OCTOBER EDITION, VOLUME 2020, NO. 10
-Capital Medical Society Celebrates National Breast Cancer Awareness Month-
BREAST CANCER – BE OPTIMISTIC By Scott Tetreault, M.D. Breast cancer comes in two stages: curable and incurable. First: curable. Almost all breast cancers discovered in Tallahassee are curable, highly curable in fact. When telling a patient that she has breast cancer, you should not use your “I’m-so-sorry-you’re-going-to-die” voice. Be optimistic, you’ll almost always be right. We look for breast cancers with mammograms because we want to find them small, not because we do not want to find them at all. Be positive because there is about an 80% chance (all comers) that she will be cured when we are done. She not only needs your empathy, but she also needs your hope, optimism, and confidence. For small breast cancers, the path to cure is: 1. surgery, 2. gene testing on the tumor to see if chemo is needed, 3. radiation if she has a lumpectomy (most women should), and 4. five or ten years of pills if the tumor is estrogen receptor positive. I have just described the vast majority of breast cancer patients you will meet. About 20% of women will present with big tumors in the breast and axillary lymph nodes. These are still curable but more serious. In most of these women, we rearrange the curative steps: 1. chemotherapy (with biologic therapy for HER2 positive cancers) to shrink everything,
2. surgery, 3. radiation, and 4. pills. The “worst” type of breast cancer, particularly affecting young African American women is triple-negative breast cancer (no ER, no PR, no HER2 receptors). The good news is that we have current trials that will likely result in the use of immunotherapy in these women. Immunotherapy is already approved in the metastatic setting for triplenegative breast cancer. Curative treatment is a long journey for any woman and every day will not be easy, but we have amazingly effective new anti-nausea drugs, immune-boosting Neulasta to prevent infections, and we have two Dignicap machines with expert nurses to run them, so hair loss is now optional. We approach all patients expecting them to be cured and you should too. For women with more serious stage 4 metastatic breast cancer, our goal is not cure but rather management of the disease. “Turn it into a chronic disease” is the mandate, and we have many new options for these women. For the more common ER positive patient, we avoid chemotherapy entirely and treat them with a combination of estrogen receptor blocking agents (Letrozole, Anastrazole, Fulvestrant) along with a new class of pill that inhibits the CDK 4, 6 pathway (Ibrance, Kisquali, Verzenio). This combination is highly effective, CONTINUED ON PAGE 3
Capital Medical Society thanks the physicians and dentists in this community who provide care to breast cancer patients. CAPITAL MEDICAL SOCIETY 2020 MEETINGS CALENDAR October 20, 2020 Virtual CME Domestic Violence (2 Hours) Speakers: Suzanne Harrison, M.D., Director of Clinical Programs and Professor of Family Medicine & Rural Health, Florida State University College of Medicine; and Robin Thompson, MA, JD, Executive Director, Survive and Thrive Chair; Co-Chair and Member, Social Services Committee, Big Bend Coalition Against Human Trafficking 6:30 pm
November 10, 2020 Virtual CME Human Trafficking (1 Hour) Speaker: Terry Coonan, J.D., Executive Director at the Florida State University Center for the Advancement of Human Rights 6:30 pm
November 24 - December 5, 2020 Virtual CMS Foundation Holiday Auction Bidding opens on Tuesday, November 24, 2020 at 12:00 pm; Bidding ends on Saturday, December 5, 2020 at 6:00 pm