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Study Shows Value of Second Opinions for Breast Cancer Diagnosis

A study done in South Carolina strongly suggests that getting a second opinion can be very valuable for people diagnosed with breast cancer: more than 40% of the people in the study who asked for a second opinion had a change in diagnosis.

The research was published in the October 2018 issue of the Annals of Surgical Oncology. Read the abstract of “The Value of a Second Opinion for Breast Cancer Patients Referred to a National Cancer Institute (NCI)-Designated Cancer Center with a Multidisciplinary Breast Tumor Board.”

Many people diagnosed with breast cancer feel a sense of urgency about jumping right in and starting treatment immediately. In most cases, though, there’s time to do some research to make sure your diagnosis is correct and your treatment plan makes sense — and this may include getting a second opinion.

Getting a second opinion means asking another breast cancer specialist, or a team of specialists, to review all of your medical reports and test results, give an opinion about your diagnosis, and suggest treatment options. A second opinion may confirm your original doctor’s diagnosis and treatment plan, provide more details about the type and stage of breast cancer, change your original doctor’s diagnosis and treatment plan, raise additional treatment options you hadn’t considered, or recommend a different course of action.

This study, done by researchers at the Medical University of South Carolina (MUSC), included 70 people who were diagnosed with stage 0 to stage III breast cancer at a different institution and came to the MUSC multidisciplinary tumor board for a second opinion between August 2015 and March 2016.

Multidisciplinary tumor boards, as the name suggests, are boards made up of medical professionals from a variety of specialties within a specific cancer field (such as breast cancer), including radiation oncologists, surgical oncologists, medical oncologists, nurse navigators, geneticists, and pathologists. The experts review a person’s records and come to a consensus about a diagnosis and treatment plan. Multidisciplinary tumor boards are becoming the standard of care at many cancer centers.

In this study, the experts on the breast cancer multidisciplinary tumor board compared the people’s radiology, pathology, and genetic testing reports from the outside institutions with test results done at MUSC.

Overall, the tumor board recommended that 43 of the 70 people have additional imaging or biopsy, which found new cancers in 16 people. The tumor board also recommended that 11 people be referred for genetic testing; genetic testing had not been recommended at the outside institution. Based on the tumor board review and the board’s second opinion, 30 people (43%) had a change in diagnosis.

“Our results show our second opinion really does provide value in potentially changing the diagnosis, which in most cases will eventually change treatment,” said surgical oncologist Nancy DeMore, M.D., of the Hollings Cancer Center at the MUSC. “I would hope this study would empower patients to seek a second opinion at centers that specialize in oncology.

“Those findings would drastically change care,” she continued. “In addition, we found the pathology review changed in 20% of people. And 16% of people who met guidelines for genetic testing by the National Comprehensive Cancer Network guidelines for genetic testing had not been referred for testing.”

The very idea of getting a second opinion can seem overwhelming at first, especially when you’ve just been diagnosed with breast cancer. It can take time and legwork to find a second doctor, arrange for the second opinion, and deal with any insurance issues that may arise. It also can be intimidating to tell your current doctor you want a second opinion. But many people with breast cancer decide to get second opinions, and doctors are used to hearing this request. In fact, your doctor may be able to help you find another specialist who can provide a second opinion. Some insurance companies even require a second opinion before treatment begins. In general, delaying the start of treatment for a short time usually does not pose a risk, although you and your doctor can discuss your unique situation and decide how much of a delay is okay.

I cannot imagine not getting a second opinion. I did and I am glad. I went with the first surgeon but valued hearing almost the same treatment plan from the second. i just liked the first doctor and hospital better.

For more information, including deciding where to get a second opinion and how to make sense of a second opinion, visit the Breastcancer.org Getting a Second Opinion pages.

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Update from American Cancer Society

From the American Cancer Society:

What’s New in Breast Cancer Research?

Researchers around the world are working to find better ways to prevent, detect, and treat breast cancer, and to improve the quality of life of patients and survivors.

