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Management of Triple-Negative Breast Cancer

Management of Triple-Negative Breast Cancer. Ismail Jatoi, MD, PhD, FACS Dale H. Dorn Chair in Surgery Professor and Chief, Division of Surgical Oncology University of Texas Health Science Center San Antonio, Texas. Three Treatment Options for Breast Cancer. Surgery Radiotherapy

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Management of Triple-Negative Breast Cancer

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  1. Management of Triple-Negative Breast Cancer Ismail Jatoi, MD, PhD, FACS Dale H. Dorn Chair in Surgery Professor and Chief, Division of Surgical Oncology University of Texas Health Science Center San Antonio, Texas

  2. Three Treatment Options for Breast Cancer • Surgery • Radiotherapy • Systemic Therapy (Chemotherapy, Endocrine Therapy, Herceptin)

  3. Rudolph Virchow/William Halsted Surgical Treatment of Breast Cancer Virchow 1821-1902 Halsted 1852-1922

  4. Options in the Surgical Treatment of Breast Cancer • Lumpectomy (Partial Mastectomy, Segmentectomy, Quadrantectomy, Wide Local Excision, Tylectomy, Breast Conserving Surgery) + Removal of Lymph Nodes • Mastectomy + Removal of Lymph Nodes • Mastectomy + Removal of Lymph Nodes + Contralateral Prophylactic Mastectomy

  5. Radiotherapy • Generally required after lumpectomy (except for women over age 70 with tumors <2cm, node-negative, ER+, and agree to take endocrine therapy) • Generally not required after mastectomy (except for patients with tumors >5cm or more than 3 positive nodes)

  6. Relative Contraindications to Lumpectomy • Pregnancy • Previous Radiotherapy • Collagen Vascular Disease • Large Tumor Size in Relation to Breast Size • Multi-centric Disease • Mutation Carriers (BRCA 1, BRCA 2, etc)

  7. Important Information About the Breast Cancer • Estrogen Receptor (ER status) • Progesterone Receptor (PR status) • HER-2 status • Tumor Size • Nodal Status

  8. Biomarkers • ER+/PR+ - Endocrine Therapy (Tamoxifen or Aromatase Inhibitors) • HER-2 + - Herceptin with Chemotherapy • ER-/PR-/HER-2- (Triple Negative)

  9. Triple Negative Breast Cancers • Can Not Treat with Endocrine Therapy (Tamoxifen or Aromatase Inhibitors) or Herceptin • Only Chemotherapy is Beneficial • More Common among BRCA 1 mutation carriers • More Research Needed in Triple Negative Breast Cancers to Improve Outcomes

  10. Conclusion • Surgical Treatment of Triple Negative Breast Cancers is the Same as for all Breast Cancers • Radiotherapy for Triple Negative Breast Cancers is the Same as for all Breast Cancers • Drug Treatments for Triple Negative Breast Cancers Differ (Endocrine Therapy and Herceptin is not effective for Triple-Negatives, so chemotherapy alone is often used) • More Research Required to Improve Treatment for Triple Negative Breast Cancer

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