment Centers of America, Zion, Illinois

Nearly 5,000 women are newly diagnosed with breast cancer every week in the United States. Despite this astounding number, early-stage breast cancer is a very treatable disease from which many patients can expect to be cured. There have been major advances in our understanding of the biology of breast cancer in the past 3 decades, and as a result, breast cancer treatment has become much more precise and effective.

Historically, surgery was always the first option for women with breast cancer. Once diagnosed, a patient was immediately referred to a surgeon who typically performed a mastectomy to remove the entire breast. However, more recently, mastectomy has been replaced by breast-conserving surgery. After surgical treatment, the patient was generally referred for appropriate drug treatment (chemotherapy and/or endocrine therapy) and often radiation.

This anatomically based approach of surgery, followed by whatever additional treatment modalities were indicated, has been largely replaced by a new paradigm, where the biology of the cancer is recognized to be of great importance.

The old treatment paradigm was based on the question—“What is the stage of the cancer?” By contrast, the new treatment paradigm asks the question—“What is the biologic type of cancer we are dealing with?” Based on genomic studies, we now recognize there are different molecular subtypes of cancer. Each subtype has a different prognosis and a unique responsiveness to specific medical treatments.

It is important to note that all relevant tumor-staging information can be obtained from imaging studies before surgery, and all relevant biologic information can be gathered (from a core needle biopsy) before any treatment is instituted.

It is, therefore, no longer appropriate to automatically send every newly diagnosed patient with breast cancer to a surgeon for primary surgical treatment. Instead, every patient should meet with a surgeon and a medical oncologist, and often a radiation oncologist before beginning any treatment, to gain a comprehensive understanding of her individual cancer and determine the appropriate course of treatment.

Surgery, drug treatment, and radiation therapy remain the major treatment modalities, but their sequencing depends on the specific details of the patient’s individual disease. We are now living in the era of personalized cancer care. It is no longer one size fits all. Each patient deserves a detailed evaluation and explanation, not only of their recommended treatment plan but also the reasons and rationale for that plan.

As an oncologist, I strongly encourage all women to understand their risks for breast cancer and familiarize themselves with their family medical history. It’s equally important for women to familiarize themselves with how their breasts feel, and report any changes promptly. I also recommend regular mammograms after age 40. Breast cancer can happen to anyone, regardless of age, ethnicity, or gender. Women of any age should seek medical attention if they feel a lump or another abnormality in their breast.

I want to emphasize the importance of early diagnosis. Despite all the publicity regarding breast cancer, it has been my experience that even today, many women still delay reporting a breast lump to their doctors. In a study I recently reported, 1 of every 10 women who felt a cancerous lump in her breast delayed seeking medical advice for a year. Typically, this delay was caused by fear. But because breast cancer is very curable at an early stage, it is important that you don’t delay!

Take control of your health, and don’t be afraid to get a second opinion if you wish. Just like the title of my book, Knowledge Is Power: What Every Woman Should Know About Breast Cancer, indicates, our greatest weapon against breast cancer is education. Empower yourself with the knowledge of the different types of cancer and the new paradigm of breast cancer treatment available today, offering patients a more targeted and precise approach.

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