NEW STUDY identifies women who do NOT need Tamoxifen

A new study published in JAMA Oncology* by Dr. Laura Esserman (she is the Director of the Breast Cancer Program at UCSF; which just happens to be where I did my fellowship training in breast surgical oncology) identifies women who do NOT need Tamoxifen (or other similar medications referred to as Endocrine Therapy) after surgery for breast cancer. This study is a breakthrough as it now allows doctors to identify which patients may only need surgical treatment for their breast cancer. These women are referred to as UltraLow Risk and were identified by genomic profiling of their tumor. This test is called MammaPrint and I utilize it for all of my patients with hormone positive (ie. ER+) breast cancer. For women with ER+ breast cancer who are ALSO post-menopausal, lymph node negative and have tumors that are 3 cm or smaller; endocrine therapy may not provide a significant benefit, as their Breast Cancer Specific Survival after 20 years was 94% with surgery alone. For women in this group that DID take Tamoxifen, their BCSS at 20 years was 97% (not much better). This is great news for women who may be struggling with the side effects of Tamoxifen. Women who fall into this UltraLow Risk category, who are finding Tamoxifen difficult to tolerate, may safely discontinue treatment, while having the peace of mind that science “supports” their decision to forego endocrine therapy. For surgeons and oncologists, this study demonstrates how the 70-gene MammaPrint assay can identify UltraLow Risk patients who may only require surgery for breast cancer treatment.

Breast cancer treatment continues to evolve and improve. This is one of the reasons why I chose to become a breast cancer specialist. I believe each woman is unique, as is her circumstances, as well as the breast cancer itself. Doctors should continue to look for ways to personalize breast cancer treatment for their patients. Genomic profiling of the tumor itself- is the most technologically advanced and scientifically driven approach to breast cancer care and I am thankful that I get to practice medicine and surgery in a time where doctors and patients can benefit from these breakthroughs.

If you would like to review the study in more detail, I have provided a full text link to the publication below.

*Use of Molecular Tools to Identify Patients with Indolent Breast Cancers with UltraLow Risk over 2 Decades

Hereditary Breast Cancer Risk

Today, one of my dearest friends, Dr. Meghan Nadeau, was honored by the Puget Sound Business Journal as a 40 under 40 award recipient. She was selected for her dedication to caring for women with hereditary breast cancer. Exemplified by her contribution, as one of the co-founders, to Jane.

What is Jane?

Well as the other co-founder, I can fill you in on some of the details…After I completed my fellowship at UCSF, I began practicing in Seattle, WA as a breast surgical oncologist. I quickly noticed a very concerning pattern. I was caring for numerous young woman with breast cancer. Some in their early 20s. Often with advanced and aggressive forms of breast cancer. Sadly, this is not that uncommon. I cared for many young breast cancer patients in San Francisco. Although breast cancer is truly a disease that most commonly occurs in older women, it CAN affect women in their 20s and 30s, well before the typical age when women begin annual screening mammograms. So what was so concerning? Well…nearly EVERY young women I cared for had multiple “red flags” that should have been identified prior to her breast cancer diagnosis. I was counseling these young women about genetic risk, submitting a sample for genetic testing, and identifying a genetic mutation (such as BRCA1) after they had already been diagnosed with breast cancer. The healthcare system had failed these young women. If these “red flags” had been identified prior to their breast cancer diagnosis, perhaps these women could have made an informed choice about their healthcare. Specifically, about their breast health. I could not continue caring for these young breast cancer patients without doing something about this blindspot in the healthcare system.

Breast cancer remains the most common cancer diagnosed in women and as I have already mentioned, it is most commonly diagnosed in older women. That is why for years and years the recommendation for breast cancer screening was to begin annual screening mammograms at age 40. But what about the uncommon diagnosis of breast cancer in young women? Well, we (the collective medical community) are supposed to notice the occasional “red flag” in a young woman’s family history and then appropriately refer her for genetic testing. Seems reasonable.

I assumed (as I’m sure most of you do too) that young women with an increased risk of breast cancer are being appropriately screened and offered genetic testing when indicated. I trusted the “system” just like all of my young patients had.

The system is broken.

I could go on and on about all the various reasons the system isn’t working, suffice to say, trust me, it is broken. I have tried to fix it, but I assure you, it doesn’t want to be fixed. At least not anytime soon.

Jane is our solution to this problem.

Rather than fix a broken system we are abandoning the system. We are on a mission to put the knowledge and tools in the hands of those who stand to benefit the most, you! We want to empower every women to take control of her breast health. We want every woman to have access to understanding her own unique, personalized breast cancer risk. Every women should have the option to be tested for genetic risk.

This is just the beginning but our little start-up, Jane, has BIG plans!

To learn more, please check out our website.

Find out when YOU should start screening mammograms

Ladies...are you confused about breast cancer screening? Well, you are not alone. Many of your doctors are also confused.  This is due to the "disagreement" in screening recommendations amongst various organizations. Historically, women had yearly mammograms, starting at age 40. This was reasonable based on the knowledge we had at that time. We now know that a one-size-fits-all approach does not work. Wow, mind-blown, women are individual and unique [insert sarcasm]. Trouble is, the United States Preventative Services Task Force created a report that misled physicians to advise against annual mammograms for women in their forties. These recommendations have been rejected by the National Comprehensive Cancer Network, the American College of Radiology, and the American Congress of Obstetricians and Gynecologists, to name a few. The take home message is that screening recommendations should be personalized for each woman based on her risk. Physicians should utilize available risk assessment tools to discuss your risk of breast cancer and your options for screening. To learn more about your risk and to receive your personalized recommendation, you can schedule an appointment (in person or via telemedicine) with Dr. Seagren.