The Overall Goal Is Your Personalized Care
The importance for breast cancer patients to consult with a multidisciplinary team prior to initiating treatment cant be overstated it can be a lot to take in, but youre not alone and theyre there to help, Dr. Moore says.
The goal is to individually tailor your therapy in order to avoid both undertreatment and over treatment of the cancer, she emphasizes. Rest assured your medical team will always walk you through what the best options are for you personally, .
Where To Find Breast Cancer Treatment Near Me
Breast cancer patients should consult with their doctors and specialists to determine the best options for treatment. Neoadjuvant therapy may work best for some patients but others may require more traditional chemotherapy after their mastectomy. No matter what type of breast cancer they have, all patients need a customized therapy to avoid undertreatment or overtreatment. Your doctor or specialist can put together the right therapy and treatment options to provide you the best possible outcome.
For lab work and consultation about breast cancer and surgery options, get in touch with the BASS Medical Group experts. We offer laboratory exams that can determine your cancer diagnosis and provide other types of medical assistance as needed. Contact us today for more details.
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Breast Cancer Patients Who Respond To Chemo May Not Need Surgery
Select breast cancer patients who after undergoing chemotherapy as their first line of treatment show no residual cancer a state known as pathologic complete response may be able to avoid follow-up breast and lymph node surgery, according to an MD Anderson study. The study identifies patients known as exceptional responders who are at lowest risk for local metastases and therefore are candidates for less invasive treatments.
Henry Kuerer, M.D., Ph.D., professor of Breast Surgical Oncology, is principal investigator of the study that enrolled 527 women diagnosed with triple negative and HER-2 positive breast cancers. All the participants received neoadjuvant chemotherapy, in which chemo was their initial treatment, followed by standard breast and lymph node surgery. Clinical staging was determined prior to chemo by core biopsy or fine-needle aspiration, followed by clinical exam, mammography, and ultrasound of the breast and lymph nodes.
Kuerer set out to identify which patients in the group could have safely avoided surgery. To do so, he first needed to identify those who achieved a pCR following neoadjuvant chemo.
Kuerer had recently completed a trial investigating the utility of image-guided biopsies to predict breast pCR. The preliminary results of that study revealed the technique to have 100 percent accuracy and 100 percent predictive value for determining residual disease following neoadjuvant chemo.
Read more about this study in MD Andersons newsroom.
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What Happens After Chemotherapy For Breast Cancer
Immediately after chemotherapy, you may feel sleepy or nauseated. Typically, the side effects of chemotherapy go away after you complete all prescribed cycles.
Tucatinib Neratinib And Lapatinib
The tyrosine-kinase inhibitors FDA-approved for metastatic breast cancer treatment are:
Tyrosine-kinase inhibitors are a class of drugs that target enzymes important for cell functions . These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.
A tyrosine-kinase inhibitor in combination with trastuzumab and chemotherapy can be used to treat HER2-positive metastatic breast cancer. This combination may give women with HER2-positive metastatic breast cancer more time before the cancer spreads compared to treatment with trastuzumab and chemotherapy alone .
Adding the tyrosine-kinase inhibitor tucatinib to treatment with trastuzumab and chemotherapy may also increase overall survival in women with HER2-positive metastatic breast cancer who were treated with trastuzumab in the past .
Neratinib is also used to treat HER2-positive early breast cancer.
Tucatinib, neratinib and lapatinib are pills.
Learn about neratinib and treatment of early breast cancer.
Tucatinib, neratinib and lapatinib and brain metastases
Many drug therapies cannot pass through the blood to the brain . So, they cant treat breast cancer that has spread to the brain.
However, tucatinib, neratinib and lapatinib can pass through the blood-brain barrier and may be used to treat some metastatic breast cancers that have spread to the brain.
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Which Breast Cancer Patients Need Chemotherapy
- Medical College of Georgia
- Most postmenopausal women with small breast tumors don’t need chemotherapy to reduce their recurrence risk after lumpectomy.
Most postmenopausal women with small breast tumors dont need chemotherapy to reduce their recurrence risk after lumpectomy.
To try to determine who does, a test that measures a tumors aggressiveness based on its DNA will be tested nationally in more than 10,000 of these women.
The dilemma physicians have with these patients is, because they have such small tumors, its hard to tell who needs chemotherapy, said Dr. Thomas A. Samuel, Medical College of Georgia hematologist/oncologist specializing in breast cancer and a study principal investigator.
If you take 100 postmenopausal women with a small tumor that has estrogen receptors most do and no sign the disease has spread to the lymph nodes, probably 12 to 15 of the women need chemotherapy to reduce recurrence, Dr. Samuel says.