Some of the many active areas of research include:

  • Breast cancer causes
  • Causes and treatment of metastatic breast cancer
  • Reducing breast cancer risk
  • Managing ductal carcinoma in situ (DCIS)
  • New lab tests for breast cancer
  • New imaging tests for breast cancer
  • Breast cancer treatment
  • Supportive care

Breast cancer causes

Studies continue to uncover lifestyle factors and habits, as well as inherited genes, that affect breast cancer risk. Here are a few examples:

  • Several studies are looking at the effect of exercise, weight gain or loss, and diet on risk.
  • Studies on the best use of genetic testing for breast cancer mutations continue at a rapid pace.
  • Scientists are exploring how common gene variations (small changes in genes that are not as significant as mutations) may affect breast cancer risk. Gene variants typically have only a modest effect on risk, but when taken together they could possibly have a large impact.
  • Possible environmental causes of breast cancer have also received more attention in recent years. While much of the science on this topic is still in its earliest stages, this is an area of active research.

Reducing breast cancer risk

Researchers continue to look for medicines that might help lower breast cancer risk, especially women who are at high risk.

  • Hormone therapy drugs are typically used to help treat breast cancer, but some might also help prevent it. Tamoxifen and raloxifene have been used for many years to prevent breast cancer.  More recent studies with another class of drugs called aromatase inhibitors (exemestane and anastrozole) have shown that these drugs are also very effective in preventing breast cancer
  • Other clinical trials are looking at non-hormonal drugs for breast cancer reduction. Drugs of interest include drugs for osteoporosis and bone metastases, COX-2 inhibitors, non-steroidal anti-inflammatory drugs, and statins (used to lower cholesterol).

When breast cancer spreads, it often goes to the bones. Some drugs that help treat the spread of cancer to the bones (such as bisphosphonates and denosumab), might also help reduce the chances of the cancer coming back. Studies done so far seem to suggest that postmenopausal women may benefit the most from giving these bone-modifying drugs after breast surgery, but more studies are needed to say for sure.

This type of research takes many years. It might be some time before meaningful results on any of these compounds are available.

Managing DCIS

In ductal carcinoma in situ (DCIS), the abnormal cells are in the milk duct and have not grown outside the duct.. In some women, DCIS turns into invasive breast cancer, or sometimes an area of DCIS contains invasive cancer. In other women, though, the cells just stay within the ducts and never invade deeper or spread to lymph nodes or other organs. The uncertainty about how DCIS will behave can make it hard to choose the best treatments. Researchers are looking for ways to help with these challenges.

Researchers are studying ways to use computers and statistical methods to estimate the odds that a woman’s DCIS will become invasive. Decision aids are another approach. They ask a woman with DCIS questions that help her decide which factors (such as survival, preventing recurrence, and side effects) she considers most important in choosing a treatment.

New lab tests

Tests for circulating tumor cells (CTCs)

Researchers have found that in many women with breast cancer, cells may break away from the tumor and enter the blood. These circulating tumor cells (CTCs) can be detected with sensitive lab tests. Although these tests can help predict which patients may have breast cancer that has spread beyond the breast (metastatic disease), it isn’t clear if the use of these tests can tell whether the cancer will come back after treatment (recur) or help patients live longer. Some studies are looking at if these CTCs can be removed and then tested in the lab to determine which specific anticancer drugs will work on the tumor.

New imaging tests

Newer imaging methods are now being studied for evaluating breast changes that may be cancer.

Scintimammography (molecular breast imaging)

In this test, a slightly radioactive drug called a tracer is injected into a vein. The tracer attaches to breast cancer cells and is detected by a special camera.

This technique is still being studied to see if it will be useful in finding breast cancers. Some doctors believe it may be helpful in looking at suspicious areas found by regular mammograms, but its exact role is still unclear. Current research is aimed at improving the technology and evaluating its use in specific situations such as in the dense breasts of younger women.

