2020 San Antonio Breast Cancer Symposium Highlights
As with most gatherings this year, the 2020 San Antonio Breast Cancer Symposium was held virtually. Even though this highly anticipated annual conference was unable to be hosted in person, the evidence-based information and new research findings were shared via amazing modern technologies. Breast cancer certainly doesn’t stop durning a global pandemic so it was absolutely wonderful this world-renowned breast cancer conference was still held, even if the experience was a little different this year. If you missed it, you can still read over the many studies presented here. We have also provided an overview of some of our top highlights below:
Study finds more women can safely avoid chemo.
Results from RxPONDER trial suggest some women with hormone receptor-positive cancer and lymph node involvement may not need chemotherapy. According to the study, chemotherapy did not lower the risk of cancer returning for postmenopausal women with low Oncotype DX scores (under 25) and cancer in 1-3 lymph nodes.
Metastatic breast cancer patients experience more time without disease progression with new oral chemotherapy.
When combined with capecitabine, metastatic breast cancer patients experienced a longer timeframe without cancer growth/spread. The CONTESSA trial found that patients taking both tesetaxel and capecitabine went about 10 months without disease progression. Likewise, about 57% of patients taking both drugs experienced a higher treatment response rate (meaning their tumors reduced in size).
Pregnancy after breast cancer is safe.
Premenopausal women who may want to become pregnant can still do so safely following breast cancer according to a recent European study. The study did however find that some women may not be able to naturally conceive following breast cancer treatment. For this reason, it is important for women considering pregnancy following a breast cancer diagnosis to discuss fertility preservation options prior to undergoing treatment.
Breast cancer patients are at a greater risk for chronic opioid use.
Women who have a mastectomy and reconstruction may have a higher risk for future addiction to opioids and sedative-hypnotic drugs. The study out ofColumbia University in New York also found that the chance of becoming a persistent user of both types of controlled substances was significantly higher among women under age 60, those with a breast cancer diagnosis (versus those who had prophylactic surgery) and those treated with chemotherapy. These findings also highlight the importance of ERAS (enhance recover after surgery) protocols which minimize narcotic use after surgery. Patients should take time to discuss ERAS protocols with their surgeons to ensure proper pain management plans are in place before and after surgery to reduce the risk of drug side effects and addiction.
Breast Advocate Celebrates National App Day 2020
National App Day has been celebrated every December 11th since 2017. Apps are now an integral part of our daily lives: they help us stay organized, monitor our health, connect us with friends and family, and navigate us to our next destination. This App Day, we are honored to celebrate the many lives which have positively benefitted from the Breast Advocate® app!
Voted as ‘one of the best apps for managing your breast cancer’ by Health Central, Breast Advocate® is the brain child of Dr. Minas Chrysopoulo, an internationally recognized expert in breast cancer reconstruction and shared decision-making. Shared decision-making occurs when the health care professional and patient work together to make a treatment decision that is best for the patient. The best decision takes into account evidence-based information about treatment options, the physician’s knowledge and experience, and the patient’s preferences and values. Multiple studies show this collaborative approach improves patient outcomes and satisfaction.
Solving a Major Gap in Breast Cancer Care
“I was growing increasingly frustrated listening to patients share the same experiences over and over again” says Dr Chrysopoulo. “Comments like ‘I wish I would have known this was an option years ago,’ or ‘I was never told. If I knew then what I know now, I would have done things very differently’. Creating an app to address this problem seemed like a great idea to me. That’s how Breast Advocate came about.”
The Breast Advocate® App is the first shared decision-making app for breast cancer surgery and breast reconstruction. Co-created by breast cancer specialists and patient advocates, Breast Advocate® provides evidence-based information and customized recommendations based on your diagnosis, personal preferences and values. It’s your treatment… Our mission is to empower patients to have the conversation they want to have with their doctors.
Today the app is best known for its Treatment Wizard. After taking your individual situation and preferences into account, the Wizard provides evidence-based recommendations personalized for YOU. The app’s support community has also grown tremendously since launch, providing a safe place for patients to connect, ask questions, and offer support.
