Virginia Commonwealth University

VCU Massey Cancer Center

New approach to treating breast cancer

For decades, the standard treatment approach for breast cancer patients requiring surgery has been to surgically excise the tumor and follow up with chemotherapy and then radiation.

In the mid-90s, Harry Bear, M.D., Ph.D., a surgical oncologist and director of the Breast Health Center at VCU Massey Cancer Center, began exploring a new approach — neoadjuvant therapy — in which chemotherapy is given before the surgery rather than after.

Dr. Bear’s interest in neoadjuvant therapy has developed into his national leadership role with the National Surgical Adjuvant Breast and Bowel Project, which sponsors clinical studies that have the ultimate goal of determining which patients are the best candidates for this new order of treatment, as well as which chemotherapy they should have within that treatment plan.

“Giving chemotherapy before surgery in many cases will shrink the tumor, which may allow for lumpectomy rather than mastectomy and also may allow for a better surgery and disease control,” said Dr. Bear, who presented “Surgical Issues of Neoadjuvant Breast Cancer Treatment” at the 2008 Annual Breast Symposium of the American Society of Clinical Oncology. “We’re also exploring whether chemotherapy before surgery can reduce the need for lymph node dissection.”

The therapy generally is considered for patients with tumors larger than 2 centimeters, with lymph node involvement or those who have inflammatory breast cancer — a more dangerous form of cancer that presents more like a rash than a tumor.

Although two large clinical studies thus far have shown that survival rates are overall the same among patients with and without neoadjuvant therapy, the neoadjuvant approach can be beneficial.

“If we can make the tumors smaller before surgery, it can have an impact on how invasive the surgery is, which in turn affects the patient’s quality of life,” Dr. Bear said.