OCTOBER EDITION, VOLUME 2021, NO. 10
~Capital Medical Society Celebrates National Breast Cancer Awareness Month~
THE EVOLUTION OF BREAST CANCER TREATMENT By Wade Douglas, M.D. and Shlermine Everidge, M.D. Shlermine Everidge, M.D. General Surgery Resident PGY-5 Florida State University Tallahassee Memorial Healthcare
As a general surgery resident, initially learning to treat and manage patients with breast cancer was a difficult task. There were components in the treatment guidelines that were in flux regarding acceptable margins and how to treat the axilla. While continuing my training, the complexity and constantly evolving breast cancer management attracted me to Breast Surgical Oncology. The management of breast cancer highlights one of the most significant evolutions in medicine. The initial treatment of breast cancer, Halstead radical mastectomy, was first described by William Halstead in 1894. This treatment involved removing the breast, overlying skin, underlying pectoralis muscles, the regional lymph nodes, and axillary vein. This was a morbid procedure, but at the time suited the locally advanced-stage breast cancers. Surgeons and patients discovered that this procedure reduced mortality and locoregional recurrence; they often died of metastatic disease. Although the procedure itself was morbid, the positive outcome led to reconsideration for local and regional control of the disease. In the 1970s, the overlap of surgery and medicine began to form as landmark trials like the NSABP B04 and NSABP B20 showed there was a role for adjuvant therapies in treating
breast cancer with radiation and chemotherapy. The '70s also brought about the groundworks for our current practice of breast-conserving therapy. This involves lumpectomy (removal of only the portion of the breast affected by cancer with negative margins), axillary lymph node sampling, and radiation. For the first time, this allowed women to keep their breasts with the diagnosis of breast cancer. This addressed the major post-treatment outcome of emotional distress many women faced after losing their breasts. Since the early '70s, we have also furthered our understanding of breast tumor biology and the different signaling pathways involved in tumor growth. This understanding brought about the concept of endocrine modification as an adjunct to reduce the risk of breast cancer recurrence and death in patients with estrogen and progesterone receptors found on their tumors. This discovery was ultimately the gateway to creating the multigene assay, Oncotype Dx, which predicts breast cancer recurrence in estrogen-receptor-positive patients and helps distinguish between patients who would benefit from adjuvant chemotherapy due to their high of recurrence vs. those with lower risk. With so many components to the treatment and management of breast cancer, this disease has brought together several specialties, including general surgery, medical oncology, radiation oncology, radiology, pathology, geneticist, and even plastic surgery. The multidisciplinary approach to breast cancer treatment has led to multidisciplinary breast cancer centers and clinics. This current treatment model has 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 2021 MEETINGS CALENDAR October 19, 2021 Virtual CME (2-Hours) Prevention of Medical Errors 6:30 pm
December 2, 2021 CMS Foundation Holiday Auction 6:00 pm University Center Club at FSU
