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Updates on breast cancer risk factors, screening methods, and treatments for the nurse navigators who are guiding patients from diagnosis to treatment and, hopefully, through survivorship.
Beth Baughman DuPree, MD
While breast cancer patients may have better 5-year survival rates than other cancer patients if their tumors are detected early, the mortality associated with the disease is still very high, with an estimated 39,520 women in the United States dying from the disease this year.
That is why updates on risk factors, screening methods, and treatments are very valuable, especially for the nurse navigators who are guiding patients from diagnosis to treatment and, hopefully, through survivorship. At the 4th Annual National Coalition of Oncology Nurse Navigators (NCONN) conference, Beth Baughman DuPree, MD, medical director of the Breast Health Program at the Holy Redeemer Health System in Pennsylvania, presented nurse navigators with some important updates that have taken place over the course of the last year.DuPree said that many new nurses begin their careers by working the night shift at various hospitals in clinics. However, working the occasional night shift and disrupting the body’s natural rhythm could increase the risk of breast cancer, according to a study published in the Scandinavian Journal of Work, Environment, and Health earlier this year.
“This night shift work disrupts the body's natural rhythm,” DuPree said. “And it's especially risky in young nurses who may have not had children yet and therefore their breasts haven't fully developed.”
In reviewing the data, DuPree said that the fact that women who worked three night shifts or less per week suggests that the body cannot adapt.
DuPree said that the disruption of melatonin production could be tied to the increased risk. The study's authors suggest that melatonin supplementation should be considered.DuPree was critical of the United States Preventive Services Task Force (USPSTF) recommendations on mammography, specifically the fact that biennial screening is recommended for women between the ages of 50 and 75 but not for younger patients.
“Mammograms certainly have their limitations,” DuPree said. “They can't screen the whole breast. They don't catch every case of cancer. But for now, they're still the best thing we have.”
However, DuPree said that there are new methods that are particularly promising. At her own health network, DuPree said she's been able to use a method called 3-D tomosynthesis. This technique takes multiple images of the breast from different angles, which are then used to create a three-dimensional rendering of the breast.
By doing this, oncologists are able to detect smaller cases of cancer and exactly where the tumors are located within the breast.
“This really is revolutionary,” DuPree said, citing a case example at the conference that she said could not have been detected through a traditional mammogram.DuPree reminded the nurse navigators that surgery has come a long way since the days of the mentality of William Stewart Halsted, mainly that the more you cut, the more you cure. Rather, DuPree said that numerous studies are confirming that patients may perform better with less surgery.
One example she provided was a study presented at the 2012 meeting of the American Society of Breast Surgeons (ASBS). A 6-year retrospective analysis found that out of 205 nipple-sparing mastectomies performed on 130 patients, only 1.8% of patients had local recurrence. Another 1.8% of patients had distant recurrence, but DuPree said that would not be a result of a mastectomy, which is designed to prevent local recurrence.
Another study followed patients who had received a combined total of 325 nipple-sparing mastectomies. After a mean period of 30 months, there was no local regional recurrence.
“These procedures are demonstrating a great oncologic result,” DuPree said.