Local regional management Project Lead Reshma Jagsi, MD, DPhil and Steve Shak, MD co-founder of Genomic Health Inc.

Local management of early-stage breast cancer includes treatments and evaluative tests to address the cancer in the breast and the area immediately around it.

Local treatments for breast cancer can include surgery and radiation therapy. Many patients with early-stage breast cancer have a choice about the type of initial surgery to have – options can include breast-conserving surgery (lumpectomy), single mastectomy (removal of the affected breast), and double mastectomy (removal of both breasts). Additionally, breast cancer sometimes spreads to the lymph nodes under the armpit, requiring surgery to removal some (sentinel node dissection) or all (complete axillary dissection) of the lymph nodes. Finally, some breast cancer patients will receive radiation therapy to reduce the risk of local cancer recurrence. Individualized care is achieved when surgery and radiation decisions are appropriate for the patient (based on the clinical characteristics of the patient and the cancer itself) and the patient experiences high decision quality – meaning that she is informed, satisfied with the decision process, and her personal preferences are incorporated into treatment decisions.

Evaluative tests can influence the type of surgery a breast cancer patient receives. Examples of tests include magnetic resonance imaging (MRI) to evaluate the extent of the cancer and genetic tests for BRCA and other gene mutations to evaluate a patient’s risk of developing additional breast cancer in the future. Every breast cancer patient is different – local evaluative tests are not appropriate or necessary for all patients. Individualized care is achieved when the right evaluative tests are ordered for the patient.

Steven Katz, MD discusses BRCA and multigene sequence testing at the labs of Ambry Genetics

Our P01 project “Individualization of Locoregional Management for Early-Stage Breast Cancer” examines the individualization of evaluative tests and treatments for breast cancer via surveys to both patients and their doctors. Through our partnership with the SEER registries, a random sample of over 5,000 eligible women with breast cancer in Los Angeles County, CA and in the state of Georgia is being surveyed for the study. To inform this project, we survey the surgeons and radiation oncologists providing treatment to the women in our sample to examine treatment decision making from the doctor perspective. This project also includes collaboration with genetic testing companies who administer the tests in women in the areas we survey. The project will look at trends in testing using standard BRCA testing and multigene panels recently made available to women and their doctors.