LiveWorld Transcripts

iBreast presents

Susan Braun, President and CEO of the Susan G. Komen Foundation
What's the Best Treatment After Breast Cancer Surgery?

November 16, 2000

Hear new thinking on breast cancer treatments after surgery, from a recent National Institutes of Health Conference whose goal was to define the "gold standards" of care, using the very latest research and clinical experience.

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Ibreast: Welcome, everyone, to our ibreast.org(TM) Third Thursday Night Chat, held in collaboration with the Susan G. Komen Foundation (www.komen.org), a nonprofit organization that promotes breast cancer research, education, screening and treatment, and The Health Library of Stanford Hospital and Clinics (healthlibrary.stanford.edu). We also want to thank Wyeth-Ayerst Pharmaceuticals for an unrestricted educational grant that makes this event possible. We will only be taking questions that relate to our topic this evening--What's the Best Treatment After Breast Cancer Surgery? So please hold other questions for future Third Thursday chats at ibreast.org(TM). If you sign up for free e-mail Updates at the site, www.ibreast.org/res news signup.html, you will receive advance notice of all live events. Our moderator this evening is Susan Braun, President and CEO of the Susan G. Komen Foundation. Ms. Braun has been an important leader in the breast cancer community, helping the Komen Foundation as they raise funds to support essential breast cancer research and develop innovative programs.

Susan Braun: Welcome to all of you. We have two distinguished experts tonight who have insights from the very important NIH Consensus Conference that just took place November 1-3. Dr. Nancy Davidson is the director of the Johns Hopkins Oncology Center's Breast Cancer Program. An oncologist in active practice, she is also an internationally recognized researcher and thought leader in breast cancer treatment. Dr. Davidson will answer your questions on chemotherapy and hormonal therapy (also called "anti-estrogen" therapy). Dr. Marisa Weiss is a radiation oncologist specializing in breast cancer who is also widely known as an author ("Living Beyond Breast Cancer," Random House), patient advocate, and founder of both the nonprofit education organization Living Beyond Breast Cancer® and the Website ibreast.org(TM). Dr. Weiss will answer your questions on radiation therapy and quality of life issues. Now, I turn the evening over to Dr. Davidson and Dr. Weiss.

Dr. Weiss: Welcome, everyone. The National Institutes of Health conference that Dr. Davidson and I attended two weeks ago had a number of goals. The conference tried to identify who would benefit most from chemotherapy, hormonal therapy, and radiation therapy; they wanted to clarify which patients might not need chemotherapy; they looked at how treatment affects quality of life; and considered what's the best way for physicians to communicate medical information to women and work as close partners through treatment and beyond. We will be offering a fuller update on the conference by e-mail from ibreast.org later in November.

Dr. Davidson: This was truly an important event, Dr. Weiss. I'm looking forward to sharing what we learned with everyone in the audience.

Susan Braun: Let's go to questions.

Dee: Why would a woman be taken off Tamoxifen after a second cancer in the opposite breast?

Dr. Davidson: I think that a woman may come off of Tamoxifen if the second cancer developed on Tamoxifen, and it lacked estrogen and progesterone receptors. Perhaps she and her physician would decide she should stop the tamoxifen.

Dr. Weiss: So if Tamoxifen didn't prevent that cancer from happening, then maybe its value is limited?

Dr. Davidson: That's correct.

Sue: After my mastectomy, lift and reconstructive surgery, the pathologist found LCIS in my other breast. The tumor in the breast removed was 1.5 cm, and all 26 nodes were negative. What treatment and/or surgery do you recommend?

Dr. Davidson: Many women who have a 1.5-centimeter node negative breast cancer would be candidates for tamoxifen and/or chemotherapy. We'd have to know more details about the patient and the tumor to decide what would be most appropriate.

Dr. Weiss: There appears to be no role for radiation after your mastectomy, because your tumor is likely to have been effectively managed from the local treatment perspective.

Susan Braun: By local treatment, you mean the surgery itself?

Dr. Weiss: I mean the breast area does not require additional local treatment with radiation.

Susan Braun: And should this person do anything, or should anything be considered for this woman for the LCIS?

Dr. Davidson: Usually, we think of LCIS as a marker for the possibility of developing basic breast cancer. This woman already has invasive breast cancer. Really, the only decision would be whether tamoxifen would be used to treat her breast cancer, and to try to prevent a second breast cancer.

Dr. Weiss: Our ibreast.org September chat with Dr. Schnitt gives a nice review of LCIS. Look in the Personal Guide section of the site.

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