New Breast Imaging Has Advantage Over Traditional Mammograms

Penn radiologists are getting a new kind of clarity when it comes to breast imaging.

A revolutionary way to perform mammograms combining traditional mammography with 3D technology, called digital breast tomosynthesis (DBT), allows for more accurate pictures of breast health.

Every woman who comes to the Perelman Center for Advanced Medicine (PCAM) for their screening mammograms will get the new DBT test.

“DBT is more accurate – even more accurate than digital mammograms – because it uses traditional X-ray technology to capture images of the breast, while moving along a small arc around the breast to record images at different depths and angles,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania. “In preliminary research, it has been shown to reduce the number of false-positives and some false-negatives making mammography more accurate.”

Like traditional mammogram, the breast is compressed for about four to five seconds while a series of low-dose X-rays are taken to capture high-resolution images of the breast. These images are then digitally “stacked” to construct a total 3D image of the breast. This 3D image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles. Radiologists can also magnify images to reveal minute details.

“DBT allows Penn radiologists to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Breast images through DBT also allow radiologists to make new recommendations for follow-up screening and tests.

“DBT lets us to see the through some of the density of a breast,” says Dr. Conant. “For a woman with dense breasts we can personalize her screening and make different recommendations than we do for a woman who does not have dense breast tissue.”

Women who get their mammograms using the new DBT technology may find they are called les often for follow-up visits and more tests.

These new imaging advantages and advances in risk assessment are part of a collaborative effort between radiologists, medical oncologists and surgeons to try to improve breast cancer detection for women.

Technology continues to evolve, but collaborative research across all disciplines at Penn Medicine means patients who come to Penn for their mammograms benefit from the latest medical breakthroughs.

The DBT technology is still new and Penn researchers are studying ways to decrease its radiation exposure without losing image integrity.

“DBT is just one more step to improving breast care on an individual, personalized basis,” says Dr. Conant. “Combining personal history, genetic testing and new breast images creates a better, overall picture for breast health.”

For more information about breast cancer diagnosis and treatment at Penn Medicine, or to schedule an appointment, please visit PennMedicine.org/cancer/breast-cancer or call 800.789.PENN (7366).

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The Future of Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

The future of breast cancer treatment

The next 20 years will bring more targeted therapy for the treatment of advanced breast cancer, and will most likely see a decline in the use of chemotherapy.

Special drugs will continue to be developed that attack special “targets” that exist only in breast cancer cells. These drugs, we hope, will spare the patient’s normal cells, thus avoiding many of the side effects we have come to expect from chemotherapy.

Drugs with names like PARP inhibitors and MTOR inhibitors will become part of our everyday language, and more drugs that target HER-2 like trastuzumab will be released in the very near future.

Twenty years from now, many things about breast cancer treatment will have changed again. Tomograms may replace mammograms as the standard method of breast cancer detection,surgeons may not need to remove lymph nodes at all, and radiation therapy may become shorter in duration. Perhaps chemotherapy will have become a thing of the past.

Whatever the case, treatments will be better, more patients will be cured, and in every respect, there will be less suffering for patients at every stage of treatment.

Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.

Watch conference presentations from the 2011 Life After Breast Cancer conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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More Advances in Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

Advances in surgery for breast cancer

Surgeons began using a technique in the mid-1990s called the sentinel node procedure to evaluate whether a breast cancer has spread to the lymph nodes under the arm.

For almost a century, the standard of care included removing a large number of lymph nodes from the underarm of most breast cancer patients in an operation called an axillary dissection. This procedure left many patients in pain, disabled, or with a swollen arm.

The sentinel node procedure allows the surgeon to detect the first lymph node in the underarm. If that lymph node contains no cancer, then the surgeon doesn’t need to perform the axillary dissection: if the first lymph node is cancer-free, the other lymph nodes will almost always be free of cancer as well.

Using this technique, hundreds of thousands of patients have avoided unnecessary axillary dissections.

Advances in radiation therapy for breast cancer

Radiation treatments for breast cancer, particularly in those women who do not choose a mastectomy, have also advanced during the last 20 years.

Partial breast radiation describes several techniques in which the radiation is applied only to the portion of the breast where the cancer was found, rather than the whole breast. Until recently, whole-breast radiation had been the standard of care. Partial breast techniques are not appropriate for all women, but are being offered to patients with increasing frequency.

At the present time, radiation oncologists are exploring more targeted, shorter treatment periods in the hope that many patients can finish treatment in as little as three or four weeks, rather than the current six or seven.

Adjuvant therapy for breast cancer

Most women who have early stage breast cancer have adjuvant therapy after surgery.

Adjuvant therapy describes drug treatments that are given for a period of time after surgery in order to reduce the risk of recurrence or spread of the breast cancer.

Patients may receive several months or years of adjuvant therapy in the form of chemotherapy, hormonal therapy or both.

The most significant advance in the adjuvant therapy of early stage breast cancer came in 2005 in the form of a substance called trastuzumab, or Herceptin®. Trastuzumab is an antibody that attacks HER-2, a protein that is present in large amounts on certain breast cancer cells.

Only 20 percent of breast cancer patients are HER-2 positive (have too much of the protein), but these cancers can be very aggressive and spread quickly and often. Patients treated with this antibody for a year, along with several months of chemotherapy, reduce the risk of their cancer spreading by 50 percent.

Nearly every patient with HER-2 positive invasive breast cancer now receives trastuzumab in addition to chemotherapy..

In 2006, we began using a special test called the Oncotype DX® assay in patients who had cancers that were considered hormone-sensitive, particularly women whose hormone-sensitive cancers has not spread to the lymph nodes.

