Best Practices in Breast Cancer – October 2018 Vol 9

One of the most important studies presented at ASCO 2018 showed that endocrine therapy alone was noninferior to endocrine therapy plus chemotherapy in women with estrogen receptor–positive, HER2-negative, node-negative early-stage breast cancer and an intermediate risk score (score, 11-25) on the Oncotype DX gene expression assay for breast cancer.
The current standard of care for women with early, HER2-positive breast cancer is 12 months of trastuzumab. Analysis of the phase 3 randomized clinical trial PERSEPHONE showed that 6 months of treatment with trastuzumab was noninferior to 12 months in terms of disease-free survival. Furthermore, the shorter course of trastuzumab was associated with a 50% reduction in cardiotoxicity leading to cessation of therapy.
It was sometime last year when I was contacted by a woman who had just been diagnosed with breast cancer. Her name was Barb. She lived in a small mountain town in Pennsylvania. She contacted me on the recommendation and encouragement of her daughter, who had done some research on the breast navigator role at the University of Pennsylvania (UPENN). That happens to be my role at the Abramson Cancer Center at UPENN. Barb and her daughter knew they wanted to come to the city after this diagnosis. That initial phone call and contact took great courage. As Barb has shared with me, she was scared. We know it is human instinct to fear for your survival.
Palliative care has a serious identity problem. Seventy percent of Americans describe themselves as “not at all knowledgeable” about palliative care, and most healthcare professionals believe it is synonymous with end-of-life care.1 This perception is not far from current medical practice, because specialty palliative care—administered by clinicians with expertise in palliative medicine—is predominantly offered through hospice care or inpatient consultation only after life-prolonging treatment has failed. This means that the majority of patients who could benefit from palliative care are not receiving it until they are very close to death. To ensure that patients with metastatic breast cancer receive the best cancer care throughout their disease trajectory, palliative care should be initiated alongside standard oncology care, and it should be implemented early.
In addition to the obligatory orange and black decorations of October, it’s also the time of year to don your pink in honor of Breast Cancer Awareness Month! The progress we have made as a nation in elevating the importance of regular breast cancer screenings, funding research, and supporting breast cancer survivors has had a direct impact on our ability to increase and improve survivorship.
In 2010, FORCE: Facing Our Risk of Cancer Empowered successfully spearheaded passage of a congressional resolution declaring the first-ever National Hereditary Breast and Ovarian Cancer Week. This also included National Previvor Day, an important step in giving an identity to individuals who have a strong family history and/or a gene mutation that places them at high risk for cancer but who do not have a cancer diagnosis. Previvors have unique needs and concerns that are separate from the general population as well as from individuals already diagnosed with cancer, and should be encouraged to connect with one another.
Cancer Screening and Genetic Services May Help Women Make Critical Decisions Based on Their Lifetime Risk for Breast Cancer

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