Breast cancer treatment

Chemotherapy

It is known that chemotherapy can be helpful for many breast cancer patients. But predicting who will benefit the most or the least is still being studied. Sometimes there are significant side effects (long- and short-term) from chemotherapy, so having tests that can determine who really needs chemo would be useful. Many studies are being done to evaluate different tests that can more accurately tell which patients would benefit from chemo and which patients could avoid it.

Oncoplastic surgery

Breast-conserving surgery (lumpectomy or partial mastectomy) can often be used for early-stage breast cancers. But for some women, it can result in breasts of different sizes and/or shapes. For larger tumors, it might not even be possible, and a mastectomy might be needed instead. Some doctors are addressing this problem by combining cancer surgery and plastic surgery techniques, known as oncoplastic surgery. This typically involves reshaping the breast at the time of the initial surgery, such as doing a partial breast reconstruction after breast-conserving surgery or a full reconstruction after mastectomy. Oncoplastic surgery may mean operating on the other breast as well to make the breasts more alike.

Triple-negative breast cancer

Since triple-negative breast cancers cannot be treated with hormone therapy or targeted therapy such as HER2 drugs, the treatment options are limited to chemotherapy. Other potential targets for new breast cancer drugs have been identified in recent years. Drugs based on these targets, such as kinase inhibitors and immunotherapy, are now being studied to treat triple-negative breast cancers, either by themselves, in combination, or with chemotherapy.

Targeted therapy drugs

Targeted therapies are a group of drugs that specifically target gene changes in cancer cells that help the cells grow or spread. New targeted therapies are being studied for use against breast cancer, including PARP inhibitors. These drugs are most likely to be helpful against cancers caused by BRCA gene mutations, and have shown some promise in treating some types of breast cancers. Olaparib (Lynparza) is now being used to treat women with BRCA mutations who have metastatic, HER2-negative breast cancer and who have already gotten chemotherapy. Other PARP inhibitors are also being studied.

Supportive care

There are trials looking at different medicines to try and improve memory and brain symptoms after chemotherapy. Other studies are evaluating if certain cardiac drugs, known as beta-blockers, can prevent the heart damage sometimes caused by the common breast cancer chemotherapy drugs, doxorubicin and epirubicin.

Thinking about taking part in a clinical trial

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases, they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials, or see Clinical Trials to learn more.

Breast Cancer Awareness Month 2018

Taking place annually throughout the month of October, Breast Cancer Awareness Month aims to raise awareness about the disease and raise funds for research into its cause, prevention, diagnosis, treatment and cure.

If you have not had a mammogram, now is the time to schedule one. Early detection saves lives.  In 2012, I was diagnosed after an annual mammogram with Stage 1 lobular carcinoma. Surgery by the amazing surgeon Dahlia Sataloff and radiation by the amazing radiologist Marisa Weiss as well as Tamoxifin by the fabulous oncologist David Mintzer, has kept me healthy for 6 years… and counting.

Pink October- Remember to get your mammogram

I decided to dye some of my hair pink as a reminder to all that this is Breast Cancer Awareness month. Schedule your annual mammogram if you haven’t already. Early detection is key to an easier and better outcome. My May 2012 a routine mammogram showed invasive lobular cancer. Luckily after lumpectomy surgery and radiation, I did not need chemo. May 2017 was my five year anniversary and my surgeon Dr. Dahlia Sataloff discharged me!

Breast Cancer Radiation Less Scary Than Thought

Breast Cancer Radiation ‘Less Scary’ Than Thought

Majority of patients report more tolerable experience than they expected. I found this to be true in my case.

Monday, September 25, 2017

HealthDay news imageMONDAY, Sept. 25, 2017 (HealthDay News) — Radiation therapy for breast cancer is actually “less scary” than anticipated, nine out of 10 patients say after treatment.

A survey of 300-plus breast cancer patients also found that more than 80 percent said the side effects of radiation were better than expected.

“The word radiation itself sounds frightening and is associated with many negative news stories,” said lead researcher Dr. Narek Shaverdian, of the University of California, Los Angeles (UCLA).

