Name: Robert Bloom, M.D.
Speciality: Hematology, Oncology
Affiliations: Providence, Sinai-Grace
What recent advances have been made in your specialty?
We now separate women into groups of standard risk, high risk and very high risk. Women of standard risk should be screened with
mammography and physical examinations. Women of high risk, based on family history, should consider tamoxifen, an anti-estrogen whic
can decrease their risk in half. There is also a national trial to compare tamoxifen to an alterative drug, the STAR trial that they might wan
to participate in. For women with very high risk, because of specific identified genetic predispositions, we discuss surgical prophylaxis.
Is there any new research you can address?
We have recently been using new drugs, new hormones, and even new antibodies to fight recurrent breast cancer.
Your advice to women who have been recently diagnosed with breast cancer:
Though the incidence of breast cancer is still on the rise, thankfully the death rate is not. As recently as 1960, if a woman was told that she had a
breast cancer it was truly a "death sentence," with at least a 50 percent mortality, and an even higher risk of losing her breast. Now women with newly
diagnosed breast cancer have over an 85 percent chance of survival and the vast majorities are able to keep their breast. The improvements are due to
earlier detection, the use of radiation instead of surgery to control local disease, and the aggressive use of chemotherapy and hormones to attempt to
eliminate microscopic spread. In many ways, most women with breast cancer have exchanged the "death sentence" for an extremely difficult year of
treatment, with a light at the end of the tunnel.
Almost all women with breast cancer need the advice and skills of a surgeon, a radiation oncologist and a medical oncologist to together plan the most
effective and personalized therapy. This is best done after the diagnosis is established by needle aspirate or biopsy, but before definitive surgery. By
doing this, the woman gets three opinions, each from a unique perspective. We are fortunate that there is a lot of talent in the treatment of both early
and recurrent breast cancer in Southeastern Michigan. Most of our hospitals have cancer centers which treat breast cancer vigorously and effectively.
Women have the opportunity to participate in the exciting national trials being done on the edge of discovery in their own community. Women with
recurrent breast cancer are living longer and living better.
Name: Laura Freedman, M.D.
Specialty: Radiation Oncology
Affiliations : Weisberg Cancer Treatment Center, Farmington Hills; Gershenson Radiation Oncology
Center, Harper Hospital
What advances have been made in your specialty in the past year?
Minimizing radiation volume and duration via new efforts aimed at treating only the tumor bed in appropriate early stage cancers
A balloon can be implanted into the tumor bed by a surgeon and the radiation is then delivered into the balloon over one week
instead of 6-7 weeks. Though this is not yet the current standard of care, exciting progress is being made. Additional efforts are also
underway to better conform whole breast radiation using external beam techniques with 3-D planned treatments.
Are there any new treatment options that women should consider?
Recent studies have brought to our attention promising new hormonal therapy which may replace tamoxifen for some patients. Additionally, new
receptors are being identified which can allow us to better individualize medical treatment to the tumor properties.
Finally, with regards to radiation therapy, we are better defining the guidelines as to who needs radiation therapy. We hope to identify a subset of
women who may be adequately treated with surgery alone depending on the tumor type and extent of surgery. For example, women with non-invasive
breast cancer may be placed on a protocol that evaluates if radiation is necessary after breast-conserving surgery.
Your advice to women who have been recently diagnosed with breast cancer:
Meet with physicians who participate in multidisciplinary care teams and conferences. Ask questions and read provided material to improve your edu
cation of the disease and its treatment. Attend support groups or educational meetings.
Name:
Specialty:
Affiliation:
.
Marc Lippman, M.D.
Medical Oncologist, breast cancer practice
University of Michigan Hospital
What advances have been made in your specialty in the past year?
Nothing revolutionary, but a series of incremental changes have substantially changed the treatment. The impact of endocrine
hormone treatments are a major advance to prevent recurrence. ATAC trial is a new class of drugs. These aromatase inhibitors are
likely better than tamoxifen.
Are there any new options that women should consider?
Be aware of the ATAC studies. The fact is the latest improvements in survival are incremental, not revolutionary. However, the best way to define
survival is to ask what would have happened 30 years ago. Thirty years ago there was a 50-50 odds of dying. Today the odds are below 20 percent.
Mortality is dropping even though the incidence is not.
What do you advise women about mammography?
It works, no question about it. Most of the debate is quite misleading. Mammograms work, and they save lives. It is absolutely insane for women not
to get mammographies. ("You can quote me on it!")
Your advice to women who have been recently diagnosed with breast cancer:
Get a second opinion. Don't panic. Time is important, but days are not.
STYLE AT THE JN • OCTOBER 2002 •
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