October is Breast Cancer
Month so I would
like to use this opportunity
to discuss a question
that comes up frequently
in my practice. Patients with
small low-grade breast cancers
generally receive surgery
as the fi rst treatment followed
by radiation and anti-estrogen
pills, and their outcome is excellent.
Questions arise with larger
higher-grade cancers and cancers
that have already spread
to the lymph nodes, under the
arm on the same side as the
cancer. Many of these tumors
are called Triple Negative because
they do not have estrogen
and progesterone receptors
and are negative for Her
2 expression. Some of the tumors
are HER 2 positive and
require antibody treatment, in
addition to chemotherapy.
In these cases, the oncology
team generally recommends
getting systemic treatment
fi rst. This is chemotherapy,
and includes antibody treatment
in the case of Her 2
positive disease.
Often patients want to take
the cancer out, and fi nd the
idea of treatment fi rst to be
counterintuitive.
Giving the drugs to start is
called neoadjuvant therapy
and now represents the standard
of care. This regimen has
quite a few benefi ts.
First, if the tumor responds,
it may shrink and allow the
surgery to be downsized from
a mastectomy to a lumpectomy.
In addition, the tumor in
the lymph nodes may resolve,
thus avoiding removal of all
of the nodes (axillary dissection).
The axillary surgery
can result in a swollen
arm, numbness in the upper
inner arm, and painful limited
motion of the shoulder.
Giving the medication
fi rst may also be
important in clinical
trials. Serial
biopsies can
be taken of the
tumor to see precisely
what pathways
are affected.
This allows for tailoring
of treatment. It is important
to remember that the
most dangerous disease is
what is outside the breast in
the rest of the body. This being
said, sometimes the treatments
are so successful that
BRONX TIMES REPORTER, O 30 CTOBER 11-17, 2019 BTR
all of the tumor is gone.
This brings up the possibility
that in the future
patients who have a
complete pathological
response may not need
surgery at all.
We are living in a time
of information explosion
and rapidly changing
therapies. Compared
with 10 years ago, more
women are being cured
with less surgery. The future
for breast cancer cures
is bright.
Dr. Nella Shapiro