Oncotype is a diagnostic test that can provide information about the biological activity of the specific tumor. Along with other information, the test results can help in making decisions about whether or not to include chemotherapy in the treatment plan and indicate how likely it is that a woman’s cancer may return in the future.

For many years, patients with hormone-sensitive cancers that have not affected the lymph nodes received both chemotherapy and hormonal therapy. The Oncotype assay enables us to determine which of these women really need the chemotherapy and determine those who can do just as well without it.

Up to 50 percent of women with this type of breast cancer don’t need chemotherapy at all.

Hormone therapy for breast cancer

Even the way in which we use hormonal therapy for early stage breast cancer has changed.

Hormone therapy works by blocking the actions of certain hormones that may trigger cancer growth, preventing the body from producing hormones that may trigger cancer growth, or eliminate hormone receptor in the body.

For many years, the drug tamoxifen was prescribed for most women who had hormone-sensitive breast cancers and it was very effective in reducing the risk of recurrence or spread of the cancer.

In late 2001, we began to prescribe a new type of pill called an aromatase inhibitor. Aromatase inhibitors work better in women who have entered menopause at the time they are first diagnosed with breast cancer.

Tamoxifen remains the best choice for premenopausal women with early stage breast cancer.

Chemotherapy for breast cancer

Over the years, the use of chemotherapy for treating patients with early stage breast cancer has changed considerably.

In general, courses of chemotherapy are now shorter, lasting from 12 to 18 weeks instead of 24 weeks or even longer. Different drugs, particularly paclitaxel and docetaxel, are used in almost every patient who receives chemotherapy. Many of the most dreaded side effects of chemotherapy, particularly nausea and the risk of infection, have decreased considerably as a result of the changes we have made in the last 20 years.

Advances in treating advanced breast cancer

The treatment of advanced (metastatic or stage IV) breast cancer has seen drastic changes in the last 20 years.

Six new chemotherapy drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced breast cancer since 1992, and several other chemotherapy drugs used for other types of cancer are given routinely to breast cancer patients as well, with some success.

For patients with hormone-sensitive breast cancer, the aromatase inhibitors mentioned above have proven very useful, as has the drug fulvestrant.

Special compounds such as pamidronate, zoledronate, and denosumab are used routinely in women whose breast cancer has spread to the bones. These compounds are not cancer treatments, but protect the bones against the injuries that the cancer can cause.


Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.


Watch conference presentations from the 2011 Life After Breast Cancer conference.


Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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20 Years of Learning Breast Cancer Causes and Prevention

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

Every aspect of breast cancer prevention, diagnosis and treatment has seen meaningful changes in the last 20 years. In some areas of breast cancer research and treatment, the advances have been subtle; in other cases, they have been profound.

Learning what causes breast cancer

In just 20 years, we’ve come to understand there are many factors that can contribute to a woman’s risk of getting breast cancer.

In 1994, we learned that certain women have mutations in one of two genes — either BRCA1 or BRCA2 — and that these women were at a higher risk of developing breast and ovarian cancer during their lifetimes.

In 2002, we learned that women who take hormone replacement therapy (HRT) in the form of premarin and progesterone have an increased risk of breast cancer versus those who do not take HRT. The risk is not great, and women who took premarin without progesterone didn’t have such a risk, but as a result, millions of women stopped taking HRT.

Advances in breast cancer prevention

Mammograms

The mammogram remains the most important screening device in the detection of breast cancer and it probably saves thousands of lives every year.

Several years ago, the digital mammogram became the standard in most hospitals and breast centers. The digital mammogram experience isn’t much different for the patient, but these digital images are more accurate than older, film screen mammograms, particularly for younger women or women with very dense breasts.

Today, the breast imaging technology at the Ruth and Raymond Perelman Center for Advanced Medicine includes digital breast tomosynthesis, or DBT, to perform three-dimensional mammography for breast cancer screening and diagnosis.

The DBT system employs a digital X-ray that records a series of low-dose, high-resolution images of the breast while traversing a small (15 degree) arc around the compressed breast. The advantages of DBT include fewer false-positives and false-negatives associated with traditional mammography.

Preventative drug therapy

By 1998 we learned that a woman’s risk of developing breast cancer can be cut by 50 percent by taking the drug tamoxifen for five years. Several years later, researchers found that the drug raloxifene could accomplish the same thing, but only in postmenopausal women. More recently, the drug exemestane has been shown to reduce breast cancer risk as well, but again, only in postmenopausal women.

These drugs, however, have not gained widespread use in most women because of unpleasant side effects.

Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.

Watch conference presentations from the 2011 Life After Breast Cancer conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Penn Program Helps Breast Cancer Survivors Exercise During and After Cancer Treatment

Kathryn Schmitz, PhD, MPH, FACSM, is an associate professor at the Perelman School of Medicine at the University of Pennsylvania. She is an exercise interventionist who has led multiple trials, including the Physical Activity and Lymphedema (PAL) Trial. Dr. Schmitz's goal is to make sure oncologists, fitness trainers, and cancer patients understand the important role exercise has in cancer prevention, and cancer treatment.

Are you a breast cancer survivor who wants her strength back? Have you been looking to get back into an exercise routine but are unsure about what is safe for you to do? You’ve come to the right place.

Many breast cancer survivors want to know: Is exercise is safe during cancer treatment or after treatment is complete? The Strength After Breast Cancer (SABC) program is a new clinical partnership between the Penn Medicine and Good Shepherd Penn Partners: Penn Therapy and Fitness.

