Dr. Steve Martinez joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about breast cancer treatment options.
Read the transcript of Dr. Steve Martinez' talk on breast cancer treatment options or listen here
Maury Eskenazi: Joining us from The Everett Clinic is Dr. Steve Martinez. We are gonna talk about breast cancer. Of course, he is general, General Surgical Oncology.
Maury Eskenazi: We wanted to talk to you about the different treatments and when women should decide on getting a mastectomy or double mastectomy.
Maury Eskenazi: What are the first steps as far as treatment goes for breast cancer?
Dr. Martinez: Treatment for breast cancer is going to depend a little bit on everybody's particular situation. One of the first things that I like to do is go over a woman's pathology report with her. That is going to tell me a couple of different things. What type of breast cancer is it? Is it something that started in the breast, or is it something that started in the lobules of the breast, an area that would produce milk? It tells me a little bit about the grade of the cancer, or basically how ugly these cells would look under the microscope, very normal or very abnormal, and can be used as a, sort of a substitute for maybe how fast this cancer would be growing. I'm also going to know from looking at the pathology report does this cancer respond to hormones? Do hormones make it grow? And, consequently, can we use hormone blocking drugs to treat her in the future after surgery? I'm going to know about the expression of this very important protein that's called HER-2/neu, or HER-2 for short. About 25% of breast cancers will overexpress that protein and these tend to be more aggressive tumors when this is overexpressed. These things will let me know a little bit about sort of the behavior of the breast cancer. Is it a little bit more slow growing, or is it something that's a little bit more aggressive? That, combined with looking at the patient's imaging, the mammogram, ultrasound, and possibly MRI, is going to let me know sort of what category in general this patient is going to be, whether we are talking about a lumpectomy, or partial removal of the breast, or a mastectomy. That's all fully colored by whatever is going in that woman's life and what her preferences are.
Shannon O'Kelley: Is that decision to have the mastectomy, we all know Angelina Jolie, for example, decided right away to have both of her breasts removed. But, if I remember right, was there a genetic predisposition...
Dr. Martinez: That's right. So she was found to have a mutation in one of the breast cancer genes. There are two of them that have been identified, BRCA1 and BRCA2. Both of these genes will increase the likelihood that woman will develop breast cancer in her lifetime, and not only breast cancer, but other cancers as well. There is a relatively decent chance that the woman may develop also ovarian cancer.
Dr. Martinez: The risk of developing breast cancer is not quite as high as originally thought, probably in the range of 45-80%, depending on whether were are talking about BRCA1 or BRCA2, but if the woman knows that she has a genetic mutation of one of those genes, and we can find out by doing a basic blood test, then somebody could conceivably decide that they want to preventatively do a mastectomy on one side or both sides.
Maury Eskenazi: Also if she had family members that have died from breast cancer, too. That's also a...
Dr. Martinez: That is a major risk factor.
Shannon O'Kelley: So, these are proteins that you can get tested for and indicate, kind of, your exposure to the disease then?
Dr. Martinez: Well, it gives you sort of a handle on the overall lifetime risk of developing. Now, not every patient who has a BRCA gene mutation has one that's bad. There are mutations that have not really been fully described yet, and there are mutations that, although known to be bad, may not... Decide for sure that you're going to get breast cancer.
Dr. Martinez: It's very multifactorial. You can have a BRCA1 mutation and never develop breast cancer. So people, rather than getting bilateral mastectomies, elect to do breast conservation surgery, or get a lumpectomy, and then go on and get additional screening mammograms every year, for sure, but also MRI. Some people also would decide to get additional medical therapy, drugs like tamoxifen, which is a hormone-blocking drug which could further lower the risk of developing a breast cancer.
Maury Eskenazi: Is that something that someone who has had breast cancer, will they take that forever, for the rest of their life?
Dr. Martinez: It could. It's generally given for people who have breast cancer for a 5 to 10 year period of time. But, if it's used preventatively, it can be given longer.