The Breast Advocate® App continues to grow and evolve to meet the needs of patients and healthcare professionals. Breast Advocate is now also available to any healthcare professional or institution interested in having their own fully customizable version of the app. The future is bright, and the team is truly humbled and honored to serve the breast cancer community by providing personalized evidence-based information across the globe!
Fertility Preservation Before Breast Cancer Treatment Improves the Likelihood of a Healthy Pregnancy After a Breast Cancer Diagnosis
A common concern for many young women following a breast cancer diagnosis is the impact cancer treatment may have on their ability to have children. Certain cancer therapies like chemotherapy and radiation can greatly impact a woman’s ability to get pregnant and have a healthy pregnancy, but fertility preservation before breast cancer treatment may help.
A Swedish study published in JAMA Oncology found that fertility preservation at the time of a breast cancer diagnosis can increase the likelihood of a healthy pregnancy and birth after breast cancer treatments.
According to the National Cancer Institute, fertility preservation is “a type of procedure used to help keep a person’s ability to have children. A fertility preservation procedure is done before a medical treatment that may cause infertility, such as radiation therapy or chemotherapy. Examples of fertility preservation procedures include sperm banking, egg freezing, in vitro fertilization with embryo freezing, and certain types of surgery for cervical and ovarian cancer.”
The Swedish study followed 425 women with breast cancer who underwent fertility preservation between 1994 and 2017. The study control group consisted of 850 women diagnosed with breast cancer who did not undergo any fertility preservation. The results showed that 22.8% of women who had fertility preservation had at least one healthy pregnancy and birth following their breast cancer diagnosis, compared to 8.7% of women who did not have a fertility preservation procedure.
The women who opted for fertility preservation also reported having more children compared to the control group at 5 and 10 year follow-up.
It is important for women who may want to expand their families following a breast cancer diagnosis to be aware that cancer treatment may lead to infertility. Likewise, it is important for women and their doctors to engage in informed shared decision-making conversations to determine if fertility preservation options may be beneficial for future family planning.
How a COVID-19 Vaccine Will Impact Patients With Breast Cancer
This week, news broke that the drug company Pfizer has developed a vaccine for COVID-19. Pfizer and its partner company BioNTech reported that “individuals who received two injections of the vaccine three weeks apart experienced more than 90% fewer cases of symptomatic Covid-19 than those who received a placebo.” So far, Pfizer and BioNTech have reported no serious safety concerns.
The Phase 3 study is ongoing and additional data is still being collected. The effectiveness of a vaccine can only truly be determined once millions of people are vaccinated. However, experts say that the preliminary data indicates that the effectiveness should be very high. Pfizer will be seeking emergency use authorization from the FDA and anticipates having 50 million vaccine doses globally this year, and 1.3 billion next year.
The news of a vaccine is obviously fantastic. As many of us struggle to find balance in this new world, the feeling of hope that a vaccine brings is most welcomed right now. Despite this being one of the most rapidly developed vaccines in history, “COVID-19 fatigue” still makes it feel overdue.
Since this particular vaccine needs to be stored in extremely cold temperatures (-94°F), distribution headaches will need to be overcome before it can reach communities, starting with highest-risk populations. Unfortunately, it may be that many people outside urban areas and major medical centers have to wait for other vaccines to work their way through the development pipeline because of this refrigeration requirement.
As vaccines begin to roll out, patients with breast cancer will hopefully be able to be among the patients who benefit.
Routine Screenings, Diagnostic Tests and Clinic Visits
So many individuals, either with a history of breast cancer or a genetic predisposition to developing cancer, have either skipped or delayed their screening appointments due to fears of contracting the coronavirus. The full impact of these delays will likely not be known for many months to come, but doctors are urging patients to return to their normal screening schedules. Likewise, diagnostic tests and necessary in-person clinic visits (eg for infusions) should continue. Currently, hospitals, medical clinics, and doctor’s offices have protocols in place to decrease the risk of exposure and spread of this virus as much as possible. Healthcare workers are doing their best to give patients confidence in these safety measures, but a vaccine would go a long way in minimizing risk and easing fears further.
