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A Custom Fit

Personalized and individualized approaches to care have been key points of progress and innovation in the field of breast oncology.

Dr. Lisa Guerra explained that the focus of breast cancer treatment has evolved into specific approaches tailored to each patient’s diagnoses and circumstances.

Over the past 20 or 30 years, the field has recognized that everybody doesn’t have the same breast history or the same cancer, so an individualist approach is best,” said Guerra, a breast surgeon at the Hoag Breast Center in Newport Beach. The Hoag Health Network includes two acute-care hospitals, seven health centers and four urgent-care centers in Southern California.

From detection to reconstruction, treatment has moved away from the “cookie cutter” treatment, Guerra said. Improvements in imaging and detection with the use of 3-D mammography and automated whole-breast ultrasound have allowed for sharper detection of tiny abnormalities, especially in dense breast tissue.

However, the largest change Guerra said she’s seen in recent years is in axillary lymph node dissection, the removal of lymph nodes in the underarm.

“In the past, as soon as cancer cells were found in one lymph node, the automatic indication was to take out all of them. But recent trials have showed that, in some cases, there is not a benefit to removing all of them if cancer has just been found in one or two,”  she said. “The hope and goal with that is to subject patients to less potential risk.”

More emphasis is also being paid to post-treatment and cosmetic aspects of breast cancer, which has led to new state-of-the-art oncoplastic surgery techniques. Decades ago, breast reconstruction was barely given a second thought, but today, skin-saving and nipple-sparing procedures have become an important part of the process. And from a mastectomy standpoint, Guerra said some women who undergo reconstruction end up even more pleased with the shape of their breasts than pre-surgery.

For many individuals, a “one-stop shopping” approach has  given  them more treatment and recovery options. As a result, patients feel more empowered and involved. However, despite innovations gaining headway every day, early screening and detection remain the key, Guerra said.

“Mammography is still our best tool for identifying breast cancer at its earliest and most curable stages,” she said. “Many people often think, ‘Oh, that’s something that happens to other people,’ or that it doesn’t run in their family, but 70% to 80% of breast cancers are not hereditary-based.”

The American Cancer Society recommends yearly mammograms for women beginning at age 40 and continuing for as long as a woman is in good health. But if a woman has a strong family history of breast cancer — especially if a first-degree relative was diagnosed with breast cancer before the age of 50 — she should talk to her doctor about the possible benefits of earlier screenings.

“Personal advocacy is a very important thing to remember,” Guerra said. “We see ourselves as the nurturers and head of the household who often take care of everyone else but ourselves. But women need to remember the importance of taking care of themselves.”

Mikaela Conley, Brand Publishing Writer

Copyright © 2014, Los Angeles Times
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