EFA Medical Conference 2017: "Breast Cancer in Young Women; Early Diagnosis Timely Intervention" Presentation by Dr. Stephanie Bernik

Dr. Stephanie Bernik's presentation at the EFA 2017 Medical Conference tackled the challenges associated with breast cancer in younger women.

Key Points

Highlights:

• Dr. Stephanie Bernik, the Chief of Surgical Oncology of Surgery and General Surgery at the Lenox Hill Hospital, presented at the EFA 2017 Medical Conference. Her presentation provides viewers with more information about breast cancer, especially in younger women.

Importance:

• Breast cancer can be challenging to detect in younger women due to the increased density of the breast tissue. This presentation discusses the challenges associated with breast cancer diagnosis in this particular age cohort, but it also reviews other options to prevent and treat breast cancer.

Key points:

• A small percentage of breast cancer cases occur in women under the ages of 40-45. That being said it is still a significant proportion of all breast cancer cases and 1,000 women with breast cancer under the age of 40 dies because of the disease every year.
• Tumors in younger tend to be larger and of a higher grade. Additionally, there are more estrogen receptor negative tumors in younger women.
• The presence of extra estrogen in a younger woman’s body is thought to worsen the disease. Additionally, increased estrogen in a woman’s body increases her risk for breast cancer. Additional risk factors include early puberty, late onset of menses, and exposure to hormones in post-menopause. Ways to mitigate risk caused by estrogen include but is not limited to weight management, healthy eating, exercise and avoidance of hormone replacement.
• Younger women diagnosed with breast cancer are often faced with fertility issues, especially if they need to undergo chemotherapy.
  • There are many options to circumvent this issue including fertility preservation.
• Methods for Breast Cancer Screening
  • Breast MRI: Cannot be used for every woman. Evaluates how a specific dye goes in and out of a woman’s breast. It cannot replace a breast ultrasound or mammography even though it is more sensitive. Unusual findings indeed require a biopsy.  Gadolinium dye is thought to be harmful, but the Gadavist dye is believed to be safe. Very expensive. Only to be used for high-risk women. Women with a lifetime risk of breast cancer that exceeds 20-25% ought to get an MRI done yearly.
  • Breast ultrasound: This test is typically used for women with palpable masses or dense breast tissue and helps with the better characterization of the tumor.
  • Mammography: Contrast-enhanced mammography uses normal CT dye to look for areas with increased blood flow; 3D Tomosynthesis looks at single slices through the breast. Recommendations for Mammography:
    • The ACOG, the ACR, and the ASBS all believe that screenings should begin at the age of 40.
    • The American Cancer Society recommends that screening begin between the ages of 45-54 and should be repeated every other year.
    • The U.S. Prevention Services Task Force recommends that screening begin at the age of 50 and should be repeated every other year.
    • The recommended age has increased because of the number of false positives that are seen in younger women. That being said Dr. Bernik still advocates for earlier screening because it will increase the effectiveness of therapies and decrease the number of medicines in the case that a younger woman does truly have breast cancer.
    • Women with a family history of breast cancer ought to be screened even earlier. The recommended age for these women would be ten years before the age of onset of their relative.
• Cancer prevention techniques
  • Chemoprevention typically involves pills that can be taken to reduce risk: 
    • Tamoxifen is the most commonly prescribed pill to reduce breast cancer risk. It is a selective estrogen receptor modulator that works by stopping cell growth. Complications associated with Tamoxifen include increased the risk of endometrial cancer, clotting, pulmonary embolism, and stroke.
    • Aromatase inhibitors have been found to be more effective than Tamoxifen, and it also has fewer side effects.
  • Surgical Issues
    • Savvy SCOUT localization technique uses radar and a handheld detector. Margin probe is used within the operating room to assess margins intra-operatively; however, this probe is not very efficient in dense tissue.
    • Advances in radiation include a shorter delivery time for radiation.
    • Surgery has gotten less traumatic over time: There are less axillary lymph nodes being done. Sentinel node surgery has less risky when it comes to lymphedema.
    • Breast conservation surgery has improved over time: A woman’s own tissue is now used in breast reconstruction.
    • The BioZorb helps maintain the shape of the breast.

Lay Summary

Dr. Stephanie Bernik is the Chief of Surgical Oncology of Surgery and General Surgery at the Lenox Hill Hospital. She recently presented at the EFA 2017 Medical Conference, and her presentation was titled “Breast Cancer in Young Women; Early Diagnosis Timely Intervention."

Dr. Bernik begins her presentation by sharing a few statistics about breast cancer in general and in women below the ages of 40-45. She then goes on to discuss the type, namely estrogen receptor-negative tumors, and characteristics of breast cancers typically found in younger women. Next, Dr. Bernik delves into the potential risk factors for breast cancer including early onset of puberty, late onset of menses, and increased exposure to hormones. These above risk factors can be mitigated if an individual makes a few lifestyle changes, a topic that was extensively covered in Dr. Marisa Weiss’ presentation.

Dr. Bernik proceeds to discuss the challenges in detecting breast cancer in younger women, namely that the breast tissue is denser in younger women. One of the techniques used by healthcare providers to identify tumors is breast MRIs. Dr. Bernik talks extensively about this aforementioned diagnostic tool and the various dyes that can be used with it. Another tool discussed at length in this presentation is breast ultrasound. A third device used for detection is Mammography.

Next, Dr. Bernik talks about breast cancer screening. She references various studies to determine the best age for screening to begin. She advocates for earlier screening than what is proposed, but her argument is supported by the fact that screening earlier will increase treatment effectiveness and will require fewer treatments overall. Additionally, Dr. Bernik believes that women with a family history of the disease should be screened even earlier. Dr. Bernik then proceeds to discuss various types of chemoprevention pills, like Tamoxifen, which are used to prevent cancer.

In the next part of her presentation, Dr. Bernik discusses various surgical techniques including the Savvy SCOUT localization technique. She also briefly delves into the advances in radiation. Next, Dr. Bernik explains different methods for reconstruction. She also spends some time talking about the BioZorb, which is a device that helps maintain the shape of the breast.

Dr. Berkin’s presentation video and transcript can be found at the following URL: https://www.endofound.org/video/breast-cancer-in-young-women-early-diagnosis-timely-intervention-stephanie-bernik-md-facs/1551.