Welcome to an Introduction to Breast Cancer! In this course, we’ll learn a bit about the leading cause of cancer in women worldwide – from the basic biology of the disease, to risk factors and prevention, to treatment modalities to survivorship. We’ll talk to leading experts, explore some of the milestone studies that have pushed this field forward, and have interactive discussions on discussion boards and social media. You’ll even have an opportunity to let us know what topics you want to cover on tweetchats, so we can try to make the content fit your interests.
There is something in this course for everyone – if you’re a breast cancer survivor or the friend/family member of someone with this disease, this course will help you to better understand this disease, and give you ideas for questions you may want to ask your doctor. Maybe you’re a healthcare provider or studying to be the same, this course is a great refresher on where the state of the science is. If you’re a healthcare administrator wondering about how the interdisciplinary components of breast cancer care fit together, or an entrepreneur thinking about unmet needs in this space, or someone in public health interested in prevention, this course is also for you!
Are you ready to learn a lot, and have some fun while we’re at it? If so, I hope you’ll join us! Let’s get started!!!
从本节课中
Beyond the Knife
Learn all about radiation therapy – who needs it, when, what are the different types, and how do we minimize side effects. Who needs chemotherapy? What about hormonal therapy? What is targeted therapy? We’ll learn all about the drugs we use to treat breast cancer in this session.
Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACS
Associate Professor, Department of Surgery Director, The Breast Center -- Smilow Cancer Hospital at Yale-New Haven Assistant Director -- Global Oncology, Yale Comprehensive Cancer Center Yale University School of Medicine
Welcome back.
I"m so glad you're here to join me today.
We're talking with Laosh Pushti,
who is the chief of breast medical oncology here at Yale.
And we're going to talk about systemic therapy.
So, welcome Laosh.
>> Thank you Anise, it's my pleasure to be here.
>> You know, we've been learning a lot about systemic therapy.
Tell me a little bit more about why it's important for breast cancer patients and
how you decide which patients need systemic therapy.
>> So the goal of systemic therapy is to eradicate run-away hiding cancer cells
which may have left the breast before the surgeon actually removed the cancer.
So [COUGH] for chemotherapy to be successful in that setting
a patient needs to have micro metastatic disease, and
it has to be a type of disease that is sensitive to chemotherapy.
So we traditionally estimate the likelihood
that someone has micro metastatic disease based on clinical pathological variables
like the size of the tumor or the number of lymph nodes involved.
And a little bit the grade and estrogen and progesterone receptor status and
her too which are minor prognostic variables.
So historically, we treated patients with systemic therapy particularly
chemotherapy, if they were high risk to have micrometastatic disease.
There are various algorithms that actually can integrate these variables into
a pretty reliable and validated score or
an actual percentage that a particular individual would have a 5, 10, 20,
30% risk of a distant recurrence without systemic therapy.
The other component, the chemotherapy sensitivity has been difficult to gauge or
predict based on essays, however for
Positive tumors if you actually have a task which is more or
less accepted as a way to estimate the chemotherapy sensitivity of
Positive disease, and that is the DX recurrent score.
And grade a little bit as well.
So, high grade tumors are more sensitive to chemotherapy, and
can see the high recurrent score, not only have the higher risk of occurrence, but
they also have a higher sensitivity to chemotherapy.
So, that's this ideal constellation that makes this essay very useful for
Positive disease.
So high recurrence score only identifies the group that is likely
to have metastatic or micrometastatic disease but
it also defines the cancer, that is actually sensitive to chemotherapy.
So that's a way how we actually or
these are the variables that we take into account.
Maybe select patients for adjuvant systemic chemotherapy.
So size of the tumor, the modal status,
the local type DX recurrent score for Positive disease.
And also other variables come into play, like patients preference, comorbidities.
>> So how do you decide which chemotherapeutic regimen to give?
I understand that there's a whole potpourri of different drugs that
you can give.
How do you decide which drug is the right one for a given patient?
>> I ask my colleagues.
>> [LAUGH] >> [LAUGH] So, yeah, so that's something
that oncologists oftentimes debate among themselves and it's a constant source
of our academic discussions and sort of off the curb consultations.
There are multiple ways to approach this.
One is that we would like to select a chemotherapy
that is the least likely to actually have toxic side effects or
side effects and adverse events in a particular individual.
So, we know that certain drugs are more prone to cause neuropathy.
And patients that have long-standing diabetes or prior neuropathy from other
reasons are obviously at a much higher risk to have this than those who don't.
Some drugs like the anthracyclins can cause, rarely, but
fairly well documented that it can cause cardiovascular