Medical, radiation, and surgical oncologists descended on Miami for day 1 of the 42nd Annual Miami Breast Cancer Conference to learn the latest insights on diagnostic, treatment, and management strategies for the complexities and challenges of breast cancer.

Today’s welcome session featured a discussion among members of a “world-class tumor board,” including Patrick I. Borgen, MD, chairman at the Department of Surgery and Director of the Brooklyn Breast Cancer Program, and other leaders in the field.

An exciting clinical case…

The panel debated a clinical case and possible treatments. The patient was described as a 36-year-old female who was undergoing regular mammograms and sonograms due to a history of bilateral palpable complicated breast cysts. She had been previously treated with therapeutic cyst aspiration (x3). Imaging showed a newly visualised irregular hypoechoic mass in the right breast; subsequent USG core biopsy yielded invasive ductal carcinoma, poorly differentiated, ER 95%, PR 5%, and HER2 3+ with Ki-67 of 99%.

Yet that wasn’t every attendee’s treatment suggestion. About one-third of respondents voted for neoadjuvant TCHP (paclitaxel, carboplatin, trastuzumab, and pertuzumab), to be administered before surgery or radiation therapy. 

Followed by a lively discussion

Kelly Hunt, MD, FACS, FSSO, Professor & Chair, Department of Breast Surgical Oncology at The University of Texas MD Anderson Cancer Center, offered: “If my patient asked, ‘You’re my surgeon. What should I do?’...I’d say it sounds like a mastectomy is needed. I don’t know if a bilateral mastectomy is needed—especially if she’s thinking about having kids. She might want to breastfeed. With negative genetic testing in someone who wants to have a family, I’d go for a unilateral mastectomy.”

Dr. Borgen also discussed the fact that 2-cm breast tumors seem to be the “magic cut off point,” in oncology—typically indicating surgery. However, he says, considering this specific patient, “It’s ridiculous to assume there’s a difference between 1.7 and 2cm.” 

He then asked the panelists if they’ve ever talked their patient out of having double-mastectomy surgery: “Our European colleagues are critical of our rate of mastectomy, and I think it’s fair. Do you ever just talk the patient out of it?” 

Josh Feinberg, MD, from the Division of Breast Surgery at Maimonides Breast Center in Brooklyn, NY, put it simply: “It’s about shared decision making and making sure the patient understands the risks… but it’s not mandatory to do a contralateral mastectomy.”