August - December 2005 Issue
Breast Cancer: Advancements in Care
Alonzo Walker, MDMedical College of Wisconsin Surgical Oncologist
Director, Breast Cancer Program
Chief, General Surgery
Named one of the "Best Doctors in America®" 2004 by Best Doctors, Inc.
Since 1995, mortality from breast cancer has declined 3.2 percent per year due to improvements in diagnosis and treatment. And researchers continue to discover new methods for attacking this disease that will affect one in eight American women. Alonzo Walker, MD, discusses the most recent advancements and the significance of coordinated care in treating breast cancer.
Q. Is there a particular area of medicine that is finding new treatment options for breast cancer? Breast cancer care involves many areas of medicine, and each has seen advancements. Most are still being studied in clinical trials but show great promise. From a chemotherapy point of view, two classes of drugs — Herceptin and aromatase inhibitors — are being examined as supplements to chemotherapy. The field of radiation is now studying a more "patient friendly" form of therapy. In the surgical arena, more targeted approaches to destroying or ablating tumors are on the horizon. And in the area of prevention, the five-year STAR drug trial recently closed and results are being evaluated.
Q. Tell us about the use of Herceptin and aromatase inhibitors in the treatment of breast cancer. Herceptin belongs to a group of drugs designed to attack specific cancer cells and is approved by the U.S. Food and Drug Administration for the treatment of metastatic breast cancer. However, two large multicenter clinical trials are now reporting very positive results on the use of Herceptin as adjuvant therapy to treat early stage breast cancer with lymph node involvement. A test can tell us if a women is more receptive to the drug, and the results so far in terms of outcome have been very positive for those patients.
Aromatase inhibitors are a new class of anti-estrogen drugs that are used to treat hormone receptor positive breast cancers. These drugs have been compared to Tamoxifen, the gold standard of treatment for these types of cancer. Aromatase inhibitors and Tamoxifen both target estrogen.
But while Tamoxifen blocks the receptor for estrogen, aromatase inhibitors actually block estrogen. Aromatase inhibitors have been found to significantly decrease the rate of recurrence of breast cancer, especially in post-menopausal women.
Q. What is this more "patient friendly" form of radiation therapy?In women who have had a lumpectomy to remove a cancerous tumor, radiation is often prescribed as a follow-up to prevent recurrence. Although whole breast irradiation has a successful track record, research is now indicating that it may be possible to achieve similar results by limiting radiation to the region directly surrounding the tumor where recurrence is most likely. This limited radiation is called accelerated partial breast irradiation. Because it is targeted and intense, it is given for a shorter period of time — twice a day for five days as opposed to the six or seven weeks required for the more conventional form of radiation.
Accelerated partial breast irradiation is much more convenient for many patients. For example, women living in rural areas who do not have access to radiation services have to spend weeks away from home to get treatment. Or, because they don't have easy access to radiation services, they may be forced to choose mastectomy over lumpectomy. Accelerated partial breast irradiation also limits the exposure of healthy tissue to radiation. So it could be very beneficial to women, but it is only being used on carefully selected patients who meet strict guidelines. Currently, Froedtert & Medical College of Wisconsin is a lead institution participating in a large national trial comparing this treatment to the standard radiation therapy.
Q. You mentioned more targeted surgical approaches to treating breast cancer. What are they?Called ablation, these are minimally invasive techniques that either remove or destroy small breast cancers. Radiofrequency ablation destroys tumors with heat, while cryotherapy destroys tumors through freezing. These techniques are currently being used to ablate tumors in other parts of the body, such as the liver and prostate gland. A very early stage of research is now evaluating these techniques to see if they can be applied to breast cancers.
Q. What is the STAR drug trial?The Study of Tamoxifen and Raloxifene, or STAR, is one of the largest breast cancer prevention studies ever. This study involving thousands of women was designed to determine if the drug raloxifene is as effective as tamoxifen in reducing the incidence of breast cancer in women who are at an increased risk for developing the disease, but with fewer side effects. The study is now closed and the results are expected in 2006.
Q. Froedtert & Medical College of Wisconsin follows a coordinated care approach to treating breast cancer. What is this approach and why is it significant?From patients’ points of view, coordinated care is extremely important. Patients know exactly what their plan of care is, right from the outset, and they know that the physicians taking care of them are on the same page and have the same objectives. Our program’s multidisciplinary team of experts includes breast surgeons, radiologists, medical oncologists, radiation oncologists and pathologists. We meet weekly to discuss each patient’s care and formulate the best treatment plan, providing women access to the expertise of many specialists.
Additional support is provided by advanced practice nurses, board-certified genetics counselors, registered dietitians and social workers to help women cope with breast cancer. And a nurse navigator works with each patient to guide her through every step of treatment. Coordinated care not only provides better care but also provides this care in a timely manner, all within one facility.
Author: Alonzo Walker, MD
Source: Every Day
Date: August - December 2005