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
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
Researchers have known for years that breast cancer is caused by alterations
in certain genes...
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
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.
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...
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
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:
- Determine the lymph node recurrence rates in patients with cancer in their
sentinel lymph node that undergo axillary radiation
- Assess reduction in morbidity associated with sentinel lymph node mapping
compared to traditional full axillary dissection
- 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.
Selected Professional Journals