Strength After Breast Cancer program is a new program for breast cancer survivors that educates survivors about lymphedema and helps them to build strength. After just a few months, the program is quickly gaining popularity among patients and medical professionals in the breast cancer community.

The feedback from participants has been extremely helpful in shaping the program, with the goal being to deliver the best education possible to patients and empowering women to be strong-- beyond breast cancer, beyond therapy - for life.

Those of us involved in the program plan to continue to integrate the great feedback we are receiving in order to improve the program. Our hope is to develop a positive buzz due to the “word of mouth” of those who have completed the program. 

What Women are Saying about Strength After Breast Cancer

Even after cancer treatment, women are finding their bodies are strong and are learning valuable information from their activity leaders and peers, while gaining support along the way.

“I’m learning to use my body in a way that I never thought I could before cancer….and surely not after cancer.”

“The human body has a second circulation, the lymphatic system. I never knew how important this was, especially for women with breast cancer.”

“I learned a lot from my peers, and exercising in a group setting enabled me to learn more quickly than I would have on my own.”

Women in the program are providing great feedback about what they like about their classes and exercise sessions.

“The class instructors were great; they really explained the exercises well. They supplied me with everything I need to be able to continue to do this on my own.” 

“It was great to be in a class where everyone is just like you. We all could relate to each other and it was a great learning experience.”

“The small class size made it easy to get individual attention when I needed it.”
“I have been doing my exercises every day, but have some general questions.  I wish there was someone I could follow up with without making another appointment.”

“The materials that I received for doing the program at home are great, but an online resource you can visit to get the same information and updates would be even better; or maybe instructional exercise videos so that you can get a refresher if you need it.”

For more information about the Strength After Breast Cancer program, visit PennMedicine.org or email fitpal@upenn.edu.

To speak directly with a therapist about the program, please call 215-662-4793.

More articles about exercise and breast cancer:

From Breast Cancer to Figure Competitor: How I Out-Muscled Breast Cancer

Strength Training Helps Breast Cancer Patients



Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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Breast Cancer Research and The Role of Complementary Medicine

Cancer research is one of the cornerstones of Penn’s Abramson Cancer Center’s mission to eradicate cancer and it has helped distinguish the cancer center from other facilities across the country.

Because Abramson Cancer Center researchers work side-by-side with clinicians, these multidisciplinary cancer treatment teams are able to bring new discoveries from the lab to the clinical setting faster than ever.

Breast cancer research seeks to find new ways to prevent, detect and treat cancer.
Clinical trials at Penn may test new drugs and treatments, new screening methods, seek to determine genetic influence in a cancer diagnosis, or seek to improve the quality of life in cancer patients with nutrition, exercise or group therapy.

In the last four years, more than 800 breast cancer survivors have participated in breast cancer research at the Abramson Cancer Center. These studies have allowed Penn researchers to generate important knowledge that is used to improve the care for breast cancer survivors.

Here are some of the research highlights from research in complementary medicine and therapy for breast cancer.

Improving Communication Between Primary Care Physicians and the Cancer Team

Oncology and primary care communication can be difficult to manage. Recognizing the need to address these issues, researchers designed a study asking breast cancer survivors to identify areas where their primary care physicians could improve the quality of care for survivors. Because of this research, clinicians and researchers at Penn and in United States are working hard to enact change based on the patients’ input and concerns.
Mao JJ, Bowman MA, Stricker CT, DeMichele A, Jacobs L, Chan D, Armstrong K. “Primary Care Physicians’ Delivery of Survivorship Care: Perspectives of Breast Cancer Patients.” J Clin Oncol. Feb 20 2009; 27(6):933-8.

Integrating Complementary Therapies into Cancer Care

In this study, Penn researchers discovered the majority of the breast cancer survivors endorse the provision of therapies such as acupuncture, massage, and yoga for survivorship care. Because of this research, the Abramson Cancer Center continues to grow its patient-centered Integrative Medicines and Wellness Program.
Bonner-Millar L, Casarett D, Vapiwala N, DeMichele A, Stricker C, Velder L, Mao JJ, “Integrating complementary therapies into an academic cancer center: The perspective of breast cancer patients.” Journal of Society for Integrative Oncology. Summer 2010, 8(3), pp.106-113.

Genetic Links to Treatment Side Effects

The most recent research has led to the identification of a novel genetic variation that can be used to predict who may develop side effects to aromatase inhibitors. With this knowledge, researchers at Penn hope to create ways to determine which patients are most likely to benefit from aromatase inhibitors as well as those who may develop side effects. This effort will allow for the administration of individualized cancer care to improve quality of life and the survival of breast cancer survivors.
Mao JJ, Su HI, Feng R, Horn M, Aplenc R, Rebbeck TR, Stanczyk FZ, DeMichele A. “Association o f functional polymorphisms in CYP19A1 with aromatase inhibitor associated arthralgia in breastcancer survivors” Breast Cancer Res. 2011 Jan 20;13(1):R8.

The Abramson Cancer Center appreciates those patients who participate in this important research. Together, researchers and breast cancer survivors can make a difference in the lives of millions of women and their families whose lives have been touched by breast cancer.

Learn more about breast cancer research at Penn Medicine.
Search for a clinical trial on OncoLink’s Clinical Trials Matching Service.
Learn more about breast cancer treatment at Penn in Philadelphia.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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From Breast Cancer Survivor to Figure Competitor: How I Out-Muscled Cancer

Leslie Spencer is a professor of health and exercise science at Rowan University in Glassboro, NJ, where she coordinates both an undergraduate and graduate degree program in health promotion and wellness. She is married to Stuart Spencer, a Presbyterian minister, and they have two sons, Sam and Miles.

