Hair loss Treatment Center

PARTICIPANTS Generosa Grana, MD Director, Breast Cancer Program, Cooper Hospital Stephen E. Jones, MD Baylor-Sammons Cancer Center, Dallas, Texas EDITORIAL CONSULTANT Maura N. Dickler, MD Assistant Attending Physician, Memorial Sloan-Kettering

GENEROSA GRANA, MD: Early-stage cancer is a disease that by definition is localized to the breast, plus/minus the axillary lymph nodes. And the stage of that cancer will depend on the size of the tumor and the presence or absence of lymph node involvement. So that an early stage breast cancer can be a stage 0 cancer, noninvasive disease, or it could be a stage 1 cancer that's less than 2 cm, or it could be a stage 2 cancer that has lymph node involvement.

ANNOUNCER: Once diagnosed, it is important to speak with your doctor to learn as much as you can about your disease.

GENEROSA GRANA, MD: The goal should be to have an understanding of the stage of disease, the type of cancer present. For example, you want to know if the cancer is invasive or in situ, noninvasive. You want to know if the cancer is a high-grade lesion, meaning rapidly growing or a low-grade lesion.

And also the other studies that need to be done and the other physicians that need to be involved in her care.

ANNOUNCER: Discovering all you can about your cancer, even if it's at an early stage, often requires more testing since there is a small chance the cancer has spread.

GENEROSA GRANA, MD: At the very minimum, most women will have a thorough physical exam by a clinician asking her a variety of symptoms related to breast cancer. A chest X-ray and routine liver function studies are often obtained. In addition to that, once a cancer is stage 2, oftentimes a bone scan is obtained.

ANNOUNCER: Once information is gathered, treatment can begin. In early-stage breast cancer this always involves surgery. But there are different surgical options to consider.

STEVEN JONES, MD: One is where there is an attempt to save the breast, so breast conservation. It usually involves a lumpectomy removing the cancer and getting clear margin of normal tissue around it. The other option, other than saving the breast, would be to do a mastectomy which generally also takes the lymph nodes. And that's either done with or without reconstruction.

GENEROSA GRANA, MD: Also very important is the woman's choice, the woman's wishes with regards to surgery. Some women are perfectly good candidates for breast conservation from a medical standpoint, but they really would rather have a mastectomy. They feel more comfortable having the breast removed.

ANNOUNCER: Depending on the type and stage of breast cancer, there may be other treatments needed. These treatments are aimed at killing any left over cancer cells in the body.

STEVEN JONES, MD: That could be radiation therapy, which is probably six or seven weeks of using radiation, which is very targeted treatment to kill residual cancer cells. There is a possibility of adjuvant chemotherapy, which is drug treatment to try to improve her overall prognosis. And there is a possibility of adjuvant hormone therapy.

ANNOUNCER: In hormonal treatment in early stage disease, again there are options to consider.

STEVEN JONES, MD: The gold standard up to this time has been a drug called tamoxifen. Tamoxifen is an antiestrogen that works stop the cancer cells from multiplying or dividing. And that's proven to be extraordinarily effective treatment. There is now another option and that's one of the drugs called an anti-aromatase agent. The one drug that is approved for this is a drug called anastrazole or Arimidex.

ANNOUNCER: Speaking with your doctor is crucial to understanding the disease and its treatment. But initially a woman may need help digesting what's being said.

GENEROSA GRANA, MD: In the first visits with her physicians, the woman should prepare herself by gathering people to go with her for these visits. These are difficult visits that shouldn't be done alone, if there is a support system that can be tapped into.

The other thing that a woman should do is prepare by reviewing materials regarding breast cancer prior to her visit.

ANNOUNCER: Having an open dialogue with your doctor, knowing your options and keeping well-informed will prove to be a valuable tool for any patient fighting breast cancer.

STEVEN JONES, MD: I think getting the right information again is crucial so there are no big surprises. I like to spell out exactly what is going to be happening so somewhere, a few months into this, there is not suddenly a big surprise like "Oh, I forgot to tell you, you need seven weeks of radiation therapy." I mean that's a disastrous type of surprise.

GENEROSA GRANA, MD: Helping a woman gather the information that she needs at the very beginning will prepare her very well for what is to come. The more prepared the woman is the better she will be able to deal with the difficult decisions that are ahead of her, and the better she will be able to handle the side effects of the treatments that are in store for her.