The Medical Oncologist's Role in Breast Cancer
By Linnea Chap, M.D., board certified Medical Oncologist at Saint John's Health Center. It's exciting to realize just how far our research and treatment of breast cancer have progressed in ten years. Women sometimes look at statements like that and ask, "How can that be? It seems everyone I know has been touched in some way by this disease." But the fact is that mortality rates have gone down. We can thank increased awareness, screening, and improved treatment for that. Then why has the incidence of breast cancer over several decades gone up? Think of it this way: if you look for something, you're going to find it. Proper screening is detecting more cancer. As a result, many lives have been saved.
When I was in medical school, radical mastectomy was the standard. This treatment was based on the notion that removing the diseased breast, the surrounding tissue, and the muscle underneath would eliminate the cancer.
But cancer often returned. It wasn't understood that microscopic cancer cells can break away from the tumor in the breast, penetrate into lymphatic and blood vessels, circulate through the bloodstream, and grow in tissue in other parts of the body (metastasize). As a medical oncologist, it's that metastasization which I try to prevent.
Before I enter the picture, the patient has been through a lot. First, there's screening. A mammographer performs diagnostic tests to determine whether a biopsy is necessary. If a biopsy confirms a malignant tumor, the surgical oncologist and the patient review the information to decide what the best treatment would be. Is the patient a candidate for breast conservation, lymph node sampling, or perhaps mastectomy? Once surgery is performed, a pathologist analyzes the diseased tissue samples and records her findings.
A medical oncologist such as myself reviews the full pathology report. I make an educated estimate, based on what we know about the patient's cancer, on whether there's a chance that microscopic cells could grow and come back somewhere else in the body. I give the patient the benefit of all available information, and do my best to address her concerns. Based on these assessments, the patient and I determine the best course of action. Might it be hormonal therapy and/or chemotherapy? A decision is made, and a course of treatment begins.
I become that patient