Innovative Advances in Breast Cancer Treatment
The experts of Dana-Farber/Brigham and Women’s Cancer Center have been at the forefront in new technologies, therapies, and surgical procedures that have changed the way breast cancer patients are evaluated and treated. These include:
Digital mammography, ultrasound and needle biopsy
Digital mammography is rapidly replacing x-ray films in many centers around the United States. Nearly all mammograms at Dana-Farber/Brigham and Women’s Cancer Center are now done with digital equipment. Physicians can access images acquired by the digital mammogram anywhere there is a computer and a computer monitor. Radiologists can manipulate the image (the contrast, brightness or magnification) to zoom in on areas of concern and use computer-aided diagnosis to cross-check findings and reduce errors.
Ultrasound or sonography is a sonar test, using sound waves to image structures in the breast. Radiologists can use the ultrasound to guide needle biopsies, localize tumors for surgery or assist in the diagnosis of mammographic findings.
Needle biopsy is increasingly used in preference to surgery for the diagnosis of breast masses, evaluation of microcalcifications or to obtain samples of cancer tissue for molecular studies that enhance our targeted therapies clinical trials. Needle biopsies can be done for tumors virtually anywhere in the body, but are most commonly done for masses in the breast. The needles used for these biopsies are specially designed for use with gentle suction or vacuum assistance; furthermore, they are designed to cut slivers of tissue by simply turning the needle. Modern needles and specialized equipment can remove much larger quantities of tissue than possible only a few years ago. Most tumors are completely evaluated and a diagnosis rendered using needle biopsy.
Application of anesthesia
Breast surgeons at the Center are now performing surgeries on certain patients using regional anesthesia, called a para-vertebral block, which provides the benefit of a faster recovery and shorter hospital stay, as well as additional options for patients who do not tolerate anesthesia well. These innovative procedures, done by specialized anesthesiologists who care for breast cancer patients, prevent post-operative pain, eliminate nausea and allow shorter stays in the hospital.
Sentinel node mapping
When a breast cancer has been diagnosed, testing the nearby lymph nodes provides critical information for treatment planning. Conventional practice commonly involved removing a fat pad containing 10 to 20 lymph nodes from the underarm. For some patients this procedure resulted in side effects including pain or loss of sensation in the underarm, reduced range-of-motion in the shoulder, and lymphedema (accumulation of fluid due to faulty lymphatic draining).
Doctors at the Center are using a new technology that helps them minimize the number of lymph nodes that must be removed to guide treatment planning. Sentinel node mapping identifies the first draining node, the so-called sentinel node. If it is cancer-free, the other nodes downstream in the lymphatic basin are also negative, and the woman can be spared further under-arm surgery. Sentinel node mapping is a valuable tool for patients who have no clinical indication of lymph node involvement.
Lymphatic mapping begins in nuclear medicine. For sentinel node mapping using a gamma probe, the radiologist injects a radioactive tracer (dye) called technetium into the tumor and scans to confirm that the tumor is draining into the axilla (cavity beneath the junction of the arm and shoulder). In the operating room, before making any incision, the surgeon scans the armpit with a Geiger counter-like device known as a gamma probe and gets an audible signal over the sentinel node, indicating precisely where to make the incision. In about 10 percent of patients, the technetium does not map. For these cases, the surgeon may inject a blue dye into the tumor. The dye drains into the lymphatic system, allowing the surgeon to visually identify the sentinel node. Together, technetium and blue dye tracers allow surgeons to identify the sentinel node in 98 percent of patients. About 75 percent of women diagnosed with a malignant breast lump are shown to have negative nodes allowing doctors to identify patients who will not need their lymph nodes removed and sparing them unnecessary surgery and its complications.
More effective chemotherapy without side effects
The medical oncology group has pioneered the use of several chemotherapy regimens that are highly effective but less toxic than some of the traditional drug combinations. In addition, with advances in support care, some of the harshest treatments are becoming much easier to tolerate. Women with breast cancer are rarely hospitalized other than for their initial surgery. This is in striking contrast with 20 years ago, when many women would be hospitalized for complications of their routine cancer care.
Patients can also avail themselves of a wide variety of clinical trials that offer a broad range of new and innovative treatments. Each year approximately 300 women with breast cancer participate in clinical trials that will establish new treatments and may provide treatment opportunities that are otherwise not available.
Leading Breast Cancer Research
Researchers at Dana-Farber/Brigham and Women’s Cancer Center have pioneered new approaches in the evaluation and treatment of breast cancer, leading to better outcomes and quality-of-life for patients with the disease.
