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Cancers of the Breast

Source: Cancer Resource Room

The breast is an organ that can have different types of cancers. They are DCIS (ductal carcinoma in situ), lobular, ductal or inflammatory. To read more about Breast Cancer >>>

Breast cancer usually develops in women's breasts, but can occur in men too. To read more about Male Breast Cancer >>>

What's New in Breast Cancer?

Researchers have known for years that breast cancer is caused by alterations in certain genes...

Gene-Expression Profiling

Still in its infancy, gene-expression profiling may someday enable doctors to predict far more accurately which breast cancer patients are at high risk of recurrence and, therefore, require more aggressive treatment, such as chemotherapy, following surgery. Conversely, it may help identify patients who are at low risk of recurrence, sparing them the side effects of these often-toxic, systemic treatments.

Equally important, this new technique will make it possible for researchers to identify genes that play key roles in the growth and spread of tumors-genes that could become the targets of new therapies.

Paula Ryan, MD, PhD is a medical oncologist and clinical researcher who specializes in breast cancer within the Gillette Center for Breast Cancer. In collaboration with Daniel Haber, MD, PhD, director of the Cancer Center, and Dennis C. Sgroi, MD, director of Breast Pathology at Massachusetts General Hospital, Ryan is involved in the first prospective clinical research study in the U.S. to evaluate gene-expression profiling as a potential new tool for predicting breast cancer prognosis.

Gene Discovery for Breast Cancer...

Dennis C. Sgroi, MD, director of Breast Pathology led a multidiciplinary team to discover a two-gene "signature" that appears to predict which breast cancer patients will response to tamoxifen therapy and those who will not. Sgroi stated, "The goal is to tailor treatment to the individual patient early on, so that each has the best opportunity for treatment success." For information about the Gillette Center for Breast Cancer and other services, please call: 877-726-5130.

Radiation Therapy...which breast cancer patients benefit and which ones do not...

In the New England Journal of Medicine, Kevin Hughes, MD, co-director of the Avon Foundation Comprehensive Breast Evaluation Center, challenges that patients over 70 yrs with smaller breast tumors should routinely get radiation. ''When treating patients, you always look at the risk-benefit ratio. Up until now, we've said [all] patients must have radiation. Now, we can go in and say this is what your real risk is, and this is what your real benefit is." To read more>>>

Lymphatic Mapping for Breast Cancer

Breast cancer unfortunately commonly spreads to the lymph nodes under the armpit (axilla). The presence or absence of cancer in these nodes is the most important prognostic factor for women with potentially curable breast cancer. Most general surgeons today continue to surgically remove all of these lymph nodes to determine tumor stage in an operation referred to as an axillary dissection. This operation is associated with morbidity, including arm swelling, decreased shoulder mobility, and underarm/chest-wall numbness. Although more limited axillary dissections are associated with decreased post-operative morbidity, these types of operations may compromise the accuracy of staging.

Others and we have pioneered an alternative to this traditional approach which is a technique referred to as sentinel lymph node mapping. By using a combination of blue dye and a radioisotope, surgeons can follow the lymphatic channels draining a breast cancer to a lymph node ("sentinel node"), which is surgically removed in a much less invasive operation. We have demonstrated that the presence or absence of breast cancer in this sentinel lymph node accurately determines whether the breast cancer has spread to the axilla. The ability of a surgeon to find the sentinel node(s) during surgery is highly dependent on the number of these operations he/she has performed. Sentinel lymph node mapping surgery is less invasive than the traditional approach of removing all lymph nodes, and is therefore associated with less morbidity. Another potential advantage of this sentinel lymph node mapping is that the pathologists can focus their analysis on sentinel lymph nodes, rather than on numerous lymph nodes removed from the axilla. They are therefore able to examine more areas of the lymph node and use special stains. These techniques have been demonstrated to identify microscopic foci of breast cancer that are missed by standard techniques.

Between 18% and 35% of patients with stage I and II breast cancer will have spread of their disease to axillary lymph nodes. In many cases, the only node containing cancer will be the sentinel lymph node. It is unknown whether complete removal of axillary lymph nodes in these patients improves local control or enhances odds of survival. Several published series have shown that radiation therapy alone is effective in controlling recurrence in the axilla.

The goals of this clinical trial are:

  1. Determine the lymph node recurrence rates in patients with cancer in their sentinel lymph node that undergo axillary radiation
  2. Assess reduction in morbidity associated with sentinel lymph node mapping compared to traditional full axillary dissection
  3. Determine the frequency with which breast cancer is identified in sentinel lymph nodes using more sensitivity pathologic analytic methods.

If you are interested in learning more about lymphatic mapping for treatment of your breast cancer, or if you would like more information on this clinical trial, please contact Beth Sawyer, PA at 617- 724-4800.

Michele A. Gadd, MD
Division of Surgical Oncology, Massachusetts General Hospital

To Search Pub Med on breast cancer, please see below.
Consumer Journals
Selected Professional Journals