Expert Q&A: Getting the Best Breast Cancer Treatment
An interview with Duke University Surgeon Lee Gravatt Wilke, MD
Q: When should I consider a clinical trial?
The only way we are going to identify the best and most effective therapies is with clinical trials, so it is important to consider joining one. Usually a hospital’s web site will list the trials that are available. Another good source is the clinical trials web site of the National Institutes of Health.
Certainly, the majority of women with metastatic disease are entered into clinical trials. And many women who are candidates for neoadjuvant therapy, which may include either chemotherapy or endocrine therapy prior to surgery, are placed in clinical trials.
Q: My surgeon tells me I can have a lumpectomy with radiation or a mastectomy. What do I need to consider?
Survival rates are the same for the two procedures in women who are candidates for breast-conserving surgery, but cancer recurrence rates are slightly higher with lumpectomy. These days women with BRCA mutations and a strong family history of breast cancer often choose mastectomy or even double mastectomy to remove both the cancerous and non-cancerous breasts. And women with small breasts and large tumors often choose mastectomy with breast reconstruction because the cosmetic results from lumpectomy may be poor.
Women who want to avoid radiation or who want to avoid regular mammograms may also opt for mastectomy over breast-conserving surgery.
Mastectomy rates have been rising in recent years, and if the trend were explored I think we would find this is because women are much more comfortable with cosmetic surgery (to reconstruct the breast) than they once were.
Q: I want to have children after treatment. What do I need to consider now?
It is very important for younger patients who want to preserve their fertility to talk to a fertility specialist as soon as possible after diagnosis. Her cancer team should also be willing to work with this specialist to identify the best way to preserve fertility.
Q: What if I want to explore alternative or complementary treatments?
Patients need to be comfortable with the treatments they receive. We don’t know a lot about how alternative treatments impact breast cancer outcomes. We are only beginning to investigate this. Standard of care treatments for breast cancer work very well, but I have patients who have rejected these treatments and I can’t say that in 100% of cases this was the wrong thing to do.