This post is written by ASK Cancer Commons Scientist and Product Team Member Amanda Nottke, PhD. Dr. Nottke regularly provides guidance to patients through our ASK Cancer Commons service.
After a diagnosis of early stage, hormone-positive breast cancer, you may find yourself facing several daunting decisions, such as choosing between the extensive surgery of mastectomy versus a more minor lumpectomy procedure paired with radiation (with all its challenging side effects). And once surgery is complete, what next? Hormone therapy is clearly indicated for many women, but which drug, and how long to take it? And what about chemo—how to know if the tough side effects are worth the possible reduction in risk of recurrence?
Fortunately, there are a wealth of quality datasets available to inform these decisions. Below are some of the questions we get most frequently from patients using our ASK Cancer Commons service, answered according to the latest thinking from scientific literature and our expert physician network. If you are facing your own cancer treatment decisions and would like free one-one-one expert support, please submit your case here.
1. If my doctor has said either mastectomy or lumpectomy plus radiation are appropriate for me, how do I choose?
Many studies have looked at this, and overall the outcomes for mastectomy versus lumpectomy plus radiation are extremely similar (both are effective treatments, so you can instead weigh the side effects of radiation versus the more intensive surgery of the mastectomy). This webpage provides a helpful summary of the pros and cons of mastectomy compared to lumpectomy.Continue reading…
“Wilmot Cancer Institute patients with advanced melanoma (stage III) now have more options for treatment, thanks to research co-authored by a University of Rochester Medical Center surgical oncologist and published in The Lancet Oncology.
“The study involved comparing two treatment approaches for high-risk melanoma patients with a BRAF gene mutation in their cancer: standard care, which calls for upfront surgery, or giving a two-drug, targeted therapy regimen before surgery and again afterward. Patients in the latter group had longer disease-free survival in the Phase 2 trial, and after seven months researchers halted the study earlier than expected due to the positive results.”
“Traditional neoadjuvant chemotherapy along with dual HER2-targeted blockade yielded significantly better response rates than a novel approach using HER2-targeted chemotherapy plus HER2-targeted blockade, according to a randomized phase III trial.
” ‘Despite the improvements in outcomes associated with HER2-directed therapy, approximately a quarter of patients who receive treatment for their early breast cancer remain at risk of relapse after 8–10 years, and around 15% will die within a decade,’ wrote study authors led by Sara A. Hurvitz, MD, of the David Geffen School of Medicine at the University of California, Los Angeles. A need for new strategies in this setting led the investigators to test a neoadjuvant regimen of the antibody–drug conjugate trastuzumab emtansine along with pertuzumab in comparison with traditional systemic chemotherapy along with trastuzumab plus pertuzumab.”
“For prostate cancer patients who have rising levels of PSA (a cancer indicator) even after radical prostatectomy, early treatment makes a difference. In a study featured in the December issue of The Journal of Nuclear Medicine, Australian researchers demonstrate that PET scans can identify which of these prostate cancer patients would benefit from salvage radiation treatment (SRT).
” ‘The research is novel because it looks at the impact of PSMA PET/CT on patient responses to treatment, not just on whether the PET scan results in changed management,’ explains Louise Emmett, MD, of the St. Vincent’s Hospital, Sydney, Australia. She elaborates, ‘In the study, these patients underwent imaging with a PSMA PET scan and had treatment based on the results of the scan findings. The study then followed how these men were treated, and whether the treatment was effective.’ ”
Johns Hopkins Bloomberg School of Public Health | Nov 1, 2017
“Nearly one-third of women with breast cancer went against their doctor’s advice and chose not to begin or complete the recommended adjuvant anti-cancer therapy to kill residual tumor cells following surgery, according to a study led by a Johns Hopkins Bloomberg School of Public Health researcher.
“A survey that included 2,754 breast cancer patients in Florida and Pennsylvania during a two-year period found that this ‘treatment discordance’ – not following a doctor’s recommended treatment plan in its entirety – was more likely among patients who reported a general distrust of medical institutions and insurers. The patients’ trust or distrust of their own doctors did not seem to be a factor.”
“Several patients with recurring glioblastoma, a deadly brain cancer, survived for more than a year in a clinical trial believed to be the first to use comprehensive DNA and RNA sequencing of a patient’s tumor to inform treatment for these patients in real-time. The study was led by the Translational Genomics Research Institute (TGen), UC San Francisco (UCSF) and the Ivy Foundation Early Phase Clinical Trials Consortium.”
“Ten-year overall survival for primary breast cancer patients treated with sentinel lymph node dissection (SLND) alone is similar to that seen in those treated with axillary lymph node dissection (ALND), according to a study published in the Sept. 12 issue of the Journal of the American Medical Association.
“Armando E. Giuliano, M.D., from the Cedars-Sinai Medical Center in Los Angeles, and colleagues compared the 10-year overall survival of patients with sentinel lymph node metastases treated with breast-conserving therapy and SLND alone without ALND (446 patients) versus women treated with ALND (445 patients). The women, with clinical T1 or T2 invasive breast cancer, all had planned lumpectomy, tangential whole-breast irradiation, and adjuvant systemic therapy.”
“A new study finds that more than half of women with early stage breast cancer considered an aggressive type of surgery to remove both breasts. The way women generally approach big decisions, combined with their values, impacts what breast cancer treatment they consider, the study also found.
“Contralateral prophylactic mastectomy – a procedure to remove both breasts when cancer occurs in only one breast – has become increasingly popular in recent years, with more than 20 percent of patients opting for it. For most women, removing the unaffected breast does not improve survival.”