 

Ask the average person how someone’s body is likely to change over the course of cancer treatment and you’ll hear a variety of responses that might include:

• Weight loss
• Weight gain
• Loss of muscle mass and strength
• A general appearance of aging skin and the lack of a healthy glow
• Chronic fatigue, resulting in less energy for both pleasure and work
• Hair loss from chemotherapy treatments, though some people do not lose their hair at all

What you would not expect to hear is that this person became stronger, gained muscle, and that people told her she looked better after cancer treatment than she did before her diagnosis. Yet this is exactly what happened to me!

 

At age 44, I was diagnosed with aggressive cancer in both breasts. In April of 2009, I began my treatment journey with a double mastectomy. In August of 2010, I celebrated its conclusion by competing in my first women’s figure and fitness contest. In between were three additional surgeries (including a hysterectomy for cervical pre-cancer), 18 weeks of chemotherapy and six weeks of radiation therapy. Of the above list of expected symptoms, I managed to avoid the first three entirely and minimize the chronic fatigue. The hair loss from chemotherapy was unavoidable, but it grew back thick and healthy-looking.

 

It’s ironic that a life-long believer in health and fitness who becomes a college health professor should get cancer. When I was diagnosed, people were shocked. My whole life has been devoted to healthful and whole living. I’ve taught courses and written articles that focus on behavior change and what it takes to help people maintain good health habits, including cancer-avoiding ones. What’s not ironic, though, is that I responded to my cancer with the full force of the beliefs and habits I’ve cultivated over my life. As crazy as it sounds, cancer gave me an opportunity to put to the test all I’ve been espousing for the past two decades. What’s been really thrilling is to see that it works! Someone going through cancer treatment can buck the typical, often negative, reaction to it and instead approach it with expectations of improved fitness and an enhanced joy for living.

 

So what motivated me to train for a figure competition through cancer treatment? I did it to experience victory over cancer in a direct, unexpected and powerful way. I wanted to be known as the woman who was training for an athletic competition through her cancer treatment, not just a woman who was going through cancer treatment. Was cancer the dominant theme in my life during that time? Of course it was; I would be in a state of denial if I said otherwise. But that didn’t mean that cancer was the only theme in my life.

 

I also found it highly encouraging to have a vision for something to look forward to and be excited about beyond cancer. When you have cancer, it’s easy to fill every day with medical appointments and research on your treatment options and decisions you have to make. I remember taking “days off” from cancer, i.e. days in which I would have no cancer-related appointments, phone calls or internet research. Planning for the figure competition was a very satisfying way to spend a day off from cancer.

 

Finally, you might be wondering why I chose to pursue a figure competition and not a triathlon or other fitness goal. The answer is that the figure competition gave me something unique that a different goal would not have provided in the same way. It allowed me to feel beautiful to the point of being stage-worthy in a “glitter” bikini and four inch heels! After having both a mastectomy and hysterectomy, it was special to me to feel beautiful, feminine and sexy after losing the parts of my body that are associated with being female.

 

Did I win any trophies? No, but I didn’t need to. I knew I was a winner just being there. Since then, I’ve started a website and blog, Strong and Built, to support and inspire other women to aspire to their dreams after cancer. Please visit and share your story with me!

 

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.
The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:
20th Life After Breast Cancer
10th Focus On Gynecologic Cancers
Focus On Your Risk of Breast and Ovarian Cancer

 

Attend Penn Medicine’s Focus On Women’s Cancer Conference
Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

 

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

 

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

 

Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

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An Alternative Therapy for Some Breast Cancer Patients

Gary M. Freedman, MD, is an associate professor of radiation oncology at the Perelman School of Medicine and physician at Penn Radiation Oncology.

For more than 25 years, breast-conserving surgery and radiation therapy have been standard alternatives to mastectomy for women with early stage breast cancer. Radiation after a lumpectomy reduces the risk of a recurrence in the breast, and for some women it may also improve survival. The past decade has seen many advances in radiation that aim to preserve the high rates of success, but often must choose between optimizing the treatment delivery and reducing acute or long-term side effects, or reducing cost and convenience of care.

Hypofractionation uses fewer, larger dose radiation treatments (also called fractions) usually given over a shorter time period when compared to conventional radiation fraction sizes.

Hypofractionated radiation has been associated with a reduction in the length of a course of treatment by two to three weeks compared to conventional schedules that can last as long as six to seven weeks. This reduced length of treatment reduces cost to patients and insurance payers, reduces costs of travel or lost days of work to patients, and reduces the inconvenience of daily radiation treatments. This is particularly important in today’s national concern for cutting health care costs.

Hypofractionated whole-breast radiation has been a major subject of research outside of the United States for more than a decade. Randomized trials have been reported from Canada and the United Kingdom that show low breast recurrence rates using hypofractionation with long-term follow up of five to 10 years. In addition, these large studies did not show significant differences in cosmetic appearance of the breast or other negative side effects in women treated with a shorter course of radiation.

Despite the successful outcomes in these randomized trials from Canada and the United Kingdom, there has not been significant adoption of hypofractionation in the United States. The American Society of Radiation Oncology convened a task force of experts to make consensus recommendations. After a review of the available literature and randomized trials, consensus was reached that hypofractionation should be used only for selected patients. This recommendation was based on the many clinical questions that still remain about hypofractionation that are not able to be addressed by the data from the existing randomized trials.

At Penn Medicine, selected women meeting these optimal criteria are being offered the shortened radiation schedule. Current trials could make hypofractionation even more widely accepted for patients with early stage breast cancer. The Radiation Therapy Oncology Group opened a phase III randomized trial in May 2011 that proposes to establish a whole-breast three-week hypofractionation schedule that can be applied to a broader patient population. The study will compare typical whole breast radiation given over four and a half to six and a half weeks to a shorter schedule of only three weeks.

