Breast Cancer Update from Dr. Lynne Jalovec ’78

[reprinted from the 2009 Annual Report of the Cancer Program at OSF Saint Francis Medical Center with permission]

This past year has been an exciting one for the breast cancer program at OSF Saint Francis Medical Center. We participated as a pilot site for the newly formed National Accreditation Program for Breast Centers (NAPBC), and this spring, we were one of the first four programs in the country to receive full accreditation. In addition to ensuring that our Comprehensive Breast Cancer Program was providing the best diagnostic and therapeutic medical care available for our breast cancer patients, participation in this program stimulated an enhanced educational initiative — our First Annual Breast Cancer Symposium. Thanks to the tremendous effort of Dr. John Murray, one of our outstanding plastic surgeons, this two-day comprehensive educational program, sponsored by the University of Illinois College of Medicine at Peoria and our local Susan G. Komen for the Cure chapter, was well attended and well received. Dr. Murray involved many members of our Breast Cancer Team as faculty for this program, as well as Dr. David Winchester, Dr. Laszlo Tabar, and several other prominent physicians as invited guest faculty. The symposium was considered a great success by those attending, and our second annual symposium will be held this October.

Our most commonly treated cancer at OSF Saint Francis Medical Center, breast cancer, is this year’s highlighted site for discussion for the annual report. For the last three years, our annual incidence has been over 350 cases per year (compared to 258 cases in 1998). An interesting trend seen nationally in the primary surgical treatment of breast cancer, the movement back toward total mastectomy surgery, is also being seen in Peoria. In 2003, we reported a 68 percent partial mastectomy (PM) rate versus a 29 percent total mastectomy (TM) rate. By 2006, the PM rate had fallen to 57 percent and in 2008, the percentage had dropped to 48 percent. Information from the National Cancer Database (NCDB) regarding this is not available for 2008 for comparison, but this movement back toward TM has been reported and discussed at all national meetings. The specific cause of this change in decision-making by patients is not completely known yet, but is believed to be due to several factors. The increasing use of breast MRI with the finding of multifocal/multicentric disease is certainly being cited as a probable cause. We began our breast MRI program in 2004, and most of our breast cancer patients are having this diagnostic test done. We are currently evaluating how this may be impacting the surgical treatment of our patients. Other factors thought to be involved in this trend back toward TM is the increasing use of genetic testing, the much-improved and more readily available breast reconstruction techniques, and the insurance companies’ willingness to cover prophylactic mastectomies. The NAPBC recognizes this trend, and in complying with their standards for surgical breast cancer treatment, they ask how often patients are offered PM — and that number at OSF Saint Francis Medical Center in 2008 was 73 percent. Multimodality treatment continues to be the norm with 75 percent of our patients receiving more than one treatment.

Our early stage breast cancers (Stages 0, I and II) had excellent survival at 97 percent, 88.6 percent and 83 percent respectively. This compares well to the NCDB data for the same follow-up period, 1998-2001 (95.1 percent, 90.9 percent and 82.2 percent). Our Stage III and IV patients had a 63.2 percent and 37.0 percent five-year survival rate, respectively, which is higher than the national average of 56.4 percent and 18.6 percent. I believe this reflects the increasing medical oncology and interventional radiology therapeutic options we have available to treat these more advanced cases.

We continue to be actively involved in all aspects of breast cancer research. Illinois Cancer Care, our medical oncology group, currently has 12 breast cancer trials actively accruing patients. The TailoRx trial, using gene profiling with Oncotype DX, has certainly been one of our most active trials. Like most breast centers in the country, our decisions on chemotherapy versus hormonal therapy are being guided by the results of tumor gene profiling. We continue to add appropriate patients to the NSABP-39 trial of partial breast irradiation, and have started to accrue patients to the NSABP-43 trial, which is looking at adding trastuzumab (Herceptin) as a radiosensitizer in Her2-positive DCIS patients. Our goal continues to be to provide state-of-the-art cancer care for all our patients with the hope of improving both their survival and quality of life.

LYNNE M. JALOVEC, M.D.

Breast cancer treatment

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