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Winter 2014 Life to the Fullest Newsletter from Swedish Cancer Institute

Jolyn Hull

Jolyn Hull
Health Education Specialist, Swedish Cancer Institute

The Winter 2014 Life to the Fullest newsletter has hit the stands and this issue is packed with helpful hints and resources. Written by three health education interns at the Swedish Cancer Institute, the focus of this issue is to offer assistance in becoming your own advocate and discusses what resources are available to you and your family. The newsletter also discusses ...

On breastfeeding & breast cancer survivors

Shannon Tierney, MD

Shannon Tierney, MD
Breast Oncology Surgeon

When I was a surgical resident, I donated 150 ounces of breastmilk to a woman I’d never met, a woman who had undergone a bilateral mastectomy for cancer. It was an easy decision – I had more than I could use, she had none that she could provide. This experience became a major one in my decision to specialize in breast surgery. The dichotomy of breasts fascinated me. Breasts are highly sexualized, yet the source of comfort and food to babies. Breasts can make life-sustaining milk, and they can develop a cancer in up to 1 in 8 women that can be life-threatening. It is no wonder that society’s relationship with breasts and breastfeeding is complicated.

I have had many patients (too many) in my practice who were young and pre-childbearing, or even pregnant or breastfeeding at the time of diagnosis. Most experience the same terror that Ms. Wax-Thibodeux felt. Many choose bilateral mastectomies, prioritizing their health and a minimization of future risk. I also care for young women with benign breast disease, that still require surgical biopsies. I do discuss the potential impact of any surgery on breastfeeding. For a lot of women, this is a side effect they hadn’t even considered. It often does not ultimately change their mind about their own most appropriate surgical choice, but there can be a pause. A moment where they consider what that means, when they reconcile themselves to that consequence, when they have the moment to grieve. Unfortunately, I suspect that not all of my colleagues do this. I wasn’t ever trained to discuss it. We spent more time, significantly more time, discussing ...

No Increase In Cardiac Mortality from Breast Radiotherapy

Vivek K. Mehta, MD
Patients that I see routinely ask me about the heart related side effects from breast treatment.

Today, I can provide them with even greater evidence that the techniques that we use today are safer and have less risk of cardiac injury.  According to a study published in the October 1, 2014 issue of the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO), the survival from breast cancer is the same regardless of whether you were treated with radiation to your left or right breast mound.   

Many studies over many decades have shown that breast cancer patients treated with radiation therapy have improved local-regional recurrence, and breast cancer-specific survival after breast-conserving surgery and overall survival (OS) after mastectomy. The media has focused its attention on long-term follow-up of historic radiation therapy trials for breast cancer which demonstrated a potential increase in cardiac mortality. However, these studies used earlier modes of radiation therapy including Cobalt and orthovoltage radiotherapy, and did not employ CT-based planning, which allows for greater cardiac avoidance. Three recent studies suggest that ....

Bilateral Mastectomies: a patient’s personal decision

Claire L. Buchanan, MD, FACS

Claire L. Buchanan, MD, FACS
Breast Cancer Surgeon

Last week the Seattle Times reported that women diagnosed with early stage breast cancer in one breast are choosing to have bilateral mastectomies to reduce their chances of getting cancer again, but recent research shows that that there is no survival benefit, even in younger women. Researchers at Stanford and the Cancer Prevention Institute of California evaluated the outcomes of over 190,000 women from the California Cancer registry who were diagnosed with breast cancer in one breast between 1998 and 2011. The rate of bilateral mastectomies rose from 2% to 12.3% over the study period, yet there was no survival benefit to bilateral mastectomies versus lumpectomy and radiation.

To those of us who work in the field, this data comes as no surprise; the trend of bilateral mastectomies is a known phenomenon. More than 10 years ago, I remember the chatter among surgeons at national meetings asking if others noticed that more and more, younger women were coming in asking for bilateral mastectomies. Back in 2007, Dr. Todd Tuttle authored a study in the Journal of Clinical Oncology that found that the rate of contralateral prophylactic mastectomy was on the rise, from just under 2% in 1998 to 5% in 2003. This week’s study only validates that this upward trend shows no sign of leveling off.

Why do patients choose bilateral mastectomies?

Many women ....

PALB2 Gene Mutation & Breast Cancer: What it Means For You

Robert Resta

Robert Resta
Genetic Counselor

PALB2 is a gene that was first linked to hereditary breast cancer risk back in 2007. Today’s Seattle Times reports on a recent study about PALB2 that was just published in the New England Journal of Medicine. The study, the largest to date, detailed the breast cancer risks faced by  women – and to a lesser extent, men – who carry a mutation in their PALB2 gene. The breast cancer risks were several times greater than the ~12% risk faced by all women, and varied with the woman’s age and family history. Currently, there is no consistent evidence to suggest  that men or women who carry a single PALB2 gene mutation are at greater risks of developing ovarian or other cancers.
 
PALB2 genetic testing can provide very important information that can help women and their families better understand and reduce their risks of developing breast cancer. However, even among women with a very strong personal or family history of breast cancer, very few will test positive. Studies suggest that only about 1-3% of high risk women  will carry a PALB2 mutation. In my personal experience, I have tested about 300 high risk women for PALB2 mutations, and ...

Reducing visits to the operating room for breast cancer patients

Claire L. Buchanan, MD, FACS

Claire L. Buchanan, MD, FACS
Breast Cancer Surgeon

Swedish Cancer Institute has changed the way early stage breast cancer patients are cared for by adopting new surgical margin guidelines.  These guidelines will reduce the need for taking women back to the operating room if cancer cells are found at or near the specimen edge, also known as the margin. Following extensive review of the data, this new guideline was established by breast experts from the Society of Surgical Oncology and the American Society of Radiation Oncology and has been endorsed by the American Society of Breast Surgeons and the American Society of Clinical Oncology.
 
Many women with early stage invasive breast cancer opt for breast conserving surgery, known as lumpectomy or partial mastectomy. For 20-25% of these patients, a second surgery or re-excision was performed because the margin was not considered adequate based on previous practice guidelines. The latest peer reviewed evidence shows disease control is excellent when surgery is combined with whole breast radiation with or without hormonal therapy and/or chemotherapy, regardless of the margin width.
 
The Swedish Cancer Institute’s multidisciplinary breast cancer team reviewed and approved these guidelines for our program. We believe by reducing the need ...

Summer 2014 Cancer Community Walks & Runs

Brian Aylward, BS, CHES

Brian Aylward, BS, CHES
Health Navigator

Each year, the Swedish Cancer Institute (SCI) partners with local and national organizations in an effort to help spread awareness of cancer, associated treatments, and resources available in our communities.
 
Summer 2014 is no different. We’ve signed on to take part in more events than ever before—and we want you to join us! As an active patient, survivor, family member, friend or advocate, your voice and participation matter.
 
American Cancer Society Relay for Life
These overnight community fundraising walks help raise money to fund cancer research, education, and support services like Hope Lodge®, Road to Recovery®, Look Good, Feel Better®, and Reach to Recovery®, all American Cancer Society-run programs. The Swedish Cancer Institute patients gain access to these programs throughout the Swedish network. There are several Relay for Life events going on in the Puget Sound. The Swedish Cancer Institute is taking part in:

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