Monica Morrow, MD, chief of Breast Service at Memorial Sloan Kettering Cancer Center, discusses the factors that impact the decision to use nipple sparing mastectomy versus conventional mastectomy in patients with breast cancer. The decision to use a nipple sparing approach in patients is dependent on 2 considerations. These relate to the cancer as well as cosmetic appearance of the breast.

Because there is a higher likelihood of nipple involvement in patients with larger cancers closer to the nipple, the ideal candidate for nipple sparing mastectomy would be a patients with a small peripheral breast cancer. Studies have also shown that for those patients where HER2 is over expressed, they are more likely to have nipple involvement because of a higher association to ductal carcinoma in situ (DCIS), says Morrow.

In terms of cosmetic appearance, the decision to move forward with a nipple sparing procedure versus conventional approaches depend on the placement of the nipple. For example, those with larger breasts may be poorer candidates, says Morrow, compared with patients who have smaller breasts.

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Monica Morrow, MD, discusses the factors that impact the decision to use nipple sparing mastectomy versus conventional mastectomy in patients with breast cancer. The decision to use a nipple sparing approach in patients is dependent on 2 considerations. These relate to the cancer as well as cosmetic appearance of the breast.

Dr. Morrow on Patient Selection for Nipple Sparing Mastectomy

Monica Morrow, MD, chief, Breast Service, Department of Surgery; Anne Burnett Windfohr Chair of Clinical Oncology, Memorial Sloan-Kettering Cancer Center, discusses the morbidity focus of the American College of Surgeons Oncology Group (ACOSOG) Z11 trial.

The Z11 trial was a prospective randomized trial for patients with T1 and T2 clinically node negative breast cancer, with positive sentinel nodes, treated with breast conserving surgery, and whole breast irradiation, that determined if axillary lymph node dissection (ALND) was of benefit to patients. It established there was no survival benefit derived from ALND.

In an examination of the morbidity caused by ALND it was conferred that sentinel node biopsy was far more benefit because it caused fewer short-term surgical issues and long-term sequelae; including numbness in intercostobrachial nerve and lymphedema.

Dr. Monica Morrow from Memorial Sloan-Kettering Cancer Center Discusses the Z11 Trial Focus on Morbidity

Dr. Morrow Discusses the Z11 Trial Focus on Morbidity

Monica Morrow, MD, chief, Breast Service, Department of Surgery; Anne Burnett Windfohr Chair of Clinical Oncology, Memorial Sloan-Kettering Cancer Center, describes the results of the American College of Surgeons Oncology Group (ACOSOG) Z11 trial as practice changing.

Morrow explains that cancer is constantly evolving and that as systemic therapy improves and disease burdens grow smaller the need to update guidelines becomes necessary. The current rules for local therapy have been in place for a long time and since they were put in place breast cancer and our knowledge of the disease has increased greatly.

Memorial Sloan-Kettering Cancer Center has already adjusted their practices to align with the findings of the Z11 trial for patients with T1 and T2 clinically node negative breast cancer, with positive sentinel nodes, treated with breast conserving surgery, and whole breast irradiation.

The idea that any patients with any degree of lymph node involvement needs complete axillary dissection is becoming outdated. What we know about local treatment options has changed how patients need to be treated.

Dr. Monica Morrow from Memorial Sloan-Kettering Cancer Center on the Z11 Trial Results Changing Practice

Dr. Morrow on the Z11 Trial Results Changing Practice

Monica Morrow, MD, chief, Breast Service, Department of Surgery; Anne Burnett Windfohr Chair of Clinical Oncology, Memorial Sloan-Kettering Cancer Center, discusses the American College of Surgeons Oncology Group (ACOSOG) Z11 trial that sought to establish whether the elimination of axillary dissection was beneficial to patients.

The Z11 trial was a prospective randomized trial for patients with T1 and T2 clinically node negative breast cancer, with positive sentinel nodes, treated with breast conserving surgery, and whole breast irradiation.

After a 6.3-year follow-up the trial found that patients receiving axillary node dissection experienced 0.4% recurrence rates compared to 0.9% that did not. These findings did not establish a significant difference at preventing recurrence or improving survival between the two groups.

These findings hold true only for the group examined in the trial. It is not suggested for patients undergoing a mastectomy or partial breast irradiation. The cancer cannot be locally advanced, have positive lymph nodes, or undergone neoadjuvant chemotherapy.

Dr. Monica Morrow from Memorial Sloan-Kettering Cancer Center Describes the ACOSOG Z11 Trial

Monica Morrow, MD

Articles

Dr. Morrow on Patient Selection for Nipple Sparing Mastectomy

Dr. Morrow Discusses the Z11 Trial Focus on Morbidity

Dr. Morrow on the Z11 Trial Results Changing Practice

Dr. Morrow Describes the ACOSOG Z11 Trial