Wednesday, December 19, 2007

San Antonio Breast Cancer Symposium

Medpage is a good site to check out. This month it gives a good review of several of the articles presented at the San Antonio Breast Cancer Symnposium. Over twenty articles are available for review and free CME credit is given after you read each one (just answer two or three questions based on what you read). A couple of highlights:
1. As breast conservation therapy has increased, the use of breast irradiation has not risen accordingly; troubling in that lack of radiation after lumpectomy doubles your risk of recurrence.

2. An interesting study detailing the arbitrary five year cutoff for Tamoxifen; ten years may be beneficial. Of course, with the enthusiasm now for aromatase inhibitors, the argument may become obsolete.

3. Speaking of aromatase inhibitors, there's an article that describes an extended benefit past completion of treatment with Arimidex.

4. A good meta-analysis on the negligible benefits of high dose chemotherapy for advanced breast cancer.

5. Another study that questions the use of antracyclines (long a primary agent) as adjuvant therapy for all women with breast cancer.


Sid Schwab said...

Another very significant development, about which I wrote a post for my blog but didn't publish it, is the report out of UCSF (my old stomping ground) regarding molecular markers of DCIS that have high correlation with those that go on to become invasive, and those that don't. Here's a link I would have used. If it holds up, it could be enormously useful in managing that entity.

Jeffrey Parks MD FACS said...

Thanks Sid. Even in multifocal disease, I always feel awful recommending mastectomy for DCIS. Would be nice to know when it is appropriate to "overtreat" pre-ivasive breast cancer.

Anonymous said...

This might be off topic, but at San Antonio there was a report that the use of prophylactic mastectomy involving the healthy breast was on the rise. The authors of the study argued that doctors need to spend more time discussing risks with patients, obstensibly to talk them out of this aggressive decision.

Comment from a young breast cancer patient: I was horrified that I had to have a mastectomy for my multi focal disease. Now, two years later, I feel that not having a bilateral mastectomy was a horrible mistake. I would have had better symmetry plus peace of mind.

Doctors shouldn't assume that every woman is happier with breast conserving surgery.

I agree with your anticipation of better tailoring surgeries to the disease. The current methods of risk assessment leave much to be desired.