 M. Michele Blackwood, MD, FACS, discusses the significance of early cancer screenings.

Dr Blackwood on the Significance of Early Breast Cancer Screenings

M. Michele Blackwood, MD, FACS, chief, Section Breast Surgery, Rutgers Cancer Institute of New Jersey, professor of Surgery, Rutgers Robert Wood Johnson Medical School, medical director, The Center for Breast Health and Disease Management, the Barnabas Health Ambulatory Care Center, discusses the significance of early cancer screenings.

According to Blackwood, routine breast cancer screenings play a pivotal role in early detection and subsequent management of breast malignancies. Mammography, the cornerstone of breast cancer screening, enables the identification of subtle abnormalities in breast tissue, often before clinical symptoms manifest. The utilization of mammographic screening has been associated with a significant reduction in breast cancer mortality rates, primarily attributable to the detection of tumors at earlier, more treatable stages, she says. Additionally, advancements in imaging modalities such as digital mammography and tomosynthesis have enhanced the sensitivity and specificity of breast cancer detection, further augmenting the efficacy of routine screenings.

Blackwood explains that early detection through routine screenings enables the implementation of less invasive therapeutic interventions, potentially mitigating the need for extensive surgical procedures and adjuvant therapies, thereby improving patient outcomes and quality of life.

Blackwood also notes that breast cancer screenings serve as a platform for patient education and engagement in health-care decision-making. Clear communication regarding the importance of regular screenings empowers individuals to proactively participate in their own health management, fostering a collaborative patient-physician relationship.

Breast cancer screenings offer substantial benefits in terms of early detection, accurate diagnosis, and improved treatment outcomes, Blackwood continues. Emphasizing the significance of these screenings within clinical practice is paramount in mitigating the burden of breast cancer morbidity and mortality. Current clinical trial pursuits combined with research and advocacy efforts are warranted to optimize screening strategies and ensure equitable access to this vital aspect of breast cancer care, Blackwood concludes.

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M. Michele Blackwood, MD, FACS, discusses the significance of early cancer screenings.

M. Michele Blackwood, MD, FACS, chief, Section Breast Surgery, Rutgers Cancer Institute of New Jersey, professor of Surgery, Rutgers Robert Wood Johnson Medical School, medical director, The Center for Breast Health and Disease Management, the Barnabas Health Ambulatory Care Center, discusses the implementation of the phase 2 I-SPY 2 trial (NCT01042379) in breast cancer at Robert Wood Johnson Medical Center.

The ongoing trial is aiming to determine which new agents are most effective in various types of breast cancer tumors by learning more about which early indicators of response are predictors of treatment success. Investigators are evaluating the efficacy of novel drugs in sequence with standard chemotherapy in order to identify treatment strategies for subsets of patients based on biomarker signatures of their disease with high estimated pathologic complete response rate.

In May through December 2021, investigators at Robert Wood Johnson Medical Center began implementing all of the components necessary to conduct I-SPY 2 by aligning staff on the procedures and goals of the study, conducting proper training, and obtaining the various agents needed for the trial, Blackwood says. This preparation was necessary due to the substantial number of operational pieces needed for this study, and this allowed investigators to enroll their first patient at Robert Wood Johnson Medical Center in January 2022, Blackwood adds.

Upon enrolling this patient and others considered for the trial, their medical information was shared at a multidisciplinary meeting with the rest of the clinical team and trial coordinators. Because patients enrolled on the study have advanced stage II and III breast cancer, investigators aimed to quickly address patients with biopsies, MRIs, and MammaPrint assays, Blackwood continues. By conducting these tests quickly, investigators could limit the time between patient enrollment and the start of treatment, since beginning treatment within the first 2 weeks of enrollment was better for overall patient care, Blackwood explains.

Notably, instead of sending patients for neoadjuvant chemotherapy, surgeons saw the patients on a more frequent basis than usual, with visits occurring at least once a month for several months prior to surgery, Blackwood notes. This allowed patients and their family or caregivers to receive pertinent information and ask questions, Blackwood concludes.

M. Michele Blackwood, MD, FACS, discusses the implementation of the phase 2 I-SPY 2 trial in breast cancer at Robert Wood Johnson Medical Center.