In summary, prospective randomized trials outside of the United States have established the principle that hypofractionation may be used with acceptable low side effects and equally low breast recurrence rates as conventional fractionation. However, for hypofractionation to become more widely applied in the United States, more data are needed about the optimal radiation techniques and limits on patient eligibility. This data may come from a newly opened phase III trial in the RTOG now opening at Penn Medicine and locations across the country. If successful, hypofractionation may be more widely accepted for use in the majority of patients with early stage breast cancer in the United States.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Learn more about radiation therapy for breast cancer at Penn Medicine.

The Abramson Cancer Center (ACC) is pleased to present the Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm

Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.


Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

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From the Lab to the Gym: Strength Training Helps Breast Cancer Patients

A few years ago, Kathryn Schmitz, PhD, MPH, proved through the Physical Activity and Lymphedema (PAL)Trial that slowly progressive weight training reduced the likelihood that breast cancer survivors who had been previously diagnosed with lymphedema would suffer a flare-up, and reduced the risk of onset for those breast cancer survivors who had not previously developed lymphedema.

Lymphedema is a side effect that can begin during or after breast cancer treatment. When lymph nodes are removed, the vessels that carry fluid from the arm to the rest of the body are also removed making it harder for fluid in the chest, breast, and arm to flow out of this area. If the remaining lymph vessels cannot drain enough fluid from these areas, the excess fluid builds up and causes swelling that may be accompanied by numbness, discomfort, and sometimes infection. It isn't life threatening, but can last a long time.

The PAL study was groundbreaking, since clinicians had previously thought breast cancer survivors should be cautious about overusing their arms, paying particular attention to how much weight they lift, in order to prevent lymphedema. No one doubted the value of the findings of the PAL Trial, but translating the program into one that could be done by any breast cancer survivor, anywhere in the country, in a safe and simple way is not quite as easy as it might sound.

The Strength After Breast Cancer Program was created after Dr. Schmitz and her colleagues took the essential elements of the PAL Trial and developed a six-session physical therapy-based exercise program for breast cancer survivors.

Consisting of a physical therapy evaluation, lymphedema education session, and four group physical therapy sessions, the Strength After Breast Cancer Program teaches breast cancer survivors how to safely perform strength training exercises so that they can exercise on their own either at home or in a gym setting.

Though the exercise sessions during the PAL Trial were led by personal trainers, exercise sessions in the Strength After Breast Cancer Program are led by physical therapists. A training program was created to educate the physical therapists at Good Shepherd Penn Partners Rehabilitation (GSPP) about how to lead these exercise sessions. Logistics were addressed in order to ensure that this program was easy for participants to access while also being representative of the challenges that participants in other cities might face when enrolling in a similar program. Once the physical therapists were trained and ready to enroll patients into the program, they began working with the doctors at the Abramson Cancer Center to refer women o the program.

Dr. Schmitz and her team have been educating clinical providers at Abramson Cancer Center, so they can refer breast cancer survivors to this program. From the front desk staff to the nurse practitioners and medical oncologists, all providers who interact with breast cancer survivors at Abramson Cancer Center are aware of the benefits of strength training for breast cancer patients, and how women can join the program.

The first group physical therapy session for the Strength After Breast Cancer Program were held in August. The first four participants have completed the program and plan to take what they have learned to exercising independently at home or in the gym.

Dr. Schmitz said everyone involved is excited that these women now have the necessary tools to improve their lives post-cancer. It is been an amazing journey trying to get from the setting of a clinical trial to the rollout of a clinical program, and it’s been an incredible learning experience for everyone involved, she said.

Learn more about Dr. Schmitz's groundbreaking research here.

Learn more about the Strength After Breast Cancer Program or email fitpal@upenn.edu. To speak directly with a therapist about the program, please call 215-662-4793.

Learn more about Breast Cancer Treatment at the Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the first Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the three conferences.

Read More

The Value of Adjuvant and Neoadjuvant Therapy for Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the last of four posts about the latest findings in treating breast cancer.

More News on Aromatase Inhibitors (AIs)
A group of bone health-related studies (Abstracts 516, 517, 518) presented at the 2011 ASCO conference provided some good news on bone loss. The studies showed that postmenopausal breast cancer patients undergoing endocrine therapy (aromatase inhibitors) do not experience an increase in their total number of fractures, despite having some level of bone loss.

Over a period of approximately six years, 5 percent of patients receiving aromatase inhibitors (AIs) suffered fragility fractures, the same percentage as occurred in the control group. Studies also show that exemestane may result in less bone loss than other AIs.

A third set of AI studies (Abstracts 522,523 525) strengthened the data supporting the proposition that women who experience endocrine-related symptoms, specifically arthralgia and bone pain, while taking AIs do have improved treatment efficacy.

Regional vs. Whole Breast Irradiation for Node-Positive Cancer
The controversy regarding the optimal treatment approach for breast cancer with one to three positive nodes has existed for some time. Current treatment guidelines call for regional lymph node irradiation (RNI) for all patients with four or more positive nodes, but have been less clear about the role of RNI in cases involving one to three nodes.

Another trial highlighted at the ACO conference, NCIC-CTG MA.20, bolsters the view that all node-positive breast cancer patients should be considered for RNI.

In this large, intergroup trial, women with positive nodes or high-risk node negative breast cancer were treated with breast-conserving surgery. They were then randomized to receive either standard whole breast irradiation (WBI) or WBI plus RNI. The study demonstrated a clear advantage for the WBI plus RNI group for five year overall and disease-free survival. They did experience modestly increased toxicity, mostly attributable to a slight increase in grade II lymphedema.

