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
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
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.