5 Moffitt Experts Share Latest Advances in Breast Cancer Treatment

August 09, 2002

Tampa, FL- Genetic screening, radioactive seed breast biopsy, and quality of life during chemotherapy were among the topics five Moffitt doctors and researchers explored with reporters and editors from TV and print. The information exchange occurred at the H. Lee Moffitt Cancer Center & Research Institute’s Breast Health Symposium on July 12. The presentation is now available on the Web at http://moffittcancernetwork.org. Click on “Conferences” in the left column, which will take you to “Breast Health Symposium for Journalists.” The symposium is packaged into five separate presentations by the following speakers.

Fatigue in Breast Cancer Survivors

“Fatigue is one of the most common and distressing symptoms our patients experience,” says Paul Jacobsen, Ph.D., who leads the psychosocial and palliative care program at Moffitt. “My program doesn’t cure or treat breast cancer, but it can make living with it and after treatment easier.”

Despite a high survival rate – 90 percent of patients experience no recurrence for at least five years after successful treatment – some survivors report feeling fatigued months and even years after treatment ends. Jacobsen developed a tool for measuring the symptoms

of fatigue and its severity and duration after treatment. Experiencing the most fatigue:

patients who were treated with bone marrow transplantation. They were followed by patients treated with chemotherapy, (severity and duration of fatigue was related to dose).

Patients treated with radiation alone experienced the least fatigue.

Reasons for the fatigue may include anemia, inactivity, depression, damage to the central nervous system caused by the cancer-killing drugs, altered immune function and altered endocrine function. “Moffitt is unique because resources are invested into quality of life research,” Jacobsen says.

Inherited Susceptibility to Breast Cancer

Advances in the genetic research have made it possible to identify individuals who run a high risk of developing breast cancer, says Rebecca Sutphen, M.D., director of genetic counseling and testing at Moffitt. “Just because you have a susceptibility to cancer doesn’t mean you’ll get cancer,” Sutphen says. “It just means you run a higher risk and should take preventive measures.”

Mutations on two genes – BRCA1 and BRCA2 – account for most breast and ovarian cancers, and the defect can be passed down from either the mother or the father. Almost 10 percent of cancers are due to inherited susceptibility, says Dr. Sutphen.

Genetic screening for breast and ovarian cancer is offered to Moffitt patients who participate in research trials and those with a family history of breast cancer. The cost is $2,700, and many insurance plans will pay for it. The results are confidential.

Sutphen is using genetic testing for research that compares mammography to magnetic

resonance imaging for diagnosing breast cancer and to compare hereditary and

nonhereditary ovarian cancers. Sutphen is also participating in a study that may lead to a blood test for ovarian cancer. Right now, the disease is difficult to diagnose and often fatal by the time it’s detected.

Microarray studies and radioactive seed breast biopsy

Charles Cox, M.D., founder of the Comprehensive Breast Cancer Program at Moffitt, is working on microarray analysis of lymph node tissue and, in surgery, is using radioactive seeds to assist in removal of breast cancers.

Cox is using an experimental microchip that provides a DNA analysis of tumors to determine the type and stage of the disease and what course of treatment will work best.

“This technology is so powerful,” Cox says. “The goal is to use the analysis to predict which breast cancer patients do not need chemotherapy.”

Cox is also studying the use of radioactive seeds for locating breast cancer tumors. The traditional method for guiding surgeons through removal of tumors is to use mammography to guide the placement of a wire, then go to the operating room where the surgeon follows the wire to the tumor. The procedure is problematic because it requires surgery immediately after the wire is placed, and the wire can move during placement. Plus it is hard to see during surgery. Using wire guidance, surgeons need to remove more tissue than necessary to get the tumor, and the operation still often leaves cancer cells behind, which requires additional surgery later.

The radioactive seeds, on the other hand, can be left in place for up to two weeks. Using a probe to find the seeds allows surgeons to remove only the tumor. In addition, research has shown that using the radioactive seeds leaves behind cancer cells only 23 percent of the time, compared to 55 percent using wire guidance.

Lymphatic mapping

Cox is also credited with developing a lymphatic mapping for determining the extent of breast cancer. The procedure involves injecting a dye around the tumor site and then following its spread to lymph nodes to determine if the sentinel node is cancerous. If the sentinel node is cancerous, then all of the lymph nodes are removed. Otherwise, they are spared. Traditional methods involve always removing all of the lymph nodes.

In 1995, Moffitt established the Center for Minimally Invasive Surgical Technique to train other physicians to use lymphatic mapping, says Claire Modarelli, who administers the training program. So far, Moffitt has trained more than 2,000 physicians worldwide to use lymphatic mapping, including 300 in Florida.

Breast cancer in older women

Lodovico Balducci, M.D., who leads Moffitt’s Geriatric Oncology Program, notes that 50 percent of all breast cancers occur in women over age 65. Although some experts have questioned whether women over age 70 should risk exposure to radiation and have mammographies, Balducci believes women should continue to be screened even as they age. His research shows that women older than 70 who had at least two mammographies were two times less likely to die of breast cancer.

Similarly, he supports the use of radiation after lumpectomy in older women. “Radiation is no worse for older women than younger women,” he says. “If you want to reduce your risk of recurrence, you need to do radiation.”

Whether or not to use chemotherapy depends on the life expectancy of the woman, Balducci says. “If she has a life expectancy of two years and the cancer has a 10 percent chance of recurring, then she doesn’t need chemotherapy,” he says.

Among those attending the symposium were Robin Adams of the Lakeland Ledger, Susan Thompson of the Tampa Tribune and Debbie Freeman of WTSP Channel 10 News.

Situated on the campus of the University of South Florida, Moffitt Cancer Center & Research Institute is a world-renowned cancer treatment and research facility. The only Florida-based National Cancer Institute Comprehensive Cancer Center in the state, Moffitt is on the U.S. News and World Report list of Top 10 cancer hospitals in America. Moffitt’s mission is to contribute to the prevention and cure of cancer.

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