Focus on Neoadjuvant Therapy for HER2-Positive Breast Cancer
Neoadjuvant therapy, or therapy that is given before primary cancer treatment, is becoming a standard way to study new approaches to treating breast cancer. Angela DiMichele, MD, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, noted the emphasis on neoadjuvant therapy at the ASCO meeting, citing several studies for women with HER2-positive breast cancer, a group for which there is a growing number of treatment options.

The first (abstracts 505, 507) combined lapatinib and trastuzamab in a neoadjuvant setting without chemotherapy for women with HER2-postive tumors >3cms or >2cms with palpable nodes. The results were positive with an overall pCR of 28 percent and a 40 percent pCR in ER- negative patients and strengthened the evidence for the dual receptor blockade as the new standard of therapy for HER2-positive tumors. The study did have an 8 percent drop out rate resulting from toxicity, primarily diarrhea and acne form rash.

The other studies (abstracts 531, 532) looked at the results of adding chemotherapy to the dual receptor blockade. The first demonstrated a clear advantage to lapatinib and trastuzamab with anthracycline-taxane therapy in terms of pCR, but left unanswered issues as to whether the increased toxicity with chemotherapy is worth the risk and whether the pCR will translate into long-term survival.

Triple-Negative Breast Cancer
While the options for HER2-postive patients continue to expand and improve, the need remains to discover more effective therapies for the 15 percent of patients diagnosed with triple negative breast cancer (TNBC). While considerable attention was focused on TNBC at ASCO 2011, the meeting did not yield significant progress for women with this disease.

Several trials offered data suggesting that basal subtypes of breast cancer might be sensitive to platinum, but much more information is needed to clarify which subgroups of patients and under which circumstances will benefit from this therapy (Abstract 1015). Similar issues apply to the use of agents targeted to the mTOR and PI3K pathways (abstract 1016). The conclusion: For TNBC, a commitment to larger, well-designed trials with integrated, adequately-powered biomarker assessment are needed.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

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E! Reporter Giuliana Rancic Reveals She Has Breast Cancer

It’s a recommendation based on years of research: Beginning at the age of 40, all women should have an annual mammogram to check for breast cancer.

But some doctors are recommending women get mammograms before the age of 40.
Recently, Giuliana Rancic, entertainment reporter for the E! Network, revealed that at the age of 36, she has breast cancer.

Rancic and her husband had been trying to have a baby through in vitro fertilization (IVF) treatments. Before her third treatment attempt, her doctor told her she should have a mammogram. If there was any chance she could have breast cancer, hormones related to her pregnancy may accelerate the cancer.

In an interview on the “Today Show” this week, Rancic said she fought the idea, as she was still under 40 and had no familial history of breast cancer in her family. Soon after her mammogram, she was diagnosed with early stage breast cancer.

“Usually we don’t recommend routine screening before the age of 40, but each woman should discuss this with her health care provider and weigh her individual risk for breast cancer. Some women at high risk we will begin screening much earlier, even as early as 25 years,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania.

Women who come to Penn Medicine for their mammograms are screened using a revolutionary new imaging process: digital breast tomosynthesis (DBT).

“DBT often allows us to see areas better than on regular digital mammograms, because the 3-D technology captures images of the breast at different depths and angles, all during the same compression as the regular mammogram,” says Dr. Conant. “In preliminary research, 3-D tomosynthesis imaging has been shown to reduce the number of false-positives and some false-negatives making mammography using the 3-D technique more accurate.”

Like a traditional mammogram, the breast is compressed for four to five seconds while a series of low-dose X-rays images are taken to capture high-resolution images of the breast. These imaged are then digitally “stacked” to construct a total 3-D image of the breast. This image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles.

“DBT offers Penn radiologists a new kind of clarity, allowing them to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference
Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

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How Weight and Hormones Affect Breast Cancer Outcomes

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the third of four posts about the latest findings in treating breast cancer.

BMI and Cancer Outcomes
In recent years, the belief that obese breast cancer patients have worse outcomes has become somewhat entrenched in the cancer community. A North American Breast Cancer Group study presented in 2010 appeared to be confirmed those findings. But just one year later, data presented at ASCO 2011 data (abstracts 513, 514, 515), appears to contradict that belief.

Angela DeMichele, MD, associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said the combined analysis of five National Cancer Institute studies demonstrate no compelling evidence that obesity, a body mass index (BMI) of 30 or more, compromises breast cancer survival. The studies also show BMI does not affect estrone (the estrogen left after menopause, made primarily by body fat) levels in postmenopausal women.

Despite the discrepancy in the findings, Dr. DeMichele reinforced the need to encourage obese women to lose weight and provide active support to women undergoing hormonal treatment to help them avoid weight gain.

Exemestane Yields Impressive Results in Prevention Study
One of the most noted studies at this year's ASCO meeting was the MAP3 trial (abstract 504), which presented persuasive evidence that the aromatase inhibitor exemestane, has a significant effect in preventing invasive breast cancer in medium to high risk postmenopausal women. The study, released simultaneously in the New England Journal of Medicine, represents a "huge victory for chemoprevention," in the words of the Angela Bradbury, MD, who presented the study at the ASCO meeting.

In this large, multinational study, women who received exemestane had a 65 percent reduction in invasive breast cancer. This is a superior result to the 50 percent reduction seen in studies utilizing tamoxifen and raloxifen.

