Breast Cancer Treatment
Breast cancer poses both a local regional risk (i.e., to the breast and regional lymph nodes) and a systemic risk. Thesurgical treatment is lumpectomy (breast conservation ther-apy) or mastectomy. Both procedures are aimed at achiev-ing local control. Mastectomy is removal of all breast tissue and the nipple areolar complex with preservation of the pectoralis muscles. A modified radical mastectomy also includes removal of the axillary lymph nodes. Radiation therapy is used in conjunction with mastectomy for later stages of breast cancer, and to accompany lumpectomy and partial mastectomy for early stages of breast cancer. Radiation is an essential component of lumpectomy. This combination yields outcomes that are equal to those of radical mastectomy.
Breast reconstruction should be an option for all women who desire it. Reconstruction can be achieved by several methods,including the insertion of a saline implant under the pectoral muscle or by using a rectus muscle to replace the lost tissue. To prepare for a saline implant, a tissue expander is placed beneath the muscle. Saline is injected into the expander over a period of weeks to months until the space is large enough to accommodate the implant. Breast reconstruction can take place immediately after surgery, or it can be delayed for sev-eral months. Radiation therapy can be given if breast recon-struction has taken place.
Adjuvant (systemic) therapy is used in the treatmentof all stages of breast cancer, regardless of lymph node sta-tus. Adjuvant therapy includes chemotherapeutic drugs that killcancer cells and hormonal therapies such as tamoxifen that act as estrogen antagonists.
Tamoxifen is used to treat women withestrogen receptor-positive breast cancer. It can be used in conjunction with chemotherapy. It is also given as a 5-year course of preventive treatment following surgery. Aromatase inhibitors (AIs) prevent the production ofestrogen in postmenopausal women.
AIs are used to extend survival in women with metastatic cancer, as primary adjuvant therapy, and in conjunction with tamoxifen to prevent cancer recurrence.
Another drug used to treat breast cancer is trastuzumab. It acts on membrane-bound protein produced by Her2/neu. If a patient’s cancer is found to overexpress the Her2/neu protein, trastuzumab can be given as adjuvant therapy. Trastuzumabis associated with significant side effects, including heart failure, respiratory problems, and life-threatening allergic reactions.
Obstetrician-gynecologists are in the unique position of providing care for women who have been treated for breast cancer. For some women, the continuation of care years, follow-up appointments occur every 3 to 6 months and then annually after that. Annual mammography and physical exams should continue indefinitely. Most breast cancer recurrence will occur within 5 years of primary therapy.