All posts by bcsurgery

Researchers Find Dozens of New Genetic Cancer Culprits, Bringing Major Implications for Preventive Surgery, Screening and Treatment

Major cancer news today in this important study identifying hundreds of genetic mutations that cause cancer, but at different rates of risk.
In the decade ahead, cancer researchers will continue to shed light on hundreds of genetic mutations _ gene variants as they are called _ that cause cancer at different rates of risk. This has major implications for people considering preventive surgeries for BRCA mutations, as well as others in families with too much cancer. If your family has breast, prostate, colon, pancreatic, colon or other cancer clusters, these findings have important implications for you.
Bottom line: If you are diagnosed, get a genetic analysis and talk with a medical oncology doctor, particularly for those in families with lots of cancer. This information should help tell you how much at risk you are; whether you need preventive surgeries; how often and earlier you should be tested to find cancer; what treatments are best for you; and what treatments you don’t need. This is one of the most important developments in cancer today. More to come.
https://medicalxpress.com/news/2020-01-genetic-comprehensive-date-breast-cancer.html

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Podcast With Author on Breast Surgery, Reconstruction Choices

Here is a podcast with Anne Doyle, creator of the Powering Up podcast series, with medical writer Patricia Anstett, author of “Breast Cancer Surgery and Reconstruction: What’s Right for You.” It addresses a range of issues, including staying flat or one-breasted; going without nipples; problems creating realistic nipples; stereotypes women face in medicine and mentoring.
https://www.podbean.com/site/EpisodeDownload/PBCB983EBH4VG

What Women Need to Know About Breast Implants: FDA Backgrounder

Proposed regulations from the federal Food and Drug Administration address problems with breast implants and call for more frequent screening, beginning at 5-6 years after surgery and every 2 years after that, for women with the devices.

Here’s a good backgrounder from the FDA on the issues:
https://www.fda.gov/consumers/consumer-updates/what-know-about-breast-implants

#breastreconstruction #mammography #breastimaging #breastimplants

FDA Calls for Warning Labels for Breast Implants

Following testimony by women last spring about problems caused by breast implants, the FDA will require new warning labels on the devices, and defines risks and problems with them. The public has 60 days to comment on the new regulations. Here’s how to comment and the FDA notice issued today:

The draft guidance, Breast Implants – Certain Labeling Recommendations to Improve Patient Communication, provides recommendations for the form and content for certain labeling information for saline and silicone gel-filled breast implants, including:

  • Boxed warning
  • Patient decision checklist
  • Materials/device descriptions, including types and quantities of chemicals and heavy metals found in or released by breast implants
  • Silicone gel-filled breast implant rupture screening recommendations
  • Patient device card

When final, the recommendations in this guidance will supplement or, in some cases, replace recommendations in the FDA’s Saline, Silicone Gel, and Alternative Breast Implants guidance, issued November 17, 2006.

This draft guidance will be open for public comments for 60 days, through December 23, 2019, at www.regulations.gov under docket number FDA-2019-D-4467.

Submit Comments

https://www.cnn.com/2019/10/23/health/breast-implants-fda-boxed-warning-bn/index.html

Free Mammograms, Pap and Nurse Navigation Help

Though it’s nearly 30-years-old, far too many women do not know about a federally-funded program that pays for mammograms, Pap smears and nurse navigation help for uninsured and under-insured women. Help spread the word and post a flyer somewhere _ on electronic bulletin boards, web sites, and other places women will see it at work, school and in their communities. http://www.bcccp.org

New Developments in Breast Cancer Screening and Treatment

Multidisciplinary Breast Cancer Symposium, 9/14/19; Henry Ford Health System, Detroit

A summary of some key points, by Patricia Anstett, medical writer

Mammography

  1. Women should request a 3-D mammogram, also called digital breast tomosynthesis or DBT, because it’s better than standard film-screen mammogram, particularly for women with so-called dense, or less fatty breasts. A traditional mammogram usually takes two X-ray images of the breast: one image from the top to bottom and another from side to side. DBT mammography takes multiple X-ray images of the breast from multiple angles that help a radiologist see tiny details.
  2. Most women can handle the information doctors provide about a woman’s risk and treatment choices for breast cancer. Doctors need to improve how they deliver these messages and choices.

Dr. Jennifer Plichta, Duke Health

Genetic Screening

  • 90% of women with BRCA mutations are not tested for genetic risks, and 95% of people with mutations for Lynch Syndrome, a type of colon cancer, aren’t tested. That means too many people lose the chance to prevent cancer or find it early.
  • Medical centers are moving towards offering earlier genetic screening before a cancer diagnosis, then offering counseling about a woman’s risks and choices afterwards. There are many reasons for the change, including a shortage of genetic counselors. Top genetic experts say that identifying women as carriers of genetic mutations after they have been diagnosed with breast cancer is a failure of cancer prevention.
  • 2.1 million U.S. women have been tested for genetic cancer risks; 13 million need testing, and another 1 million to 1.8 million need retesting because they were tested with what is not outdated techniques.
  • Costs of genetic testing has plummeted and is cheap, compared to a decade ago.
  • A few medical centers have begun studies to conduct genetic testing of children at birth for a range of diseases, including cancer.
  • Breast cancer is caused by a number of gene mutations, not just BRCA1 and BRCA2. Each gene brings different cancer risks. Information about the variance in these risks is at www.ask2me.org
  • What’s coming: testing for as any as 20,000 genes, for more than cancer.