Shannon O'Kelley: When is someone who has had breast cancer and then goes in for their yearly mammograms, how many years of being clean can you say, "Okay, you're cancer free?"
Dr. Martinez: Most people who are going to have a recurrence from breast cancer are going do so in 3-5 years. You feel better about things at that five year point.
Shannon O'Kelley: What about chemo and radiation. When do you pull those tools into your grab bag?
Dr. Martinez: Let’s talk about radiation first. In general, people will need to have radiation if they have a lumpectomy done. So, a lumpectomy is almost never done on its own, it's always combined with radiation. If we just gave people lumpectomies they would have a pretty high rate at 10 and 20 years of having a recurrence at that site.
Dr. Martinez: That's a 40% risk.
Maury Eskenazi: A lumpectomy is you find a lump in the breast, you take that out, get rid of all the cancer around it?
Dr. Martinez: It’s a removal of that lump or that tumor and a rim of normal tissue around it for a margin.
Maury Eskenazi: The breast still is okay, though? Still looks okay?
Dr. Martinez: Still looks okay. That's part of the idea of doing a lumpectomy. You don't want to do a lumpectomy that's going to be disfiguring.
Dr. Martinez: In general, the smaller the tumor, the larger the breast, the better the cosmetic outlook is going to be.
Shannon O'Kelley: This is particularly important when it's caught early. This is a cancer that it’s localized, it's small, and you can do a lumpectomy. But, the radiation comes into play because you just don't know if there are other cells?
Dr. Martinez: That's right. What the radiation is trying to do, it's like surgery, it's a local treatment in this case, and it's a local treatment whose goal is to prevent the cancer from coming back in that spot.
Maury Eskenazi: What happens during radiation?
Dr. Martinez: It's a process. Most radiation that is given in this country is for breast cancer, in general about five days a week for six or so weeks, and so it's a relatively daily treatment. It's a way of delivering energy, those x-rays, to this very localized area of your breast. In general, the entire breast is treated at the time the radiation is given.
Shannon O'Kelley: Basically, you're trying to kill these cancer cells. How does the radiation recognize cancer versus healthy cells?
Dr. Martinez: Cancer cells are disordered. They have irregular growth and their repair mechanisms when their DNA, their genetic information, is injured it can't repair. They are much less likely to repair damage from x-rays than are normal cells from normal tissue. That's how this in general works. It's direct DNA damage.
Shannon O'Kelley: You're very specific about the area you are radiating?
Dr. Martinez: I don't do give radiation, but my colleagues in Radiation Oncology have gotten very good over the last 10-20 years of localizing and sparing underlying tissue, sparing the lung, that is right under the breast. Sparing the heart. And there are newer techniques of giving the radiation over a shorter period of time that we are sort of moving toward in the future.
Maury Eskenazi: We are talking to Dr. Steve Martinez from The Everett Clinic about different cancer treatments. Fascinating stuff. Chemotherapy. Tell us what chemo does.
Dr. Martinez: Unlike surgery and radiation, chemotherapy is a body-wide treatment. This is a treatment that's going to address any cancer cells that may be outside the breast, and also will treat cancer cells that may be remaining in the breast, in the lymph nodes, but also body wide. It is a systemic or a whole body type of treatment, and its goal is to destroy any remaining cancer cells so that there is no recurrence of cancer, either locally in the breast or at some distant site, some other organ.
Shannon O'Kelley: What is chemo and how does that drug know what cells to attack?
Dr. Martinez: The mechanisms are a bit different for each type of chemotherapy agent that is given. Some of them will work directly as a cytotoxic, or a poison to these cells, and they poison the normal cells as well. But, again, normal cells have the ability to recover, more so than do abnormal or malignant cells, cancer cells.
Maury Eskenazi: Absolutely. Your knowledge! I learn so much every time you come on. Thanks so much for comin on with us.
Maury Eskenazi: everettclinic.com is where you want to go to, and that's how you can get more information and talk, and see Dr. Martinez. We're takin a break. It's Health Matters, brought to you by IRG Physical & Hand Therapy. We are here on Fox Sports 1380.