A Q&A With Dr. Ed Sauter

July 25, 2016

Ed Sauter, MD, PhD, the director of the breast surgery program for the Hartford HealthCare Cancer Institute, met with a group of current and former patients and other members of the public July 21 to answer their questions about breast cancer.

Dr. Sauter, who has an extensive background in breast cancer surgery and research, sat down in an informal question-and-answer session at the Hartford HealthCare Cancer Institute’s cancer center in Avon, where he responded to numerous questions about everything from prevention to diagnosis to treatment to the future of breast care. Here is a sample of some of the questions that were raised.

Q. How do breast cancers develop?
A. The biology of breast cancer is centered around mistakes, including mutations and other related cellular changes that occur in healthy breast cells which prevent or block the body’s ability to correct common mistakes that occur as breast cells divide. Most of the resulting abnormal cells die, but some survive and grow faster than normal cells. The cells with faster-than-normal growth can multiply to form a tumor mass, and may undergo further changes which allow them to spread locally to surrounding breast tissue, regionally to nearby lymph nodes, or distantly to other organs. One of the great challenges of breast cancer research is identifying the mutations that “drive” the creation of the mass, as well as its spread locally, regionally, and distantly, so that they can be attacked or targeted.

Q. What is the best way to diagnose breast cancer?
A. There are many methods for diagnosing breast cancer, most often involving imaging technology including mammograms and breast ultrasound. The most reliable way to get an accurate diagnosis is through a fine or core needle tissue biopsy. Researchers are continuing to explore the potential to eventually conduct “liquid biopsies” through the analysis of blood and/or breast fluid, which would be less invasive and more convenient.

Leading-edge 3D mammogram (tomosynthesis) technology provides a larger number of breast images compared to the standard two views seen on plain film or digital mammography. These “finer cuts” of the breast sometimes overcome difficulties that may occur in visualizing tumors on mammography, especially in women with dense breasts. Still, the imaging process is not perfect; it misses some tumors and calls things suspicious for cancer, which turn out to be benign on biopsy. The best way for people to be sure is through regular screenings through breast imaging and examination by the provider who follows the individual for breast health.

Q. Why is radiation therapy necessary, and what are the side effects, long-term and short-term?
A. Radiation therapy is proven to significantly reduce the chances for cancer to return after breast conservation surgery to treat breast cancer. Without radiation therapy, patients have approximately a 40 percent chance of having their cancer return, while the chances drop to roughly 10 percent with radiation therapy. The most common form of radiation therapy is external beam radiation therapy, which delivers highly targeted beams of high-energy x-rays from a device such as a linear accelerator to the site of the tumor. Radiation therapy generally takes place after a tumor has been surgically removed, and is required to eliminate any microscopic disease which might remain within the breast. Radiation therapy can lead to short-term swelling and edema as the tissue heals itself, as well as some degree of shrinkage and/or hardening of the tissue over time. The longer term changes are variable but rarely severe. One patient at the session, who had gone through radiation therapy, said the only side effects she noticed was that it made her tired.

Another common treatment is systemic therapy, given either by IV or taken in the form of a pill, including chemotherapy, which targets rapidly dividing cells, as well as hormonal and other more targeted therapies which focus on a specific change present in the patient’s tumor. Advances in research and clinical trials have led to the development of agents that attack only cancer cells and not healthy ones, reducing the severity of side effects as well as the effectiveness of the treatment.

Q. What is the survival rate for breast cancer?
A. Advances in breast cancer prevention and treatment have improved to the point that the five year survival from breast cancer is 90 percent. That number was in the 75 percent 40 years ago, which is due both to earlier detection and improved treatment. The five-year survival rate is 99 percent for women whose tumors are confined to the breast, and 85 percent for those whose tumors are confined to the breast and nearby lymph nodes, and there continues to be advances in the treatment of cancers that have spread or metastasized to other parts of the body. Currently there are over 15 million breast cancer survivors in the U.S. This number is projected to reach 20 million by 2026.

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