To save those patients lives, all 100 have to be treated with chemotherapy, because no definitive test indicates who really needs it, says Dr. Samuel. Yet the vast majority will do well with lumpectomy, radiation and hormone therapy that keeps cells from being refueled by estrogen.
If the federally funded study of thousands of women over the next five-plus years backs up smaller studies, the test likely will become part of the standard of care for this group of women, he says.
Many With Early Breast Cancer May Not Need Chemo
The new study of nearly 7,000 women found that use of the already available Oncotype DX gene test could pinpoint those women who needed chemotherapy, and those who did not.
The findings could be a game-changer in breast cancer care, researchers and experts said.
Half of all breast cancers are hormone receptor-positive, HER2-negative, and axillary node-negative, noted study author Dr. Joseph Sparano, who helps direct clinical research at the Albert Einstein Cancer Center in New York City.
Our study shows that chemotherapy may be avoided in about 70 percent of these women when its use is guided by the test, thus limiting chemotherapy to the 30 percent who we can predict will benefit from it, Sparano said in a news release from the American Society of Clinical Oncology .
His team is scheduled to present the study findings Sunday at the ASCO annual meeting, in Chicago, and the study is also being published simultaneously in the New England Journal of Medicine.
One oncologist agreed that the highly anticipated findings could transform care.
New England Journal of Medicine
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How Do I Know Which Breast Cancer Treatment To Choose
Your doctor will think about a few things before they recommend a treatment for you:
- The type of breast cancer you have
- The size of your tumor and how far the cancer has spread in your body, called the stage of your disease
- Whether your tumor has things called receptors for HER2 protein, estrogen, and progesterone, or other specific features.
Your age, whether youâve gone through menopause, other health conditions you have, and your personal preferences also play a role in this decision-making process.
Possible Side Effects Of Chemo For Breast Cancer
Chemo drugs can cause side effects, depending on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:
- Hair loss
- Hot flashes and/or vaginal dryness from menopause caused by chemo
- Nerve damage
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
- Increased chance of infections
- Easy bruising or bleeding
These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.
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Moving Genomic Testing Into Practice
This study is a big deal, said Dr. Timothy Byun, a medical oncologist with The Center for Cancer Prevention and Treatment at St. Joseph Hospital in Southern California, who was not involved in the study.
In an interview with Healthline, Byun said the study may result in fewer breast cancer patients getting chemotherapy, at least in European countries.
In the United States, many of us have already been using the Oncotype DX test to help guide our decisions, said Byun. It uses a 21-gene score. It gives similar information, but we dont know if theres a 100 percent correlation with the MammaPrint test.
Byun referred to the recent TAILORx Trial using the 21-gene test. It found that low-risk patients did well without chemotherapy.
That study showed the test could select a cohort of patients with a 99 percent chance of five-year survival without distant metastasis. For those women, the risks of chemotherapy arent justifiable.
Researchers are still waiting for this data to mature, cautions Byun.
We know that when oncologists see patients after surgery, we look at traditional clinical indicators to guide our decision-making process as to benefits and harms of chemotherapy, he said.
With the information currently available, its likely that some breast cancer patients get unnecessary chemotherapy.
Theres a caveat, according to Byun. Genomic studies, for the most part, have included only estrogen-receptor positive breast cancer patients.
Chemotherapy Unnecessary For Thousands Of Women With Breast Cancer
Oncologists say the TAILORx trial is likely have an immediate impact on how the disease is treated in the UK.
Monday 4 June 2018 06:47, UK
Gruelling chemotherapy may no longer be required to treat breast cancer following a landmark study.
More than 10,000 women with the most common form of early breast cancer took part in a trial that found the treatment was not necessary for many after they had surgery.
A leading oncologist said the findings will lead to a fundamental change in how the disease is treated.
It is estimated that 3,000 to 5,000 women in the UK are likely to avoid chemotherapy every year following the trial.
Each year more than 20,000 women in the UK are diagnosed with hormone-receptor positive, HER2-negative, node-negative breast cancer.
Historically around half of these patients undergo chemotherapy after surgery to remove their tumour to stop the cancer returning
The TAILORx trial shows that only 30% of women with this particular form of early-stage breast cancer derive any benefit from the treatment.
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What Is The Prognosis For Triple
A good treatment result depends on several factors. Chemotherapy is what can really make a difference in the outcome. The size of the invasive part of the tumor, and the number of involved lymph nodes can also greatly influence your prognosis, Sun says, but adds that if the cancer has spread , the prognosis is less certain.
There is hope, even with this serious diagnosis, and staying optimistic is essential. It can be stressful and scary to go through chemo, but positive thinking can make a difference. You have to believe that its doing you good, and for most people, it does.
