Week 2 - New Perceptions

In my previous entry, I described in detail the procedures that I have been able to watch thus far, lumpectomies and mastectomies, which is the bulk of what my surgeon does, as a highly specialized early stage breast cancer surgeon. This week I want to discuss my perception of breast cancer and how it has been altered in the short two weeks we've been here.

One thing that I have been struck by repeatedly during my time spent with Dr. Tousimis is how controllable and treatable breast cancer is when it is caught early. There are so many excellent diagnostic tools that have come into regular practice over the last ten years, that it is becoming more and more common to catch breast cancer before it even becomes palpable. To me, the traditional idea of breast cancer is that women do monthly breast exams, and then one month they just happen to feel something in their breast that shouldn’t be there, they schedule a mammogram, and then the tumor is biopsied and then either removed, treated with chemotherapy, or both.

However, with todays advances, women who have a strong family history of breast cancer (meaning either their mother, sister, or more distant relatives have been diagnosed with the disease) are on even higher alert, having routine mammogram and/or MRI’s, which can show even the tiniest of lesions. Most of the surgeries I have observed thus far have dealt with tumors that were under 2 cm – very small in relation to the size of the breast. The tumor (or abnormal cells, or microcalcification, as seems to often be the case instead of just a straightforward tumor) is biopsied, pathologically analyzed, and then an area of the tissue is removed with the goal of having clear margins. During that same procedure, sentinel lymph node biopsy is usually performed, which I described in my previous entry. That way the surgeon and the patient immediately have an idea of whether the cancer has spread, and in many cases, caught this early, it doesn’t.

So I guess that the side of breast cancer that I’ve been able to observe so far has really altered my view of it. My previous belief was that it was difficult to treat, difficult to remove entirely, and would really change a woman’s lifestyle – both physically and psychologically. A substantial portion of breast cancers, though, are caught early, treated immediately, and the woman retains excellent quality of life.

Having said that, I am very interested in learning more about the other sides of breast cancer – what happens when the tumor isn’t just a small group of abnormal cells, but in turn is poorly differentiated and highly aggressive. Dr. Tousimis has a colleague who focuses on metastatic breast cancer, both in her research and in her practice, and I am anxious to get the opportunity to shadow her and learn about the challenges that she faces. Certainly the face of breast cancer has changed a lot in the past 10 years, but metastatic breast cancer remains extremely difficult to treat effectively.