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Dr. Lucy Langer and Dr. Tammy De La Melena Present at the 2016 San Antonio Breast Cancer Symposium

March 23, 2017

The San Antonio Breast Cancer Syposium was held December 6 - 20, 2016 in San Antonio, Texas. Dr. Tammy De La Melena, Breast Surgical Oncologist, and Dr. Lucy Langer, Medical Oncologist, gave presentations at the symposium focusing on individual topics and how Compass Oncology uses clinical research to provide the best care possible for their patieints. Below are summaries of the two presentations given by Dr. Langer and Dr. De La Melena.

Triple-Negative Breast Cancer and What’s Changed

Dr. Lucy Langer, Medical Oncologist - Compass Oncology

There are several different types of breast cancer, including triple-negative breast cancer. This means that there are no receptors for HER2, Estrogen or Progesterone on the breast cancer cells. This changes the types of treatments available to the patient. Currently medical oncologists can only use chemotherapy to treat these cancers. There are drugs and treatment therapies for triple-negative breast cancer currently being analyzed through clinical trials and research.

Preventing Triple-Negative Breast Cancer (TNBC)

The current medications recommended for the prevention of breast cancer in high risk individuals are good at preventing only estrogen-positive breast cancers and have minimal or no impact on the rates of triple-negative cancers. More studies are needed to understand how these cancers come about, and how best to prevent them.

Some of the ongoing studies for prevention of triple-negative breast cancer include the following naturally-occurring agents:

  • Retinoids - found in leafy greens & tomatoes
  • Omega-3 fatty acids - found in fish, especially salmon, and nuts, especially walnuts
  • Polyphenon-E - the ingredient extracted from green tea

Also Metformin, a drug typically used for diabetes treatment, appears to have some promise in the prevention of TNBC in some cases.

Subtyping of Triple-Negative Breast Cancer is under Clinical Research

More specific subtypes of the triple-negative breast cancer are being analyzed for more personalized treatment of individual cases. An emerging test called PredictAR, not yet commercially available, is being used to collect data about these subtypes. The PredictAR test is similar to other subtyping tools like the Oncotype Test, the Breast Cancer Index, or other tests that are being used now to help guide treatment.

Physicians and cancer researchers are getting smarter when designing triple-negative breast cancer trials based on these subtypes of the cancer. The PredictAR test can show which patients will react positively to specific drugs, allowing researchers to assess that data in determining treatment options in future cases.

Compass Oncology offers over 60 clinical trials, and we have many trials in breast cancer. Some trials are evaluating optimal treatment for specific subtypes or for triple-negative breast cancer. This is available through Compass Oncology to patients in the Portland, OR and Vancouver, WA area. We will continue to monitor data from these trials and research to provide the best possible treatment options for our patients.

How Close is Too Close? The 30 Year Margin Debate on Lumpectomies is Concluded

Dr. Tammy De La Melena - Breast Surgical Oncologist, Compass Oncology

The debate of how far from the tumor a breast cancer surgeon must go while taking the least amount of breast tissue when performing lumpectomies dates back to the mid-1960s. Back then they didn’t have data proving the best margin of normal tissue to be removed around a breast tumor. That resulted in about 50% of lumpectomy cases going back for additional surgery because it was missed the first time. In the 1990s, their target of how close they could get to the tumor was about 1 centimeter. In the 2000s, that target was decreased to 4 mm, and then decreased still to 1-2 millimeters in the 2010’s. So what is the margin today?

With advancements in technologies over the years, and being able to see the tumor and its location more clearly through things like breast imaging, oncologists are now able to make a conclusion about the best way to decrease the margin between where the tumor is located and how much of the breast to remove in patients who undergo lumpectomies. This can help decrease the chances of additional surgery if the first lumpectomy didn’t catch the entire tumor.

The Consensus Challenge

In 2014, a multidisciplinary panel of surgeons, radiation oncologists, and medical oncologists from the Society of Surgical Oncology, American Society of Radiation Oncology, and American Society of Clinical Oncology all gathered together to review data from over 33 studies, consisting of over 28,000 patients, and gave a consensus based on their data. For the data to be approved and used by oncologists including our team at Compass Oncology, this group had to achieve a 90 percent consensus on their findings and they were recently able to reach that.

The Final Conclusion

So what was their consensus? The panel concluded that if there is no ink touching the tumor, it can be considered a clear margin.

What does that mean? The pathologists used what is called the “staining technique,” which involves using a safe dye (or ink) to color the area of the breast tissue sample removed where the tumor is located. When looking at the sample under a microscope the pathologist can see how far the tumor tentacles extend towards the cut edge of the sample (inked edges).  As long as the tumor is not touching that cut (now-colored) edge, it’s safe to consider this a “clear margin,” and the likelihood of the patient going back for additional lumpectomies is greatly decreased.

What Does this Research Mean for Breast Cancer Patients?

This is important because the surgical oncologist has a much better idea of how much (or how little) breast tissue to remove during surgery, resulting in better outcomes and decreased chances of additional surgery.

Compass Oncology continues to stay aware of the latest evidence-based findings from the key players in cancer research making recent advances such as these available to breast cancer patients in the Portland and Vancouver area. By understanding how to use the latest technologies our oncologists in multiple disciplines (surgery, radiation and medical oncology) are able to reduce additional required surgeries for some breast cancer patients. This can also help in reducing financial burden on patients, and reduces their time away from work and regular duties for their families.