2014 Breast Cancer Symposium Highlights on Breast Cancer Surgery Research, Julie Margenthaler, MD

September 2, 2014
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In this podcast, we’ll discuss two studies highlighted at the 2014 Breast Cancer Symposium that relate to surgery for breast cancer treatment and prevention. 



ASCO: You’re listening to a podcast from Cancer.Net (Cancer dot Net). This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors that care for people with cancer.

In today’s podcast, we’ll discuss two studies highlighted at the 2014 Breast Cancer Symposium that relate to surgery for breast cancer treatment and prevention. One study presents research on possible complications after breast surgery and reconstruction. In the other study, researchers looked at factors that affect whether women consider having a surgery called a mastectomy to prevent breast cancer. This podcast will be led by Dr. Julie Margenthaler, who is the Director of Breast Surgical Services of the Joanne Knight Breast Center at Siteman Cancer Center and Associate Professor of Surgery and Director of the Breast Fellowship Program at Washington University School of Medicine in St. Louis, Missouri. Dr. Margenthaler is also the Chair of the Communications Committee for the American Society of Breast Surgeons and a member of the News Planning Team for the 2014 Breast Cancer Symposium. ASCO would like to thank Dr. Margenthaler for summarizing this research.

Dr. Margenthaler: Hi. My name is Julie Margenthaler and I’m a breast surgeon at the Siteman Cancer Center in Washington University School of Medicine in St. Louis Missouri. And today I’m going to talk about two studies dealing with surgical choices for women who are diagnosed with breast cancer.

The first study is looking at a very important issue of the decision to have the normal opposite breast removed when you’re diagnosed with breast cancer on one side. And this is an issue that has become much more talked about over the past few years. And as breast surgeons, we’re seeing more women select bilateral or both-side mastectomy, despite having cancer on only one side.

Now, this is an important issue because want to make sure that the women who are undergoing both-sided mastectomies are doing this appropriately, meaning that they are at higher risk for breast cancer and therefore it makes a lot of sense to have the other breast removed preventively. This has become very important in the era of genetic testing where we see that we’re able to identify mutations that account for breast cancer, such as the BRCA mutations, which are becoming much more well-known by many women.

But the important thing for women to know is that those mutations are actually quite rare in the population, meaning that only 5 to 10 percent of women who actually get breast cancer have an inherited form. So most women may be surprised to learn that the majority of breast cancer is what we call sporadic, meaning that there is no inherited reason for it and it’s simply a factor of being a woman and getting older.

Now, for those women who are of average risk who do not have a genetic mutation, it’s very important that we try to educate those women on what their actual risk for future breast cancer is because we don’t want her to select a treatment that may be overly aggressive or more than what is needed to adequately treat her cancer. This study addresses that issue and looks at what women actually reported as their reason for wanting to have bilateral mastectomy.

And it’s probably what most women who are diagnosed with breast cancer can imagine. They’re concerned about their future risk, they have fear over recurrence, and they have anxiety about the testing that may need to be done in the future. And that’s all very reasonable and we understand that. But I think it’s important for every physician to counsel women on what her actual risk is.

So as a patient, if you are diagnosed with breast cancer and you’re contemplating that decision of whether to have a lumpectomy or a one-sided mastectomy or both-side mastectomy, I think it’s very important to ask your physician what your future risk is for breast cancer on the other side because it may be much lower than you would expect, and you could be very adequately treated with just a lumpectomy or just a one-sided mastectomy.

The other study that I will also discuss is very similarly related to this in that it looks at what the complications are if you have a both-side or bilateral mastectomy, compared to one-sided mastectomy. This was looking at a database that’s available nationally that records surgical complications across many hospitals in the country.

And what the researchers found was that women who are having bilateral or both-sided mastectomy had a greater risk of losing an implant if they had implant reconstruction. They were also at much higher risk to have a blood transfusion or a longer hospital stay. And I think the importance of this study just points out that when making these decisions about bilateral or one-sided mastectomy, it’s important to know that there are risks associated with essentially doubling the surgery that you’re having.

So these two studies tie together very well because this is an issue that’s very important to women who are newly diagnosed. And again, I think it’s also very important that you ask your physician what the complications may be related to having a bilateral mastectomy versus a unilateral or one-sided mastectomy.

What we want to do is make sure that we’re treating patients appropriately for their cancer, but we also know that there are minimal surgical options that give exactly the same survival outcomes. And so choosing the course that’s most appropriate has to do with your own personal situation when you’re diagnosed with that cancer, what your personal risk is for future breast cancer, and then understanding some of the complications that are associated with going through a more aggressive or more extensive surgery.

ASCO: Thank you, Dr. Margenthaler. More information from the 2014 Breast Cancer Symposium can be found at www.cancer.net, including additional podcasts covering other highlighted research from this event.  Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.