Surgery Scheduling
During the COVID outbreak, many hospitals and surgeons canceled elective (defined as “not immediately life-saving”) surgical cases to help reduce the burden on the healthcare system, to help preserve personal protective equipment (PPE) for healthcare workers, and to minimize potential exposure to the the virus. While elective procedures, including breast reconstruction, have mostly resumed, some patients remain fearful of proceeding with a procedure that may be able to wait and are therefore postponing scheduling. Additionally, infection numbers are once again increasing across the US raising the question whether another shut down of elective procedures is a possibility. A successful vaccine program would essentially ensure hospitals could return to normal pre-pandemic operative schedules while providing patients with some added peace of mind.
No Vaccine is ever 100%
Even if you receive the vaccine soon, it is important to remember that you will still not be completely protected. Until vaccination is widespread and we beat this pandemic, we strongly recommend you continue to protect yourself and follow the CDC guidelines.
Breast Advocate Proudly Supports Breast Reconstruction Awareness (BRA) Day
Breast cancer is the most commonly diagnosed cancer in women (after skin cancer), yet less than half of American women are offered the option of breast reconstruction after mastectomy or lumpectomy. Likewise, less than 25% of women are provided information on ALL breast reconstruction options available to them.
BRA Day’s primary mission aims to change these statistics! The annual Breast Reconstruction Awareness Day is celebrated on October 21st this year. According to the Plastic Surgery Foundation, the purpose of this day is to “educate, engage and empower women to make the decision that is best for them following a diagnosis with breast cancer. That involves informing women, family members, caregivers and the media that the breast cancer loop remains open until a woman is informed of breast reconstruction options.”
The mission of BRA Day is very much aligned with Breast Advocate’s! Co-created by leading specialists and patient advocates, Breast Advocate is a free breast cancer app that provides evidence-based information and treatment recommendations, personalized for users. These recommendations include a vast amount of information on ALL breast surgery options, including all types of reconstruction, and the option of no reconstruction. With the personalized information in a patients hand, it is our hope to empower individuals to have the conversation they want to have with their medical team.
In honor of BRA Day, Breast Advocate founder Dr. Minas Chrysopoulo joined BRCA Strong to discuss breast reconstruction options available to women and men today. Watch it below:
Advances in Breast Reconstruction Are Changing How Women “Feel” After Mastectomy
Many patients undergo a mastectomy as part of their breast cancer treatment. A mastectomy is a procedure that removes the breast tissue and, in some cases, the breast skin and nipple-areola. During mastectomy surgery, nerves that allow patients to feel (known as ‘sensory’ nerves) are often cut, leaving the patient numb.
Unfortunately, many patients are not told they could end up with a numb chest after their mastectomy, so this often comes as a shock to patients following surgery. This statement was recently echoed by NBC’s Kristen Dahlgren in an article published on Today.com who “…never realized that women who have mastectomies lose feeling in their chests.”
There is some good news though… Thanks to advances in surgical techniques, patients can now maintain or restore feeling following breast cancer surgery.
Sensory Nerve Preservation
The first step in preserving feeling is identifying and protecting the sensory nerves at the time of mastectomy, if the patient’s anatomy and diagnosis allows. During a mastectomy, surgeons must prioritize removing all tissue that looks and feels like breast tissue, otherwise the patient will not get the maximum benefit from the mastectomy in the first place. However, there are steps surgeons can take during the surgery to identify and preserve some of the nerves that provide feeling. However, sometimes this is not possible because of the patients’ anatomy, or because of the location of the breast cancer.
Sensory Nerve Reconstruction
Sensory nerve reconstruction (microneurorrhaphy) is a microsurgical technique designed to reconnect sensory nerves that were cut during the mastectomy. This can be performed with or without a nerve graft.
Most commonly, sensory nerve reconstruction is performed in conjunction with autologous (‘flap’) breast reconstruction procedures like the DIEP flap. However, nerve reconstruction is also possible with implant-based breast reconstruction.
