Navigating Treatment Options for Breast Cancer
Breast cancer treatment can not be approached with a one-size-fits-all strategy. Not only are there many different subtypes of breast cancer that respond differently to various treatments, but care must be tailored to each patient.
“As clinicians, our job is to work with people and try to help them arrive at the right treatment
plan for the cancer and for them,” says Eric Winer, MD, director of the Yale Cancer Center and president of Smilow Cancer Hospital.
Doctors have two goals when it comes to breast cancer, explains Melanie Lynch, MD, director of breast surgery at Smilow Cancer Hospital in Bridgeport, Trumbull, and Fairfield. “We need to get local control where the cancer is, and we need to make sure there’s systemic control so the cancer doesn’t go elsewhere in the body,” she says.
To that end, surgery and radiation are used to control cancer in the breast and to prevent cancer recurrence. “As we plan an operation, it’s specific to individual patients,” Dr. Lynch says. “We can do a mastectomy and remove the entire breast, or we can do breast conservation, which is removing the area where the cancer is with a clear margin, followed by radiation therapy.”
Medical treatment, which includes hormonal therapy, chemotherapy, immunotherapy, and targeted therapies, can also be used to prevent cancer from coming back elsewhere in the body. Targeted therapies are a newer class of drugs that can be administered orally or intravenously.
“They specifically go after a protein on the tumor cell and are much more selective than our traditional chemotherapy agents, where they can be potentially more effective and, in some cases, have less toxicity,” says Maryam Lustberg, MD, director of the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center.
Immunotherapy, Dr. Lustberg adds, can be effective for what’s known as triple-negative breast cancer, which is a subtype of breast cancer characterized by the absence of three common receptors: an estrogen receptor, a progesterone receptor, or HER2 (human epidermal growth factor receptor 2). “This tends to be our most aggressive type of breast cancer, and it has been shown to benefit greatly from the combination of chemotherapy and immunotherapy,” she says.
At Yale, various providers often meet as a group (called “tumor boards”) to develop treatment plans for each patient. “We’re focused on providing the very best care to the patients we see today and on trying to make that care better in the future by conducting research,” Dr. Winer says. “We can enroll our patients in research trials.”
In the video above, Yale breast cancer experts talk more about how treatment options have evolved.
