ONCOLOGY: BREAST CANCER
For surveillance, the patient should have a clinical breast exam every 3 to 6 months for 5 years, then annually after year 5. radiation therapy focused on the chest wall and regional lymphatics. Because the patient was estrogen and progesterone receptor-negative, endocrine therapy to decrease these hormones in the body to reduce the risk for recurrence or spread of disease was not indicated.The patient also was not a candidate for targeted ERBB2 therapy because she was ERBB2-negative. The patient received a cold cap during treatment, which is associated with a significant reduction in alopecia among patients receiving chemotherapy with a taxane, anthracycline, or both.6 Cold caps work by narrowing the blood vessels beneath the skin to reduce the effect of chemotherapy drugs near the hair follicles. For surveillance, the patient should have a clinical breast exam every 3 to 6 months for 5 years, then annually after year 5.7 Because the patient had a total mastectomy on the left side, she does not need mammography of her left breast but should continue annual right breast screening mammography. The patient did not undergo immediate breast reconstruction because of the need for radiation after mastectomy. If she desires reconstruction in the future, she can be referred to a reconstructive surgeon to discuss options. Reconstructive surgery should not take place any sooner than 6 to 12 months after completion of radiation to allow the tissues time to heal.1
Conclusion
Triple-negative breast cancer is the most aggressive breast cancer phenotype. It is considered aggressive because the tumor grows and spreads quickly and is more likely to recur after treatment. Targeted therapy options for this type of malignancy are limited. The 5-year survival rate for patients with regional triple-negative breast cancer (has spread outside the breast to nearby structures or lymph nodes) is 65%, compared with approximately 90% survival rate for localized triple-negative disease and other breast cancer types.3,8 Patients must be monitored closely for side effects while receiving chemotherapy and radiation therapy and followed closely for recurrence and metastasis. ■ Sunayana Chopra Pydah, PA-C, MBA, MHA, MPAM, works in the Department of Pediatrics at Santa Clara Valley Medical Center in San Jose, California; Erin Hernandez, PA-C, works in the Department of Surgical Oncology at MD Anderson Cancer Center in Houston, Texas, and has over 13 years of experience in treating patients with breast cancer; and Melissa Shaffron, MPAS, PA-C, works in emergency and urgent care medicine. She serves as the associate program director and director of clinical education for the University of Lynchburg School of PA Medicine in Virginia. References 1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer stat facts: female breast cancer. Accessed August 22, 2021. https://seer.cancer.gov/statfacts/html/breast.html
POLL POSITION
2. Plasilova ML, Hayse B, Killelea BK, Horowitz NR, Chagpar AB, Lannin DR. Features of triple-negative breast cancer: analysis of 38,813 cases from the national cancer database. Medicine (Baltimore). 2016;95(35):e4614.
What percentage of breast cancer cases are triple negative?
3. Howard FM, Olopade OI. Epidemiology of triple-negative breast cancer: a review. Cancer J. 2021;27(1):8-16. 4. National Comprehensive Cancer Network. Breast cancer (version 6.2021). August 16, 2021. Accessed August 22, 2021. https://www.nccn.org/ 4.03% 0.81%
■ 5% to 10% ■ 10% to 15% ■ 20% to 25%
professionals/physician_gls/pdf/breast.pdf 5. MD Anderson Cancer Center. Breast cancer—invasive stage I-III. Accessed August 22, 2021. https://www.mdanderson.org/content/dam/mdanderson/
67.74%
27.42%
documents/for-physicians/algorithms/cancer-treatment/ca-treatment-breastinvasive-web-algorithm.pdf 6. Nangia J, Wang T, Osborne C, et al. Effect of a scalp cooling device on
■ Greater than 25%
alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial. JAMA. 2017;317(6):596-605. 7. Smith TJ. Breast cancer surveillance guidelines. J Oncol Pract. 2013; 9(1): 65-67.
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8. American Cancer Society. Triple-negative breast cancer. Accessed August 22, 2021. https://www.cancer.org/cancer/breast-cancer/about/types-of-breastcancer/triple-negative.html
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