Dr. Blackwood on the Implementation of the I SPY2 Trial in Breast Cancer

Thanks to advances in research, targeted therapies, and a more personalized approach to treating patients diagnosed with breast cancer, more surgical options exist for patients with breast cancer patients than ever before.

With numerous options for reconstruction, surgeries can be minimal or advanced. Breast preservation and scar minimization have become real options for women undergoing surgery. Surgeons, once solely interested in the removal of the primary tumor, are now incorporating techniques to precisely remove all cancerous cells while preserving healthy breast tissue, skin and nipples, and giving patients the option to receive their desired cosmetic outcome. 

Due to more frequent detection of smaller cancers and a better understanding of cancer biology, de-escalation of therapy is becoming increasingly more common in the breast cancer world.

Only a couple of decades ago, patients diagnosed with early-stage breast cancer (stage 0/stage 1) were often limited to lumpectomy with radiation or mastectomy to achieve recovery, and most  received the same care. Now, patients have many choices, and there are many changes in the way that surgeons approach breast cancer removal that have evolved over the past 10 to 20 years; this involves surgical techniques such as lumpectomies that hide scars, nipple-sparing mastectomies, reconstruction, and in some cases, no surgery at all.

During a lumpectomy procedure, the surgeon removes the cancer or other abnormal tissue and a small amount of the healthy tissue that surrounds it. This ensures that all of the abnormal tissue is removed and is also breast-conserving, leaving the natural breast intact. Now, surgeons have options such as an oncoplastic breast reduction and mastopexy, which allows tumors in problematic locations to be treated, while avoiding a poor cosmetic result or asymmetry. To do this, surgeons will combine breast cancer tumor removal and plastic surgery techniques at the same time of breast conservation surgery, giving patients confidence in knowing they can have their cancer removed while receiving their desired aesthetic outcome.

Although breast conservation surgery has become the gold standard for patients with early breast cancer, mastectomy remains an option for patients and is sometimes necessary, and we often find that women may experience a feeling of safety from having the whole breast removed. However, long gone are the radical mastectomies that removed not only breast tissue, but also extensive breast skin, lymph nodes, and underlying chest muscles. 

New techniques can often preserve the skin and nipple of the breast during surgery so that a later reconstruction looks and feels more natural; this includes procedures such as DIEP flap, which even offers a mini tummy tuck as part of the procedure. Surgical reconstruction of the breast following mastectomy has also become an important aspect of the patient’s rehabilitation process, as this can improve self-esteem.

Women have many options available to them today to strengthen their confidence after breast cancer. As another form of reconstruction post-mastectomy that does not require additional surgery, we have seen in recent years that patients may opt for acquiring 3D nipple tattoos. Tattoo artists can create an amazingly realistic image of a nipple that appears to have physical dimension, but is flat to the touch. These permanent nipple tattoos are designed and performed by tattoo artists in shops and in some specialized medical centers.

Patients are often shocked to learn that one of their options may be no surgery at all. Depending on the type of cancer, the quality of their health, age, and pre-existing conditions, it may be determined that the patient should take a daily antiestrogen pill. With this option, we see that their cancers are either shrinking or drying up dramatically, or they haven't grown at all.

Breast cancer is a complex disease with multiple causes, types, and treatment options. Although the surgical emphasis remains on removal for the cancer, the future of breast cancer care began only a short time ago with the revolutionary concept of breast conservation, and has not yet finished. Clinical research, multidisciplinary approaches, and more effective treatments are continually evolving through research and clinical trials. Surgeons must keep up with this process, and lead future changes to reach the goal of complete recovery for every patient.

, is chief, section of breast surgery at Rutgers Cancer Institute of New Jersey and northern regional director of breast services for RWJBarnabas Health.

Articles

Thanks to advances in research, targeted therapies, and a more personalized approach to treating patients diagnosed with breast cancer, more surgical options exist for patients with breast cancer patients than ever before. 

M. Michele Blackwood, MD, FACS

Articles

Dr Blackwood on the Significance of Early Breast Cancer Screenings

Dr. Blackwood on the Implementation of the I SPY2 Trial in Breast Cancer

The Future of Breast Cancer Surgery Is Here