Screening and treatment of breast cancer

Pablo BedanoBreast cancer is the most common type of cancer in women in the United States. Studies have shown that regular screening of women with no symptoms can decrease the number who may die from breast cancer.

Current screening guidelines for average risk women include:

Women with above-average risk for breast cancer should consult their healthcare provider for screening recommendations. This group includes women with a family history of breast cancer, personal history of breast atypia, personal history of radiation for Hodgkin's disease, and a family or personal history of a genetic predisposition for breast cancer.

Most breast cancers are diagnosed in women with no symptoms. An abnormality is usually seen on a screening mammogram. Ultrasound and diagnostic mammograms can be used to further characterize the abnormality. If a biopsy is recommended, options include ultrasound-guided core biopsy, stereotactic-guided core biopsy and surgical biopsy. Because image-guided breast core biopsies are extremely accurate, the need to perform a surgical biopsy for the diagnosis of breast cancer is quite rare.

The treatment of breast cancer utilizes a multidisciplinary approach including, surgical oncology, plastic reconstructive surgery, medical oncology and radiation oncology.

Surgical treatment for breast cancer can involve either lumpectomy with radiation or mastectomy. Breast conservation therapy has been compared to mastectomy in six prospective randomized trials, and these studies demonstrated equivalent survival. Combining lumpectomy with oncoplastic techniques results in very good cosmetic results with no sacrifice in oncologic outcome. When mastectomy is the chosen option, this can be performed in either a skin-sparing or nipple-sparing fashion. The preservation of the skin and sometimes the nipple leads to a more natural shape and very good cosmetic outcome.

Axillary node status is an important prognostic indicator for breast cancer patients. In the past, axillary lymph node dissection has been standard approach for breast cancer patients. This procedure can result in many potential long-term consequences including chronic pain, limited mobility and lymphedema. Sentinel lymph node biopsy is a less invasive method of determining nodal status, and this has become the standard of care for axillary staging for breast cancer patients with clinically node-negative disease. Traditionally, a sentinel node with evidence of metastatic disease would lead to a completion axillary lymph node dissection. The trend of less invasive procedures with less risk of morbidity continues as recent studies have demonstrated that in certain breast cancer patients with positive sentinel node, axillary lymph node dissection did not offer any improvement in local recurrence or long-term survival. This has led to many patients being spared the potential lifelong consequences of an axillary lymph node dissection.

The surgical management of breast cancer patients continues to evolve. We continue to work toward achieving superior oncologic outcomes, with good cosmetic outcomes and minimal patient morbidity.

—Nate Thepjatri, M.D.