Dr. Kevin Hughes, Massachusetts General Hospital

Ductal Carcinoma in Situ

  1. An estimated 60,000 American women are diagnosed each year with DCIS, an early tumor that increasingly is under debate as to whether it should be described as cancer or a possible precursor. Its diagnosis has increased with mammography improvements.
  2. Treatment decisions for women with DCIS are among the most difficult doctors discuss with patients because it’s still unclear which tumors may be aggressive, requiring surgery and other treatments, and which ones can be monitored without surgery or treated with breast-conserving options. The question is, which ones will progress and when? Studies vary from 14% to 53% in assessing which DCIS cases won’t progress.
  3. Most U.S. women with DCIS now get surgery and radiation; some with estrogen-positive tumors also have chemotherapy to reduce the risk of recurrence.
  4. Nearly all women diagnosed with DCIS don’t die of breast cancer. 
  5. Over-treating DCIS may cause physical and mental disaffects and may affect a woman’s sexual well-being. Those issues have raised discussion about whether some women can be followed with active surveillance, including mammograms and MRIs.
  6. Factors that affect treatment decisions for DCIS include the size of the tumor; surgical margins; pathology reports and a patient’s age.
  7. New computer tools are improving a doctor’s ability to assess and score a DCIS tumor for its likelihood to progress. However, these tools “aren’t yet perfect” to determine who needs surgery or radiation. Ongoing studies hope to provide better insights.

Dr. Emilia Diego, University of Pittsburgh Medical Center

Pre-Surgery Drug Options

  1. Chemotherapy and endocrine therapy may be offered women with more aggressive risks to down-size a tumor, allowing a woman to have breast-sparing surgery, and possibly lower the chance her tumor will progress. The largest study to date shows no survival advantage of these options though they did allow seven percent of women to have a lumpectomy instead of a mastectomy.
  2. So-called adjuvant therapy with the drug tamoxifen or an aromatase inhibitor, a class of medicines that help reduce estrogen levels in the body, has proven as effective as chemotherapy’s response rates, while improving surgery options with fewer side effects.
  3. Studies undergo should help doctors sort out whether a woman can use less toxic hormonal options with similar benefits to chemotherapy.

Dr. Haythem Ali, Henry Ford Cancer Institute

Axillary Dissection Decisions

  • Medical centers are working to study which breast cancer patients need more than a biopsy of a single sentinel node to find whether cancer has spread. Studies show 50-70% of women have no other tumors outside the breast other than a single node.
  • Removal of more than one lymph node can cause serious medical problems afterwards, including lymphedema, a swollen chest and arm problem; tingling, burning of numbness in the skin; and shoulder problems.
  • New computer models are helping doctors assess whether a woman needs more than a sentinel node biopsy if she has had chemotherapy or endocrine therapy prior to surgery, to help reduce surgery complications in some women.

Theresa Schwartz, St. Louis University Hospital

Gene Profiling

  • There’s a new era in medicine to de-escalate or downsize breast cancer treatment because options may cause serious health and financial issues for patients and add significant health care costs.
  • Cancer teams are using new computer tools to calculate which tumors are most likely to cause a late recurrence of breast cancer, which can reoccur as many as two decades later after an initial diagnosis.

Tatiana Prowell, Johns Hopkins Medicine

Surgery for Lymphedema Prevention

  • 3-5 million breast cancer patients in the U.S. have lymphedema, an often-debilitating swollen arm and chest condition following breast cancer surgery, particularly after surgery to remove more than one lymph node. Risk factors include age over 25; obesity; post-operative radiation; and wound and drainage issues from surgery.
  • Some medical teams now offer surgery that connects lymphatic vessels in the chest and arm to veins in the arm, a type of bypass process performed by some microvascular plastic surgeons. The technique is challenging to perform; remains under study; and may not be a good choice for all patients with lymphedema with various medical issues.

Dr. Dunya Atisha, Henry Ford Cancer Institute

Radiation for Advanced Breast Cancer

  • Radiation for breast cancer patients with 1-3 positive lymph nodes is under study and increasingly will benefit from computer models sorting out which women will benefit most.

Dr. Eleanor Walker, Henry Ford Cancer Institute

Fertility issues

  • Of the 1 in 8 women to be diagnosed in her lifetime in the U.S. with breast cancer, 3% are between 25 and 35, prime child-bearing ages. Half want to have children after a breast cancer diagnosis but only 1 in 10 do.
  • Chemotherapy may cause temporary or permanent loss of ovarian function, affecting a woman’s ability to have a baby. A woman’s age and type of chemotherapy are factors in her ability to have a baby. Women should discuss with reproductive endocrinologists which drugs affect their risk of having a baby later.
  • Most women resume menstrual periods within six months of chemotherapy. If a woman hasn’t started having periods 12 months after chemotherapy, it’s unlikely she will, affecting her chance to have a child.
  • Top medical centers now offer breast cancer patients several options to preserve eggs prior to chemotherapy or surgery, but choices vary greatly in cost and insurance coverage.
  • Women can assess their chance of getting pregnant or having a child, as well as find help with other questions, through the Society of Assisted Reproductive Technology, www.sart.org.
  • Some medical centers are willing to perform assisted reproductive techniques within six months of a woman’s surgery or chemotherapy, not the 24 months that remain standard in most places.
  • Some studies suggest some breast cancer patients can delay chemotherapy for two years so they can have a baby.

Dr. Monique Swain, Henry Ford Cancer Institute

Textured Breasts Implants Withdrawn World-Wide

At the request of the federal government, the manufacturer of textured breasts implants has withdrawn the product world-wide over cancer concerns. The federal Food and Drug Administration, which requested the action, said women with the implants who do not have problems do not need to remove them.
https://www.nytimes.com/2019/07/24/health/breast-implants-cancer-recall.html?action=click&module=Top%20Stories&pgtype=Homepage