Insights and Updates in Breast Cancer. No Disclosures. Learning Objectives. Mountain States Cancer Conference 2017 Regina Jeanise Brown MD

Transcription

1 Insights and Updates in Breast Cancer Mountain States Cancer Conference 2017 Regina Jeanise Brown MD 10/14/17 No Disclosures Learning Objectives Understand screening recommendations Understand the effectiveness of scalp-cooling to prevent hair loss from chemotherapy. Understand how supportive care can affect mortality 3

2 Breast Cancer Most common cancer diagnosed in US women Second-leading cause of cancer death after lung cancer in women About 252,000 new cases expected to be diagnosed in 2017 Over 40,600 women will die of breast cancer in 2017 In the U.S. a woman has a 1 in 8, lifetime risk of a breast cancer diagnosis 4 Breast Cancer Screening Recommendations Annual screening mammograms at age 40 Annual clinical encounter (risk assessment, reduction counseling and CBE) to maximize earliest detection Breast awareness 5 Signs of Breast Cancer Lump or thickening in breast or armpit Change in size or shape of breast Change in the look or feel of the nipple Change in the look or feel of the skin around the breast 6

3 Digital Breast Tomosynthesis Increased cancer detection rate of 25% Recall rates are decreased by 20% Chemotherapy Basics Chemotherapy for some breast cancer improves disease free and overall survival Not every patient needs chemotherapy Personalized medicine Regimens contain multiple agents and treatment lasts 3-9 months Benefits of chemotherapy are independent of benefits of endocrine therapy All regimens for breast cancer treatment cause hair loss Cold Cap Therapy Scalp cooled to very cold temperatures Cold temperature constricts blood vessels to hair follicles A process used in Europe for over 20 years Two machine systems have received FDA clearance

4 Chemotherapy without Hair Loss The Rapunzel Project: Cold Cap Therapy Death rates from breast cancer decline They have declined approximately 40% between 1989 and 2015 Attributed to improvements in treatment and early detection by mammography Better chemotherapy regimens and introduction of tamoxifen Between 2006 and 2015, death rates decreased for all racial and ethnic groups tracked In 2015, the death rate for black women was 39% higher than for white women 11 Contributing Factors Black women lack screening and treatment advances Black women are twice as likely to develop triple negative breast cancer Difficulty making appointments due to work 12

5 Supportive Care Services and Team Members Social work Patient navigator Financial counseling Psychology Palliative care Dietician Support groups and education programs Survivorship program Chaplaincy Art therapy Music therapy 13 Case Study 59 year old black female diagnosed with left breast cancer Palpable mass, positive lymph nodes ER negative, PR negative, Her2/neu negative Clinically Stage III Work up delayed Staging CT revealed liver metastases Started chemotherapy Missed treatments, poor support system 14 Case Study No patient navigator Toxicities from treatment Missed worked Poor coordination of care Diagnosed with brain metastasis Died 6 months later 15

6 Case Study Niece diagnosed with advanced breast cancer 6 months later at age 41. Clinically Stage III, large right breast mass, bulky axillary adenopathy Patient navigator assigned Enrolled in a neo-adjuvant clinical trial Lumpectomy and sentinel lymph node biopsy Final pathology showed a complete response 16 Triple negative breast cancer Makes up approximately 20% of all breast cancers More common in younger women More common in women of African descent More common in women with BRCA1 germline mutations Typically high grade Typically advanced stage Only approved systemic treatment is chemotherapy There is a need for new targeted therapies 17 Conclusions Screening recommendations for breast cancer include breast awareness, yearly clinical breast exams and mammograms starting at age 40. Scalp-cooling can prevent hair loss from chemotherapy. Supportive care affects mortality in various ways. 18