Although the sensation that returns is not usually as good as that provided by Mother Nature before the mastectomy, for most patients, regaining some feeling is far preferable to the alternative of a numb breast.
Unfortunately, at this time, sensory nerve reconstruction is only performed at the time of breast reconstruction and is not offered routinely by all plastic surgeons. Patients must do their research to find a surgeon who offers and regularly performs this procedure.
5 Things You Should Know Before Having Breast Reconstruction Surgery
Breast implants are NOT the only option
The most commonly performed method of breast reconstruction performed today uses tissue expanders and implants. Although this approach is a good option for many, it’s not the only option. Likewise, implants may not be the best option for some patients. Reconstruction options using your own tissue (referred to as autologous or “flap” reconstruction) is also an option. In particular, after radiation treatment flap procedures are associated with fewer complications than implant-based reconstructions.
Sensory nerve reconstruction may be an option
Following a mastectomy, many patients experience permanent numbness to the chest area and reconstructed breast. This is because the sensory nerves that provide feeling are usually cut during the mastectomy. There is some good news though! Advances in breast reconstruction techniques have made sensory nerve reconstruction possible: reconnecting the sensory nerves in the chest can significantly improve the return of feeling to the reconstructed breast.
Enhanced Recovery After Surgery (ERAS) protocols are making recovery easier
Many surgeons are now implementing ERAS protocols to ensure their patients experience an easier recovery following breast cancer surgery, with or without reconstruction. Regardless of the type of reconstruction performed, ERAS protocols are reducing hospital stays, shortening recovery, and reducing the need for narcotics to control discomfort after surgery.
Shared decision-making matters
Breast reconstruction is not a one-size-fits-all procedure. Ensuring you discuss all your options and how they align with your lifestyle, preferences, and goals is critical in planning the best reconstructive option for you.
You can choose NOT to have breast reconstruction
It is important for patients to remember choosing NOT to undergo breast reconstruction and instead opting to “go flat” is an acceptable choice. Going flat (aesthetic flat closure) gives patients seeking no reconstruction the ability to maintain balance and symmetry without reconstructing the breast(s). Women can also choose to go flat after breast reconstruction if they are unhappy with their reconstruction results or have experienced complications after breast reconstruction.
To learn more about ALL your options, download the Breast Advocate App today!
BETting Against Brain Mets With Promising Combination Therapy
Breast cancer metastasis (also known as “stage IV”) occurs when cancer cells leave the breast and travel to other parts of the body in the bloodstream or via the lymphatic system. The most common sites of spread are the liver, brain, bones, and lungs. About 30% of women diagnosed with early-stage breast cancer will ultimately develop metastatic disease. About 55% of women with HER2-positive breast cancer will progress to stage 4. Metastasis greatly impacts long-term survival; for breast cancer patients whose cancer has metastasized to the brain, the life expectancy is only about six months.
Brain metastases are difficult to reach and often are not susceptible to the same treatments as breast cancers in other parts of the body because they are blocked by the blood-brain barrier. However, a new study from Northwestern Medicine is reports some positive findings on a new treatment option.
A new combination therapy including a class of drug known as a BET inhibitor, greatly decreased the size of brain mets and increased survival in mice. About 75% of the mice who underwent this new treatment were cancer-free following the treatment. The BET inhibitor appears to sensitize breast cancer brain metastases to vinorelbine, a drug already approved by the FDA, demonstrating a potentially very promising therapeutic combination.
“The new combination therapy we identified can cross the blood-brain barrier,” said lead study author Dr. Maciej Lesniak, Northwestern Medicine chair of neurological surgery and professor of neurosurgery at Northwestern University Feinberg School of Medicine. “The therapy also targets brain metastases and significantly improves survival.”
The drug I-BET-762, used in combination with vinorelbine in the study, is only approved for trials by the FDA at this time.
