Emerson Hospital

Patient 2
A young woman who had been successfully
treated for colorectal cancer with surgery,
radiation and chemotherapy was found
to have a small, grade 1 breast cancer.
Dr. Schoenthaler mentions there is a history
of cancer in the patient’s immediate family.
“Well then, the first thing we’ll need is genetic
testing,” says Dr. Sajer. “Once we have
those results, then we can move on to appropriate
surgical and radiation recommendations,
as well as potential hormone therapy.
The moral of the story is, as patients are
cured of one cancer, they are at risk for other
cancers and should receive standard cancer
screenings, including mammography.”
Patient 3
The group then discusses a patient who had
come to Emerson with stage IV breast cancer
that had metastasized to her lung. “She has
been on hormone therapy—an aromatase
inhibitor—for more than two years,” notes
Dr. Sajer. “I see her on a regular basis, but
last month my exam showed a new 8-millimeter
breast tumor. It appears her hormone
therapy is losing its effectiveness.”
“Is it time to operate?” Dr. Schoenthaler
asks.
“No, there is no evidence this patient will
benefit from mastectomy,” says Elizaveta
Ragulin-Coyne, MD, a general surgeon, noting
that the standard of care for stage IV
breast cancer is systemic therapy with hormonal
therapy or chemotherapy and possibly
radiation.
“Yes,” says Dr. Sajer. “I think the patient is
a good candidate for alternate hormone therapy
to help put the brakes on cancer cell
growth and division.” Dr. Vora suggests that
the patient may wish to consider participation
in a clinical trial evaluating new endocrine
therapies alone or with alternate
hormone therapy.
Patient 4
Dr. Rose then shows different imaging views
of a woman on whom he recently performed
a core biopsy. “You’ll see a small, 4-milli-
Continued on page 8
Conference reviews a range of images,
considers a range of treatments
There is much information to consider at
Emerson’s Breast Cancer Conference—not
just an individual patient’s situation and medical
history, but all the diagnostic information
in a variety of formats and numerous options
for treatment.
Imaging tests are presented to the group, including
mammograms, ultrasounds, chest CT
scans, breast MRIs and bone scans, as well as
PET/CT images. The pathology reports that
are presented may be based on tissue taken
during biopsies or surgery, with or without
lymph node sampling. Treatment may include
each or all of the following: surgery—lumpectomy,
mastectomy or re-excision—radiation
therapy, chemotherapy, hormone therapy and
targeted therapy, including in the context of a
clinical trial.
Shedding light on mammography
screening guidelines
The recent announcement that the American Cancer Society (ACS) changed its guidelines
for breast cancer screening sent many women and their physicians into another
confusing tailspin. The group says that most women should begin having annual mammograms
at age 45 instead of 40 and scale back to having the screening test every other
year beginning at age 55.
Many are asking, in the face of an overall increased survival rate for breast cancer of 90
percent—the result of early detection and improved treatment—why there should be a
change. “Here at Emerson, we have diagnosed so many women in their early 40s thanks
to mammography,” says David I. Rose, MD, chair of radiology. “We know that the greatest
number of lives will be saved by having women begin mammograms at age 40.”
Dr. Rose also questions the scale-back to having mammograms every other year beginning
at age 55. “A woman’s risk of developing breast cancer increases at around age 50,”
he notes. “For many women, the new recommendations will result in delayed diagnosis
and larger tumors.”
The ACS acknowledges that women who have a family history of breast cancer should be
handled on an individual basis, probably beginning mammograms earlier based on discussion
with their physician. “But the vast majority of women who are diagnosed don’t
have a family history,” says Dr. Rose. “Thinking that you’re low-risk doesn’t work.”
Continued on page 8
Today, treatment is based on a number of factors,
starting with the stage of the disease—its
size, whether lymph nodes are involved and
whether the primary cancer has metastasized
to another part of the body. The treatment
plan also considers whether or not the tumor
has hormone receptors—that is, sensitive to
either estrogen or progesterone—as well as
the HER2 status (indicating the presence of a
protein associated with a specific type of
breast cancer) and the patient’s genetic status.
For example, does the woman carry the BRCA1
or BRCA2 mutation that puts her at high risk
for developing breast cancer?
Finally, a woman’s age, medical history, overall
health and personal preferences are each considered
by the Breast Cancer Conference members
as they work together to develop the right
treatment plan for each patient.
american cancer society is questioned by those
who care for patients
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