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COV ER FE AT UR E "We've now found some targeting agents that can get into the resistance mechanisms that cancer cells build up, rendering them no longer sensitive to hormonal agents," she says. "For triple negative breast cancer (breast cancer that does not express estrogen or progesterone receptors and is not HER-2 positive), one of the directions we're taking is through clinical trials at UH Seidman Cancer Center. In early fall, we hope to have specific drugs t hat ca n overcome triple-negative brea st ca ncer reliably a f ter it ha s metastasized. Clinical trials are how advances in cancer therapy are made, and we offer dozens of them for breast cancer patients." Genomics May Be Key to Treatment Selection Genomic medicine may become the key to optimal treatment and to precise prognosis. Advanced genomic sequencing of breast cancers may help determine certain abnormalities that may respond to specific targeted drug therapies. UH Seidman Cancer Center is testing some of those predictors now in clinical trials. "In the breast cancer program we are starting to do more genomic sequencing a nd becoming more able to ta rget tumors in a way to make individualized treatment plans for patients based on the exact type cancer and the genomic abnormalities that their cancer holds," says Dr. Silverman. She points out that it's not appropri- ate for every tumor to be sequenced for its genomic abnormalities. But when there are difficult cancers that aren't responding to therapy as expected, or with some of the triple negative cancers, genomic sequencing can offer direction for treatment or help avoid treatments that might not be helpful. "So that's the idea of genomic analysis of tumors," says Dr. Silverman. "It's very new, very cutting edge and something we're very excited about at UH Seidman Cancer Center." Oncoplastics Improve Outcomes Oncoplastics has become an inte- g ra l pa r t of comprehensive brea st cancer care — one that often plays an important part in a patient's return to normalcy, both physically and emo- tionally. Once utilized as a corrective post-treatment measure, oncoplastic surgery is now increasingly combined with breast conservation therapy and oncolo g ic pro ce du res. Accord i ng to Dr. Dietz, this results in a better cancer outcome and a better cosmetic result — especially for women with very large breasts. She expla ins that la rge-breasted women who have a lumpectomy and radiation usually get a lot of shrinkage and then, down the road, asymmetry of the breast. She also points out that it's more difficult to get a clear margin when doing a lumpectomy on a large breast, so more tissue is taken and that results in asymmetry. For large-breasted women, there tends to be more side effects from radiation therapy, as well. "So for women having a lumpectomy, we do a simultaneous bilateral reduc- tion. Not only does the patient get a good cosmetic outcome, but also (because the breast is smaller), the patient can tolerate the radiation better," she says. Nipple-sparing surger y is another oncoplastic procedure that can help restore a breast to near-normal appear- ance. Recently, the indications for this procedure have expanded to include women who have had a previous breast reduction or ot her brea st surger y. Women who are bigger breasted are now viable candidates, as well. "There's such a stigma for losing a breast, but (with some of these new and improved procedures) we do a much better job now," says Dr. Dietz. "And very often we're able to combine plastic procedures, like an oncoplastic reduc- tion with a breast lift that maybe the patient always dreamed about anyway." She emphasizes that women who have their cancer detected early have the best outcomes. "For the primary care physician, the key is understanding patients' risk and making sure they're getting screened at appropriate levels." F o r m o r e i n f o r m a t i o n a b o u t brea st health ser vices at Universit y Hospitals Seidman Cancer Center, visit UHSeidman.org. To refer a patient, call 216-844-BRST. ■ Dr. Jill Dietz is a breast surgeon who recently joined UH Seidman Cancer Center. She serves as Director of UH Breast Center Operations. Dr. Paula Silverman is Clinical Director, Breast Cancer Program, at UH Seidman Cancer Center, where she specializes in hematology and oncology. 1 0 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ S E P T E M B E R /O C T O B E R 2 0 1 4