Advances in Surgical Management of Breast Cancer Video and Transcript

Tari A. King, MD

  • Chief of Breast Surgery, Dana-Farber/Brigham and Women’s Cancer Center
  • Associate Division Chief for Breast Surgery, Brigham and Women's Hospital

Receiving a diagnosis of breast cancer is a very difficult thing to accept. Women are often quite anxious when they first receive their diagnosis. They're looking for information. They're looking for guidance on how to best approach the treatment. Breast cancer treatment is what we call a multidisciplinary treatment -- meaning there's a role for breast cancer surgeons, breast cancer medical oncologists, and breast cancer radiation oncologists.

And here at the Dana-Farber/Brigham and Women's Cancer Center, we have a great group of physicians to care for patients in all of these modalities. We work together as a team to provide our patients with the most comprehensive treatment plan tailored directly to their needs. We see patients at the same office visit. I will see the patient first, followed by the medical oncologist so the patient doesn't need to come back for a second visit to get all the information that they need from their care providers.

This also allows the care providers to talk in real time about what is the best treatment strategy for this individual patient with her individual tumor. We know that breast cancer is not just one disease, it's many different diseases, and our improved understanding of the biology of breast cancer has allowed us to tailor therapies to each individual woman's tumor.

New Approaches to Lymph Nodes

It's a really exciting time to be in the field of breast cancer -- not only breast cancer surgery, but also the whole breast cancer management field. We're seeing a lot of improvements in the way that we deliver our therapies to our patients and the trend is really “less is more.” We're learning that we can do less surgery, we can give less chemotherapy, and sometimes even avoid radiation therapy and our patients are still having excellent outcomes.

Traditionally, we thought that if there was any breast cancer under the arm and the lymph nodes that it would require full lymph node surgery, which for patients was very inconvenient and frequently led to complications such as lymphedema.

We've had several important trials now demonstrating that for women with small amounts of disease in the lymph nodes under the arm that we can actually leave those nodes in place. And the combination of the other therapies that patients are receiving-- systemic therapy and sometimes radiation therapy-- seems to provide excellent local control, despite the fact that we're doing less surgery.

New Options for Breast Cancer Patients: Radioactive Seed Localization

We live in a time where, fortunately, most women who are diagnosed with breast cancer are diagnosed with non-palpable lesions, or lesions that are picked up on screening mammography. This, again, affords us the opportunity to do smaller surgeries, to do lumpectomies instead of mastectomies, but as a surgeon we need our breast imaging colleagues to help us localize that lesion within the breast. Wire localization or a needle localization has been the traditional way where breast imagers have helped surgeons identify the lesions.

We are now moving into an era where we're using very small seeds labeled with I-125, a small amount of radioactivity, that can be placed into the breast by the breast imager; the surgeon can then use a probe in the operating room to localize the tissue to be removed. The advantages of using the seed localization procedure are that it really completely disconnects the radiology scheduling from the operating room scheduling. And this is great for patients because patients can have these seeds placed up to a week before surgery, then they can come into surgery for their scheduled time without having to go through other procedures in the morning of surgery.

They were previously waiting with the wires in their breast on the morning of surgery, which is often very anxiety provoking and uncomfortable for patients. So this is a great advance for our patients and it's also great for our hospital.

Research and Innovation at Dana-Farber/Brigham and Women’s Cancer Center

We treat an incredible number of women each year, thankfully with excellent results, and it really provides us an opportunity to come together to adopt best practices and to analyze our results and help to move the field forward. Since joining Dana-Farber/Brigham and Women's Cancer Center, our surgeons have agreed upon several best practices that we are going to all adopt and use uniformly in patient care and we've already seen how this has improved not only efficiency, but also satisfaction from our patients.

The Breast Cancer Surgery Group here at Brigham and Women's Hospital, is a diverse group of surgeons with different research interests. Some of our surgeons are interested in optimizing surgical outcomes, such as using the AMIGO suite and image-guided techniques to reduced rates of positive margins. We also have a group of surgeons that are very interested in patient reported outcome measures and making sure that patients' satisfaction and expectations are met with regard to their surgery and to their whole treatment care plan.

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