Clinical research is a vital aspect of the mission of the Center. The goal of this research is not only to give current patients the opportunity to participate in clinical trials offering promising new treatments, but also to improve the lives of future generations of women with breast and gynecologic cancers.
These studies are broad in scope, and include investigations of prevention and early-detection strategies, new therapies, novel combinations of existing treatments, quality-of-life studies, and laboratory analyses of tumor samples to better understand the relationship between tumor types and patient outcomes.
Findings from the Center include:
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Development of a two-drug combination - vinorelbine and Herceptin® - was first evaluated at the Dana-Farber/Brigham and Women's Cancer Center and has benefited many women with breast cancer.
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Weight and weight gain may predict breast cancer survival. Researchers at the Center found that women who maintain a healthy weight before diagnosis and avoid weight gain after treatment may have improved survival compared with women who are overweight or obese prior to diagnosis or who are lean and gain weight after diagnosis.
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Exercise after diagnosis may help breast cancer patients live longer. Researchers with the Nurses’ Health Study at Brigham and Women’s Hospital have found that exercise might help promote breast cancer survival. Of course exercise has multiple other health benefits and should be part of an overall plan to promote better health.
The Center has been selected as a site for the Specialized Program of Research Excellence (SPORE) in Breast Cancer, a five-year, multi-center translational research initiative funded by the National Cancer Institute, designed to lead the development of new scientific approaches in the prevention, detection and treatment of breast cancer. In addition, Center investigators were awarded a Department of Defense Center of Excellence grant to investigate the risk factors, diagnosis and treatment for estrogen receptor negative (ER-negative) breast cancer. These grants are highly competitive and given to fewer than 10 academic medical centers in the United States.
Bringing together leading scientists and clinicians in breast cancer, current endeavors of the Harvard SPORE in Breast Cancer at Dana-Farber/Brigham and Women’s Cancer Center include:
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Study of the genetics of breast cancer, focusing on important genes and pathways underlying the origin and development of disease and its progression so that breast cancers can be placed into categories based on their genetic and molecular makeup, with the goal of devising an optimal therapy for each tumor.
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Innovative preoperative chemotherapy options use a targeted approach to help shrink the tumor and indicate how the tumor is responding to treatment. This form of treatment is followed by surgery to remove the tumor. In select cases, preoperative chemotherapy may shrink a tumor significantly to enable breast conservation, where the surgeon can perform a lumpectomy instead of a mastectomy (removal of the breast).
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Researchers are beginning to measure changes in the genes ot the tumors at the start of chemotherapy and again at the end. The changes in the profiles during the course of chemotherapy will help researchers identify the precise mechanism of the drugs’ effects.
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Loss of life from breast cancer is principally due to metastasis, the process by which cancers starting in the breast spread through the bloodstream to distant organs in the body. Researchers at Dana-Farber/Brigham and Women’s Cancer Center are seeking the genetic answers to metastasis by application of modern technologies, by creating a program to follow women with metastatic breast cancer more intensely.
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Tumors are made up of both malignant cancer cells and normal supporting cells such as blood vessels and connective tissue. The interaction between the cancer cells and the normal supporting tissue (the stroma) is a new area of research. Researchers are using anti-angiogenesis drugs in combination with chemotherapy, studying the normal stroma of early breast cancers, and testing the ability of stroma from cancer bearing women to stimulate growth of experimental breast cancers.
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Basic scientists have uncovered the way in which the breast cancer susceptibility genes BRCA1 and BRCA2 act to cause breast cancer, interact with other important cancer-causing genes, and are similar to genes causing cancer syndromes in children.
The Breast Center
The Breast Center at Dana-Farber/Brigham and Women’s Cancer Center provides comprehensive, state-of-the-art care for women with all types of breast and gynecologic cancers in an attractive setting dedicated exclusively to women. The Center brings together radiation oncologists and medical oncologists with breast surgeons, radiologists, and other specialists to treat patients as one medical team.
The Center also includes a cutting-edge research facility that enables physician/scientists to carry the knowledge that they gain from their laboratory discoveries and research to their patients through advanced treatment.
Dana-Farber/Brigham and Women’s Cancer Center cares for patients in 12 specialized treatment centers, one of the most comprehensive and advanced programs for adult cancer care and research available.
For More Information
If you would like to schedule an appointment or are experiencing symptoms that may need evaluation, please call Dana-Farber/Brigham and Women’s Cancer Center at 1-877-DFCI-BWH.
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