Healthlink >>>

Experts share ndings on diagnosis, surgery and research

Natalia Marchenko, Ph.D. Assistant Professor, Department of Pathology Stony Brook University Medical Center Bradley Cohen, M.D. Breast Cancer Surgeon Good Samaritan Hospital Medical Center Robin Ehrenpreis, M.D.
Modality Chair of Breast Imaging NRAD Medical Associates, P.C. (Nassau Radiological Group)

BREAST CANCER
Q. How have surgical options advanced in the past 20 years? A. Breast cancer care is now highly individualized. The general trend has been toward removal of less breast tissue (breast preserving lumpectomies) and fewer lymph nodes, while simultaneously increasing survival rates. Twenty years ago, most patients underwent mastectomy whenever cancer was found. Ten years ago, women with invasive breast cancer had almost all the lymph nodes in their axillary area removed. Now, with the sentinel lymph node biopsy procedure we can identify which lymph nodes the cancer may spread to rst. If these nodes are clear, we dont need to remove the others. We also have better imaging modalities. Mammography and sonography technology has improved. Tomosynthesis (3-D digital imaging) and MRIs can also be very helpful. Gaining this diagnostic sensitivity and accuracy gives us a better ability to make sure that we are fully evaluating the problems in the breast. Also, oncoplastic procedures have improved, giving women a more natural look with lumpectomy and mastectomy reconstructions. Of all the advances though, the most important one has been the progress we have made in curing breast cancer.

ADVERTISING SPECIAL SECTION

Q. Describe the p53 protein and the breast cancer research underway to eradicate its mutations.
in all cells and provides strong protection from cancer. Mutations in the p53 gene constitute the most frequent, genetic alteration in cancer and have been found in more than 50 percent of all human cancersincluding breast cancer. Importantly, the mutated p53 proteins not only lose their cancer preventing function, but also gain new properties that drive the disease progression. Typically, presence of mutant p53 in breast cancer correlates with more aggressive recurrent disease, resistance to therapy and shorter overall patient survival. We found that decreasing mutant p53 levels in breast cancer cells strongly inhibits their malignancy. This very tumorspecic property opens up exciting prospects for rapid translational development of therapeutic intervention. There are two drugs currently in the clinic that can reduce mutant p53 protein levels. These drugs have a much stronger effect on mutant p53 breast cancer cells than other types of cancer, and are non-toxic for normal human cells. We hope that our work will help to ght the mutant p53 breast cancer, one of the deadliest diseases.

Q. Mammogram aside, how signicant is Magnetic Resonance Imaging (MRI) in diagnosing breast cancer?
Mammogram screening is the gold standard, followed by ultrasound testing. If those tests raise outstanding questions and an issue cannot be resolved, then maybe an MRI should be ordered. The MRI is a very sensitive tool, but we are selective about who should have it. Indications include screening for women with a history of breast cancer if their doctor feels it is necessary; high risk patients (those who have more than a 20 percent lifetime risk of getting breast cancer (based on the Breast Cancer Risk Assessment Tool); positive genetic testing for BRCA1, BRCA2 mutation; prior chest radiation for Hodgkins disease; a newly diagnosed malignancy (to examine the extent of the disease); detecting leaks in siliconegel breast implants. Magnetic Resonance Imaging is also used if a patient has had chemotherapy before breast cancer surgery to see if the tumor has shrunk to be operable. An MRI is not a general screening tool. If you dont need one you should be happy. It means you are not at high risk.
To access the National Cancer Institutes Breast Cancer Risk Assessment Tool, go to cancer.gov)

A. The p53 protein regulates many normal processes

A.

The beauty team

helping you look good feel better

ealing takes form in many ways. As your medical team works to rid your body of breast cancer, there are other professionals dedicated to helping you battle the side effects of treatment. Among those, are the volunteers of the American Cancer Societys, Look Good Feel Better program. Their free, two-hour workshop focuses on bringing beauty back into the equation for cancer patients experiencing hair loss and skin care issues. Marie Perico, a licensed hair stylist, cosmetologist and hair salon owner has been a volunteer for the Look Good Feel Better program for the past eight years. Women going through treatment experience a lot of redness and dryness on their skin and scalp. In the rst hour we

concentrate on skincare and makeup application. Everyones favorite thing is learning how to draw in eyebrows, she says. The second hour covers hair loss and how to choose and care for a wig. She tells attendees the best time to shop is before the hair starts to fall out. That way, a stylist can see you beforehand and help recreate your natural, everyday look. From what she has observed, Perico believes the program greatly impacts healing. The free make-up kit and the beauty advice they receive, along with the chance to share breast cancer experiences with each other gives them hope, she says. These women are sick, but then they look in the mirror and it just boosts their spirits.