These slides are intended as an educational overview for newly diagnosed early stage breast cancer patients. My hope is that it can complement and enhance the doctor-patient relationship and shared decision making. I welcome any feedback on how to improve it.

1. Early Stage Breast Cancer Matthew Katz, MD October 2011

15. Early Stage Breast Cancer No lymph nodes involved References: Solin et al, http://1.usa.gov/slIK15 Wapnir et al, http://1.usa.gov/ry1gBf Coburn et al, http://1.usa.gov/tGM1oo Adjuvant! Online v 8.0 Stage 10-year Breast Cancer Survival 0 (DCIS) 99% T1a/b N0 95+% T1c N0 90+% T2 N0 80%

16. Early Stage Breast Cancer 1-3 Lymph Nodes Involved References: Adjuvant! Online v 8.0 Stage 10-year Breast Cancer Survival T1a/b N1 80-85% T1c N1 80% T2 N1 70%

36. Differences in Early Stage Breast Cancer * Some patient with lymph node involvement may need radiation § Varies based upon several factors (age, tumor type + size, etc.) Factor Mastectomy BCS Keep my breast No Yes Avoid radiation Usually yes* Usually no § Less treatment time Depends how you define it ‘ Do everything’ Yes No ‘ Less (surgery) is more’ No Yes Recurs in breast Lowest Slightly higher Survival/Cure Equal

50. Who is suitable for partial breast irradiation? Source : http://bit.ly/ASTRO-APBI-Consensus Factor Criterion Age 60+ years old BRCA 1/2 Not present Tumor 2 cm or less Margins Clear/negative by 2mm Vascular invasion No Type Invasive ductal, other favorable ER Status Positive Multifocal/centric No (unless <2 cm under microscope only) Nodes Negative or only on immunohistochemistry Node surgery Yes, either axillary sentinel node biopsy or axillary dissection

56. Planning: Right Breast Image Credit: Phillips Medical Systems

57. Planning: Blue beam Image Credit: Phillips Medical Systems

62. Side Effects Image Credit: Phillips Medical Systems

64. Side effects ≅ Inflammation Source : http://bit.ly/WikiInflammationSigns Feature Why Redness Increased blood flow Warmth Increased blood flow Swelling More fluid + inflammatory cells to help with repair Pain/Irritation Chemicals released is tissue, nerve activity Altered organ function Ongoing injury

69. Managing Side Effects Side Effect Treatments Skin Hypoallergenic soap, moisturizers, lotions and sometimes pads Breast Ibuprofen (e.g. Advil), not likely to need prescription pain medicine Tiredness Pace yourself, prioritize what you need to do Rarely patients have break from treatment before completing it

83. Resources For More Information Organization Website National Cancer Institute www.cancer.gov American Cancer Society www.cancer.org American Society of Radiation Oncology www.rtanswers.org American Society of Clinical Oncology www.cancer.net Association of Cancer Online Resources www.acor.org Breastcancer.org www.breastcancer.org LIVESTRONG www.livestrong.org