3 New Genetic Mutations Linked to Male Breast Cancer
Our genes determine everything about our bodies. They play a key role in our health and can determine our likelihood of developing diseases. Some genetic mutations significantly increase the risk of developing breast cancer. The most common mutations associated with breast cancer involve the BRCA1 and BRCA2 genes. About 10% of male breast cancers are caused by mutations in the BRCA2 gene. Other examples of mutations that increase the risk of male breast cancer include those found in PTEN, PALB2, CHEK2 and NBN genes.
In addition to these well-recognized gene mutations, other very minor changes to our DNA code (known as single-nucleotide polymorphisms, or SNPs) also influence our risk of developing cancer. Unfortunately, these types of changes in our genetic code are much more common than BRCA gene mutations.
Although most genetic research associated with breast cancer risk is derived from studies in women, newly published findings bring insight on the genetic risks of developing breast cancer in men. A UK study, published in the Journal of the National Cancer Institute looked at the genotypes of 1,380 men diagnosed with breast cancer.
Results revealed that 3 new SNPs were significantly associated with an increased risk of male breast cancer. One of these SNPs is located on chromosome 6 (rs9371545), and two are located on chromosome 11 (rs554219 and rs78540526). These SNPs increase the risk of developing breast cancer in men by about 47%, 45%, and 61% respectively. Consistent with the predominance of ER-positive tumors in men, genetic correlation was strongest between male breast cancer and ER-positive female breast cancer. Although these genetic mutations are also linked to an increased breast cancer risk in women, the 3 new SNP variants have a greater impact on men.
Improved Decision-Making
While there is still a lot of research still needed, these findings can aid in the development of better risk assessment for men. For those choosing to undergo genetic testing, test results can help quantify individual risk and help guide treatment decision-making around risk-reducing options.
“This study, which shows more of a similarity between the genetic causes of the disease in men and women than previously thought, is a major step forward,” shared Dr Simon Vincent, director of research services at Breast Cancer Now. “Our knowledge of breast cancer in men is limited, because male breast cancer is rare which makes it difficult to collect enough tissue or blood samples to research and understand the disease. We now look forward to further research into the shared genetic causes of male breast cancer which could lead to developing risk reducing treatments and interventions to help prevent more cases among those at increased risk in the future.”
Potential Impact of Delays in Breast Cancer Surgery On Patient Outcomes During COVID-19 Pandemic
The COVID-19 pandemic is impacting many breast cancer patients and their surgical treatment plans across the globe. Many patients today are reporting delays in their breast cancer surgery due to the limitations in place by local governments to help ease the burden on the healthcare system created by COVID-19. The impact of these delays has raised concerns from patients and medical professionals about the long-term impact on patient health. A new study published in the Journal of American College of Surgeons attempts to provide some better understanding.
To gain insight into the effects of surgical delays on early-staged breast cancer patients, the researchers used the National Cancer Database to analyze breast cancer patients treated between 2010 and 2016. About 379,000 patients in the database underwent breast cancer surgery following a diagnosis of DCIS or early-stage (cT1-2N0) ER+ disease. The study evaluated whether longer times between diagnosis and surgical treatment had an impact on 5-year survival rates and cancer staging.
The authors of the study concluded that for women with early-stage breast cancer who had to delay their surgical care due to COVID-19, there should be no impact on overall survival.
The published research also noted there was no negative impact to survival for patients with estrogen sensitive, early-stage breast cancer who were taking tamoxifen or aromatase inhibitors as part of their treatment plan. Interestingly, patients with invasive early-stage breast cancer who had to delay their surgical treatment did not have an increased rate of pathologic upstaging (or a higher cancer stage diagnosis after surgery). Women with ER+ DCIS have a slightly higher risk of upstaging with surgical treatment delays of over 60 days. Similarly, patients with ER- DCIS have a higher risk of upstaging if surgical cancer treatment is delayed more than 120 days. However, even with the elevated risk in upstaging for the DCIS patient populations, there was no impact on their overall survival.
Although these findings cannot accurately account for the delays experienced by patients being treated during the COVID-19 pandemic, this information provides some reassurance for surgeons and their patients dealing with delays in breast cancer surgery.