Over a three-year period, exemestane reduced the incidence of ductal carcinoma in situ and other precancerous conditions, and appeared to reduce the incidence of more aggressive breast cancers in those women who did develop the disease. In addition, the study found that the side effects; hot flashes, insomnia, and arthralgia; were not excessive and generally well tolerated by the study participants. Serious toxicities including fractures, other cancer, osteoporosis and cardiovascular events were not seen in the study participants.

While the MAP3 results are without question important and exciting, some experts question whether healthy women will take a drug that is associated with a spectrum of menopausal type symptoms, even to achieve an important goal of reducing invasive breast cancer. The answer may depend on a variety of factors including:

• Level of individual risk
• Age
• Overall health
• Conversations between women and their doctors as they become aware of this new study and its implications for preventing the second leading cause of cancer deaths in women

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, The Value of Adjuvant and Neoadjuvant Therapy.

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As Surgery for Breast Cancer Evolves, So Do Outcomes

Carla S. Fisher, MD, is an assistant professor of surgery at the Perelman School of Medicine and a breast surgeon. Dr. Fisher sees patients at the Rena Rowan Breast Center.

An article was published earlier this year in the Journal of the American Medical Association (JAMA) that challenged the current way we approach breast cancer treatment and surgery.

The article discusses the results of a randomized clinical trial that took place at many hospitals across the United States. In this trial, breast surgeons found that not every woman with breast cancer that has spread to the lymph nodes may need a full axillary (armpit area) lymph node dissection. As those of us in the medical community examine the results of this study and how they apply to our own patients, it seems appropriate to review a brief history of the evolution of surgery for breast cancer.

The history of the discovery and treatment of breast cancer is rich and one that has been documented back to the ancient Chinese and Egyptian cultures, as far back as 2600 BC. The most common forms of early treatment were medical remedies. In more “modern times,” beginning the 18th century, surgery became more common and well developed as a treatment for breast cancer. Surgery almost always involved removal of the entire breast (mastectomy).

Eventually, removal of all of the axillary lymph nodes and the pectoralis major muscle (one of the main muscles of the chest wall), a radical mastectomy, was also recommended. The surgery was always the same, regardless of the size of the breast cancer or presence of disease in the lymph nodes. This radical procedure, with some minor modifications, was practiced for over 70 years, well into the 20th century. In fact, many women may recall an aunt or grandmother who underwent a radical mastectomy with subsequent deformity of the chest wall.

Surgical techniques continued to become more refined and less morbid for the patient, but it was truly the discovery of the roles of radiation therapy, medical therapies (chemotherapy and endocrine treatment) and early detection (mammography) that propelled breast cancer treatment to where it is today. In the later part of the last century, breast conservation surgery was introduced. This surgery involved the removal of the cancer, without removal of the entire breast, followed by radiation therapy. Additionally, the sentinel lymph node biopsy technique was developed that allowed breast cancer staging without removal of all of the lymph nodes in the armpit area. If the sentinel nodes contained cancer only then would a full axillary dissection (removal) be performed in which the rest of the lymph nodes would be removed.

All of these surgical advances have given women with breast cancer more choices while maintaining or improving cancer care with less side effects and better cosmetic outcomes.

Now in 2011, we have evidence that suggests that even when breast cancer has spread to the axillary lymph nodes, we may not have to remove all of these lymph nodes. The important thing to point out is that while these findings are exciting and may represent a change for some women with breast cancer, the research and findings only apply to SOME women.

Not all women undergoing surgery for breast cancer will fall within the criteria used in this study, specifically women undergoing mastectomies. Younger women and women with certain types of breast cancer also may not qualify for this less aggressive surgery. What this study emphasizes, more than ever, is the importance of an informed discussion between patients, surgeons, medical and radiation oncologists.

At Penn, our multidisciplinary approach to breast cancer care gives us the opportunity to discuss the most up-to-date research, such as this recent publication, and determine how we can best apply it our patients.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:

• 20th Life After Breast Cancer
• 10th Focus On Gynecologic Cancers
• Focus On Your Risk of Breast and Ovarian Cancer

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

 

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Understanding the Biology of Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the second of four posts about the latest findings in treating breast cancer. 

One of the larger trends in cancer treatment, especially breast cancer treatment, is the increasing ability to identify biologic subtypes of the disease and the need for better prognostic biomarkers, or biomarkers that provide information regarding outcome without regard for therapy.

Angela DeMichele, MD, MSCE

At the 2011 ASCO conference, Angela DiMichele, MD, MSCE, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, talked about the important role biology plays in identifying these markers. As co-program leader of the Abramson Cancer Center's National Cancer Institute (NCI)-approved breast cancer program, she discussed one such marker, Ki-67, and intrinsic genetic subtypes.

Two studies (Abstracts 500 and 501) provide support for the validity of Ki-67 as a means of identifying highly proliferative tumors and those that are more likely to respond to specific chemotherapy regimens. Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This characteristic makes Ki-67 a good tumor marker. This test is done on a sample of tumor tissue, to help predict your prognosis.

Many studies have been done to determine Ki-67's value as a tumor marker test. Researchers agree that high levels of Ki-67 indicate an aggressive tumor and predict a poor prognosis and tumors that tested positive with high levels of Ki-67, have a higher risk of recurrence.

Perhaps more intriguing is the emergence of intrinsic subtypes of breast cancer. Gene expression studies have identified several distinct breast cancer subtypes. The value of this information is less clear, but understanding the specific biologic characteristics that influence these subtypes may help determine which patients will respond to which therapies.

Cancer researchers now understand that breast cancer is a spectrum of diseases, ranging from those that are more endocrine driven to those that are more chemosensitive. These findings reinforce the need for accurate molecular profiling for all breast cancer patients.