Breast Cancer Treatment at Johns Hopkins
The breast cancer program at Johns Hopkins is made up of a diverse group of nationally-recognized specialists in breast cancer research and treatment.
What If Cancer Is Detected In The Lymph Nodes
If you have lymph node positive breast cancer, it is likely you will be offered chemotherapy. Premenopausal women and those with multiple positive lymph nodes generally benefit from chemotherapy. If your breast surgeon detects cancer in your lymph nodes before surgery, there may be specific advantages to undergoing neoadjuvant chemotherapy.
If you have lymph node positive cancer and are elderly or not healthy enough to tolerate the side effects of chemotherapy, you may conclude that the risks of chemotherapy outweigh its benefits. These situations vary greatly from person to person. A detailed discussion with your medical oncologist is essential to make the best decision for yourself or a loved one.
Some women who have an early stage, lymph node positive breast cancer may meet the criteria to consider genomic testing of a sample of their tumor to see if they might be able to avoid chemotherapy. This is a rapidly evolving field in breast cancer. Ask your medical oncologist if a node positive genomic assay is appropriate for your unique cancer situation.
Thousands Could Avoid Chemo
You may have read the news that a ‘test means fewer women will need chemotherapy’.
The news reports follow a study, called TAILORx, of a test widely used on the NHS.
The test Oncotype DX predicts whether someone would benefit from chemotherapy.
The test is suitable for women whose breast cancer:
- is HER2 negative
- hasnt spread to the lymph nodes under the arm
However, there’s a significant grey area of women for whom the benefit is unclear. The researchers looked at this intermediate group. They concluded that for most women in this group over the age of 50, chemotherapy didn’t have any benefit, and hormone therapy alone led to similar survival rates. For some women under 50 in this group, chemotherapy could also be spared.
This means that several thousand women a year could avoid having chemotherapy, which can cause a range of often unpleasant side effects.
You can read a more detailed analysis of the study on the NHS Choices website.
Most Women In The Mid
The new study looked at the 6,711 women from the trial who fell in the mid-range of 11 to 25. The goal of the study was to find out if these women could safely skip the chemotherapy.
Following surgery, the women were randomly assigned to receive chemotherapy followed by hormone therapy, or hormone therapy alone. The study was intended to measure invasive disease-free survival, the proportion of women who had not died, or had their cancer return, or developed a new cancer. Results were very similar between the 2 groups.
- Five years after treatment, the rate of invasive disease-free survival was 93.1% for those who had chemo and 92.8% for those who did not.
- Nine years after treatment, the rate of invasive disease-free survival was 84.3% for those who had chemo and 83.3% for those who did not.
Rates of overall survival were also very similar between the 2 groups.
- Five years after treatment, the rate of overall survival was 98.1% for those who had chemo and 98.0% for those who did not.
- Nine years after treatment, the rate of overall survival was 93.8% for those who had chemo and 93.9% for those who did not.
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Advocating For Your Breast Cancer Care
For newly-diagnosed breast cancer patients and their support systems, speaking with oncologists and evaluating treatment options can be daunting. But Gralow says there are many things patients and caregivers can do to feel more confident working with their care teams.
Patients and their family members feel that they overnight need to become experts on breast cancer, Gralow says, adding this is not the case. Establish a relationship with a healthcare team that you can trust. They should explain your diagnosis, the features of it, and make their recommendation with the support for why they chose one plan over the other.
To facilitate better communication between cancer care providers and patients, Gralow recommends a support person attend appointments and take notes so the patient can listen, process, and think of the next question. If you cannot have a support person present, Gralow suggests asking permission to record the visit.
Studies show that patients retain little of what we tell them at the first visit, but having your visit recorded so you can listen again or you can share with family members can be helpful, she says.
Gralow also cautions to be careful when doing online research.
There is so much on the internet. Much of it is excellent, but so much of it is just wrong, she says. Gralow recommends seeking out ASCO and the American Cancer Society websites for reliable information.
Its Not Like The Movies
Lets just debunk this myth right now. Sitting in the chemo chair is not like the movies. At least not the ones that I have seen, where youre sitting right next to someone else getting chemo. Its also not like the newest episode of New Amsterdam where Max gets chemo and is sitting there playing cards with his chemo friends. I was like, Oh cool, maybe Ill make friends like he did.
But honestly yall, Im glad it isnt like the movies. I wasnt sure if I was going to feel up to entertaining or making friends with others. This is completely new to me and I wanted to tackle this by myself, no social strings attached! My sister, husband, and one close family friend are the only people who come with me to my treatments.
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means youll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while youre taking it, although they should start again once your treatment is complete.
If youre approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.