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Lani · 03-12-2008, 06:43 PM

Dr. Kent Osborne --great researcher, I understand he also sees patients

Dr. Jenny Chang--whom Dr Osborne introduces as the oncologist at Baylor in charge of most of the neoadjuvant trials of targetted therapies

You can hear both of them talk on the videos of the Miami BC conference I supplied the link for

Dr. Anthony Lucci --breast surgeon at MD Anderson who does research on
cox2 inhibitors and diet (walnuts, etc) and breast cancer He also has published on the costs/reimbursements of different breast surgeries and whether that influences/has influenced the trends of surgery done in this country. He is a very nice man, easy to talk to. I asked him several questions and he converses easily and explains well and seems to have a
human touch. Perhaps he could be helpful in your sorting through the disagreement between the oncologist and the surgeon at Baylor.

I have posted before that there is a trend to doing the least surgery that will answer the question/take care of the problem/ allow staging in breast cancer because 1) surgery causes inflammation and the gene expression profile of breast cancer looks very much like inflammation 2) there is a feeling that breast cancer (stem cells) in a dormant condition hide out in the bone marrow and that angiogenic substances are what awaken them like Prince Charming and Sleeping Beauty. The theory goes that the larger the surgery the more angiogenic substances are released.

3) In cases where lumps are found long before surgery, the tumor recurs/metastasizes x months after surgery (x depending on the subtype of bc) NOT x months after the lump was found, implying that something about the surgery started "the clock ticking" This has been found when fear, lack of local medical care, or other circumstances cause the surgery to be delayed long after the lump was found.

The above is theoretical, just as it is called the "stem cell THEORY" of breast cancer, but my impression from attending meetings is that more and more experts are switching to believing in the "theory"

This is not to say choosing to have a mastectomy is the wrong decision--it is just to say that there are alternatives and the right answer is not known, so it is reasonable to get second/third opinions and ask for lots of input on what the alternatives/pros & cons of each are.

If the mastectomy is being recommended to help your mom avoid radiation therapy I think consulting with the radiation therapist BEFORE rather than AFTER surgery may be in order in order to be sure it is his/her opinion that you mom wouldn't need radiation therapy ANYWAY or that it would/would not be given in a different way.

There are trials of IORT (intraoperative radiation therapy done at the time of lumpectomy as a one time treatment not requiring more after), accelerated partial breast radiation where tubes are implanted at the time of surgery and treatments take place for 5-7 days thereafter and are then over as well as external beam accelerated partial breast radiation which is done after surgery externally.

It makes sense to get all the info and make decisions and a game plan BEFORE undergoing surgery. I hope one/several of the doctors above might be able to help you with that.

Is it your mom's left breast(side the heart is on)? Doubt this would have an influence as if your mom had heart problems I doubt they would have given her herceptin.

Just a word of correction, if your mom doesn't have inflammatory bc (and even if she does) 95% is NOWHERE NEAR what the rate of complete pathological response is with neoadjuvant therapy. It would be WONDERFUL if it was!!!!

Hope some of this helped.

03-12-2008, 06:43 PM	#14
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	oncologists/surgeons I have heard talk/asked questions of at meetings Dr. Kent Osborne --great researcher, I understand he also sees patients Dr. Jenny Chang--whom Dr Osborne introduces as the oncologist at Baylor in charge of most of the neoadjuvant trials of targetted therapies You can hear both of them talk on the videos of the Miami BC conference I supplied the link for Dr. Anthony Lucci --breast surgeon at MD Anderson who does research on cox2 inhibitors and diet (walnuts, etc) and breast cancer He also has published on the costs/reimbursements of different breast surgeries and whether that influences/has influenced the trends of surgery done in this country. He is a very nice man, easy to talk to. I asked him several questions and he converses easily and explains well and seems to have a human touch. Perhaps he could be helpful in your sorting through the disagreement between the oncologist and the surgeon at Baylor. I have posted before that there is a trend to doing the least surgery that will answer the question/take care of the problem/ allow staging in breast cancer because 1) surgery causes inflammation and the gene expression profile of breast cancer looks very much like inflammation 2) there is a feeling that breast cancer (stem cells) in a dormant condition hide out in the bone marrow and that angiogenic substances are what awaken them like Prince Charming and Sleeping Beauty. The theory goes that the larger the surgery the more angiogenic substances are released. 3) In cases where lumps are found long before surgery, the tumor recurs/metastasizes x months after surgery (x depending on the subtype of bc) NOT x months after the lump was found, implying that something about the surgery started "the clock ticking" This has been found when fear, lack of local medical care, or other circumstances cause the surgery to be delayed long after the lump was found. The above is theoretical, just as it is called the "stem cell THEORY" of breast cancer, but my impression from attending meetings is that more and more experts are switching to believing in the "theory" This is not to say choosing to have a mastectomy is the wrong decision--it is just to say that there are alternatives and the right answer is not known, so it is reasonable to get second/third opinions and ask for lots of input on what the alternatives/pros & cons of each are. If the mastectomy is being recommended to help your mom avoid radiation therapy I think consulting with the radiation therapist BEFORE rather than AFTER surgery may be in order in order to be sure it is his/her opinion that you mom wouldn't need radiation therapy ANYWAY or that it would/would not be given in a different way. There are trials of IORT (intraoperative radiation therapy done at the time of lumpectomy as a one time treatment not requiring more after), accelerated partial breast radiation where tubes are implanted at the time of surgery and treatments take place for 5-7 days thereafter and are then over as well as external beam accelerated partial breast radiation which is done after surgery externally. It makes sense to get all the info and make decisions and a game plan BEFORE undergoing surgery. I hope one/several of the doctors above might be able to help you with that. Is it your mom's left breast(side the heart is on)? Doubt this would have an influence as if your mom had heart problems I doubt they would have given her herceptin. Just a word of correction, if your mom doesn't have inflammatory bc (and even if she does) 95% is NOWHERE NEAR what the rate of complete pathological response is with neoadjuvant therapy. It would be WONDERFUL if it was!!!! Hope some of this helped.