OncotypeDX has become a standard means for molecular profiling and guiding breast cancer treatment decisions, but another, potentially even more comprehensive tool is on the horizon. PAM-50 screens for 50 genes and is potentially more sensitive, but is not yet clinically available. Further studies are needed to validate its use.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, How Weight and Hormones Affect Breast Cancer Outcomes.

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Latest Trends in Treating Breast Cancer - 2011

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the first of four posts about the latest findings in treating breast cancer.

The summary of the latest news in breast cancer treatment was delivered in rapid-fire style at the Abramson Cancer Center’s 2011 Update in Breast Cancer ASCO summary course. Unfortunately, many of those attending the annual conference thought the news was "not as exciting as last year," because of the lack of any single, major breakthrough.

At the 2010 conference, Penn cancer researchers highlighted the promising results of targeted immunotherapy in treating metastatic breast cancer.

While there may have been no single big story, significant data were presented across the full platform of breast cancer-related topics: from prevention to neoadjuvant therapy and managing metastatic disease. Major emphasis was placed on improved understanding of the biology of breast cancer and the development of more targeted therapies tailored to match the specific genetic profiles of patients.

From the Headlines: FDA Approval for Bevacizumab

David M. Mintzer, MD

One issue that has been in the headlines during the past months is the status of FDA approval of bevacizumab (Avastin®) for first-line of treatment of HER2-negative metastatic breast cancer in combination with paclitaxel.  Bevacuzumab received fast track approval in 2008. Subsequent studies, including those presented at ASCO 2011, demonstrated modest improvements in progression-free survival, but none in overall survival or improvement in disease-related symptoms.  The down sides of the drug are its toxicity and high costs of administration.

Just hours after the update concluded, the Oncologic Drugs Advisory Committee voted 6-0 to withdraw FDA approval for bevacizumab for treating HER2-negative metastatic breast cancer. While the committee vote was unanimous, the hearing itself was marked by emotional pleas from breast cancer patients who believe they are benefitting from bevacizumab treatment.   The recommendation is not binding and a final decision is expected in September. It also does not affect insurance coverage or availability at this time, or the drug's approval for other cancer types.

"We know this drug has activity in some women," said David Mintzer, MD, clinical associate professor and chief of hematology/oncology, Pennsylvania Hospital. "We have all seen it and we know that activity stops when you stop giving the drug, but we just know now how to predict which women will get that benefit."

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer 

Coming up next, Understanding the Biology of Breast Cancer.

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Woman Beats Breast and Esophagael Cancer: Wants to Give Back

A 12-year breast cancer survivor, Gail Slappy was diagnosed with esophageal cancer in April 2009. Upon being diagnoses, Gail began receiving treatment at Penn Medicine's Abramson Cancer Center. When she retires from a teaching career this upcoming Spring, Gail plans on volunteering at the Abramson Cancer Center.

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My name is Gail Slappy. I’m a breast cancer survivor. In April of 2009 I was diagnosed with esophageal cancer.

I felt fullness in my chest that wouldn’t go away. After repeated attempts at diagnosing myself, I went to my primary care physician. She referred me to Gregory Ginsberg, MD, from Penn Gastroenterology.

Following an endoscopy, it was determined that I had a mass at the bottom of my esophagus leading into my stomach. Dr. Ginsberg informed me that I had esophageal cancer.
I thought to myself, “Oh no, not again!”

I’m a 12-year survivor of breast cancer. I was shocked that I was having another recurrence of cancer.

The multidisciplinary approach

Then, Dr. Ginsberg and I began to talk. I’m familiar with Dr. Ginsberg because he has been treating me over the years. He told me how he would handle my cancer treatment. Then, a team of doctors came in and discussed how I would be treated. The team consisted of Ursina Teitelbaum, MD, a hematology/oncologist; John Plastaras, MD, a radiation oncologist; and Ernest F. Rosato, MD, a surgeon. We all discussed how my case would be handled.

I felt quite relieved and confident that I was receiving the best treatment possible. There was a comprehensive team of doctors, and everyone was consulting with one another about my treatment.

Compassionate care

Throughout my experience at Penn Medicine's Abramson Cancer Center, I felt supported. Everyone was just so compassionate towards me and my care. I would receive phone calls at home asking how I was doing.

At my lowest point, I grew quite weak from the combination of radiation and chemotherapy. When I would go to receive therapy, everyone understood how I was feeling and treated me with the most compassion I could ever receive. One time, when I was receiving radiation, one of the radiation therapists talked to me so nicely. The nature of his voice and the way he spoke to me so calmly let me know I would be alright. It truly made all of the difference. He even said that I looked great even though I felt lousy and I probably looked lousy too! He was endearing and he helped me a great deal.

After I had my surgery, the nursing staff and the doctors in the hospital were so kind and gentle. They helped me through the whole process. Everyone was very concerned, very attentive, and genuinely interested in my care, my progress, and my recovery. People always asked what they could do to make me comfortable and how they could help me. That was the sentiment throughout my whole recovery at the hospital.

That’s why I like the comprehensive approach at the Abramson Cancer Center because everyone is in dialogue with one another. They are constantly updating each other on your condition, and making sure that you are okay.

Giving back
I’ve been recovering from my illness. I’m a teacher, and I plan to retire in June. Once I heal, I want to give back. I plan on volunteering at the Abramson Cancer Center. I want to help other individuals who may be diagnosed with cancer and help them get through it. I want them to know it’s not a death sentence or the end of the world. In spite of the seriousness of the illness, you can conquer it. You can be a champion.

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