But over the last 20 years, significant advances have been made, said Shaverdian, chief resident in radiation oncology at UCLA’s David Geffen School of Medicine.

“These changes allow us to spare critical organs, create an individual radiation plan for each patient, and also deliver radiation in more convenient schedules,” he explained.

Shaverdian and his team surveyed patients who had received radiation while treated at a UCLA breast cancer clinic between 2012 and 2016.

“The vast majority of patients agreed that if future patients knew the real truth about radiation therapy, they would be less scared about treatment,” he added.

Recent studies have shown better survival and quality of life in patients treated with breast-conserving surgery and radiation rather than breast removal (mastectomy), Shaverdian noted.

“Despite this, more and more patients are electing for mastectomy, and there is an underutilization of radiation therapy, even in patients treated with mastectomy where radiation has shown to result in superior survival,” he said.

What women may not realize is that the course of radiation in many cases has been cut from six weeks to barely three weeks, said Dr. Jed Pollack. He is chairman of radiation medicine at Lenox Hill Hospital in New York City.

Modern radiation therapy also results in less damage to the skin or other body organs, Pollack said.

“Those things added up make radiation a lot more convenient and a lot more tolerable” than it was in the past, Pollack explained.

In this study, researchers wanted to look at radiation therapy from the patient’s perspective, Shaverdian said.

“We hoped having tangible real-world data could help guide patients and providers in their decision-making,” he added.

Questionnaires were completed between 6 months and 5 years after radiation therapy. The women underwent either standard whole-breast radiation that did or did not include the lymph nodes, or short-course radiation after mastectomy, or partial breast radiation.

Nearly 50 percent of the patients said they’d heard horror stories of patients having serious radiation side effects.

And 94 percent said they had feared radiation. Their greatest concerns were damage to internal organs, skin burning and, for a small number, becoming radioactive, the survey found.

Only 3 percent, however, found the negative stories to be true, according to the researchers.

When patients compared their experience to their expectations, between 80 percent and 90 percent found their actual side effects were less than or as expected, Shaverdian said.

“We found most patients treated with radiation as part of breast conservation said that their radiation toxicities were less than expected regarding breast pain, work limitations, limitations on recreational activities, disruption on family and time felt ill,” he said.

In addition, the overwhelming majority of breast-conservation patients and mastectomy patients agreed with the statement, “After treatment, I now realize that radiation therapy is not as bad as they say it is.”

The study focused on 327 patients, average age 59. Eighty-two percent had had breast-conserving surgery.

The results were scheduled for presentation Monday at a meeting of the American Society for Radiation Oncology in San Diego. Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

SOURCES: Narek Shaverdian, M.D., chief resident, department of radiation oncology, University of California, Los Angeles; Jed Pollack, M.D., chairman, radiation medicine, Lenox Hill Hospital, New York City; Sept. 25, 2017, presentation, American Society for Radiation Oncology, San Diego

HealthDay

Stages of Breast Cancer

The stage of breast cancer provides key information about how invasive it is, and whether it has spread or is likely to spread to other areas of the body.

Stage zero breast cancer or stage 0 is noninvasive. That means it has not spread to other cells in the breast or to other organs. Some doctors refer to stage zero breast cancer as precancer.

In most cases, it is discovered by accident, such as after a biopsy or during a breast-imaging test to view another lump. Stage zero breast cancer does not usually cause lumps or other symptoms.

Article from Medical News Today

3 Key Lifestyle Factors Can Lower Breast Cancer Odds

3 Key Lifestyle Factors Can Lower Breast Cancer Odds

Tuesday, May 23, 2017

HealthDay news imageTUESDAY, May 23, 2017 (HealthDay News) — Things that keep you healthy overall, also appear to help lower a woman’s risk of breast cancer, a new review says.

The review found that exercising regularly, maintaining a healthy weight and limiting alcohol could all reduce breast cancer odds.

The report, from the American Institute for Cancer Research and the World Cancer Research Fund, is based on a review of over 100 studies.

On balance, researchers found, regular exercise was tied to small reductions in the risk of breast cancer.

On the other hand, the risk was elevated among women who drank regularly — even at a “moderate” one-drink-a-day level.

Meanwhile, women who were overweight throughout adulthood faced a heightened risk of breast cancer after menopause.

The bottom line is that women can take steps to cut their odds of developing the disease, according to Dr. Anne McTiernan, one of the report authors.

“I think of lifestyle choices as being like wearing a seatbelt. It’s not a guarantee you’ll avoid injury in a car accident, but it significantly reduces your risk,” said McTiernan, of the Fred Hutchinson Cancer Research Center, in Seattle.

In the United States, a woman has about a one-in-eight chance of developing breast cancer, on average, according to the American Cancer Society.

Some of the risk factors for the disease cannot be changed — such as older age and having a strong family history of breast cancer.

But lifestyle still makes a big difference, said Dr. Paula Klein, an oncologist with the Mount Sinai Health System, in New York City.

“We know that more than 50 percent of cancers are preventable with lifestyle choices,” said Klein, who wasn’t involved in the report.

So if a woman takes steps to curb her breast cancer risk, Klein said, she’ll also be lowering her odds of developing other cancers — including major diseases, such as type 2 diabetes and heart disease.

“And you don’t have to run a marathon, or be skinny like a model,” Klein pointed out.

The research review found that women who were moderately active throughout the day tended to have a lower risk of postmenopausal breast cancer — the most common kind.

Overall, women with the highest amounts of daily activity were 13 percent less likely to develop postmenopausal breast cancer, versus women with the lowest activity levels.

That included formal exercise, such as a 30-minute fast-paced walk. But it also included housework, gardening and other daily tasks that got women moving.

According to McTiernan, fitting in physical activity throughout the day is key. “That is, once you do your 30-minute walk, don’t spend the rest of the day on the couch,” she said.

When it came to breast cancer before menopause, only vigorous exercise was tied to a lower risk. The women who were most active had a 17 percent reduced risk of premenopausal breast cancer versus those who were least active.

For postmenopausal women who were the most active when it came to vigorous exercise, the risk of breast cancer dropped by 10 percent compared to the least active, the study showed.

Women who were overweight or obese faced a higher risk of breast cancer after menopause. For every 5-point increase in body mass index (BMI), the risk of breast cancer rose by 12 percent, McTiernan said.

BMI is a measure of weight in relation to height. As an example, McTiernan said, a woman who is 5 feet, 4 inches and weighs 140 pounds has a BMI of 24 (which is normal-weight).

If she gained 30 pounds, McTiernan said, her BMI would reach 29 — a 5-point increase.

“While 30 pounds might seem like a lot to gain,” she noted, “many women do gain that amount over the years.”

As for alcohol, the review found that even moderate drinking was tied to increased breast cancer risks: Drinking the equivalent of a small glass of wine each day boosted the odds of breast cancer by 5 percent to 9 percent.

Does that mean women need to give up that glass of wine with dinner?

Klein recommended looking at the big picture. “If you’re thin, you exercise and you don’t smoke, maybe that small additional risk from your glass of wine isn’t a big deal,” she said.

But the calculation might be different, Klein said, for a woman with risk factors, such as a strong family history of breast cancer.

The report included 119 studies that looked at the relationship between breast cancer risk and diet, exercise and body weight.

The review dug up only “limited” evidence that specific diet habits are related to breast cancer risk.

But a few studies have linked diets high in dairy, calcium and non-starchy vegetables to a lower risk, the report noted. Foods containing carotenoids — such as carrots, spinach and kale — have also been tied to a benefit.

SOURCES: Anne McTiernan, M.D., Ph.D., researcher, Fred Hutchinson Cancer Research Center, Seattle; Paula Klein, M.D., medical oncologist, Mount Sinai Health System, New York City; May 23, 2017, World Cancer Research Fund/American Institute for Cancer Research, Continuous Update Project