Surgical Oncology — Breast cancer

Management

Breast cancer is the most common type of cancer among women in the United States other than skin cancer, and is second only to lung cancer as a cause of cancer death in American women. Each year in the United States, more than 192,000 women are diagnosed with breast cancer. Over the past several years, however, deaths from breast cancer have decreased as cancer prevention, detection and treatment options have improved.

UC Davis Comprehensive Cancer Center recommends that women have regular clinical breast exams and mammograms to help find breast cancer early. Treatment is more likely to work well when breast cancer is detected early. Women should get regular mammograms every one to two years beginning at age 40. Women who are younger than 40 and have risk factors for breast cancers should consult with their health care providers about the frequency of mammograms or other screening methods.

If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other tests, such as imaging tests (an ultrasound or a Magnetic Resonance Imaging test, or MRI) or a biopsy.

Surgical interventions

Specific surgical procedures may include:

• Skin-sparing mastectomy: A skin-sparing mastectomy, or breast-conserving surgery, is a surgical technique that preserves the breast skin, or as much of the breast skin as possible, during a simple, modified or total mastectomy. During the procedure, the surgeon removes cancerous tissue through a small incision made around the areola; the surrounding breast skin becomes a “pocket” to then be filled with an implant or tissue from another part of the patient’s body. The skin-sparing procedure, for which most women are candidates, frequently offers the best option for a realistic and aesthetically pleasing reconstruction.  
• Sentinel node biopsy: The "sentinel node" is the first lymph node to which the tumor would spread. A sentinel node biopsy is a highly specific and accurate form of lymph node sampling widely used in the cancer center for tumors with risk of lymph node involvement.
• Sentinel node mapping: This procedure determines whether the cancer has spread beyond the primary site and into the lymph system. The sentinel node is identified via injection of a blue and/or radioactive dye, and the node is subsequently removed.
• Breast conservation therapy: the use of lumpectomy in conjunction with postoperative radiation therapy.
• Oncoplastic surgery: to prevent the lumpectomy site from looking malformed or sunken if it is simply closed after removing the lump, breast tissue from other areas of the breast can be moved to fill in the area using oncoplastic surgical procedures.

Radiation therapy: This treatment uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy can be given according to the whole breast, a treatment which can range from three to six weeks depending on risk factors, or over an accelerated time series that treats the area where the tumor started, primarily the lumpectomy site with a margin (accelerated partial breast radiation therapy).

Radiation may be required after mastectomy as well in patients with large (>5 cm) tumors, tumors that invade the skin or chest wall muscles, and in people with four or more lymph nodes with cancer. Radiation has been shown to minimize disease recurrence and improve survival in these patients.

There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters, which are placed directly into or near the cancer. The accelerated partial breast program uses this type of radiation.

Clinical trials

The close collaboration among our doctors and research scientists means that new drugs and treatments developed in the laboratory can quickly move to the clinic, offering our patients immediate access to the latest therapies.

For example, our surgeons were among the first in the country to pioneer a treatment known as non-surgical lumpectomy, or radiofrequency ablation. This investigational treatment employs heat to destroy small, early-stage breast cancers. Our scientists are also developing a new CT breast-imaging machine that could become an alternative to standard mammography.

UC Davis Comprehensive Cancer Center offers a number of breast cancer clinical trials including:

The ENIGMA (Early Neoadjuvant Image and Glycomic Marker Assessment) trial is an attempt to identify women who will effectively respond to pre-operative breast cancer chemotherapy by performing novel breast PET/CT imaging, and assessing blood and tumor tissues for cancer-related changes.
VIEW STUDY DETAILS 

Pilot Tumescent/Standard Mastectomy trial: Current surgical mastectomy technique relies on electrocautery dissection of the breast tissue from the surrounding structures. We hypothesize that using techniques routinely employed by plastic surgery (i.e., tumescent surgery, the injection of a dilute solution of numbing medicine into the breast prior to removing it), the operation may result in less post-operative pain and allow patients to recover more quickly.
VIEW STUDY DETAILS 

Publications

Martinez, S.R., M. Gelfand, H.S. Hourani, J.J. Sorrento, E.P. Mohan. Cardiac injury during needle localized surgical breast biopsy. Journal of Surgical Oncology. 2003 April; 82(4):261-265. 
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Martinez, S.R., S.E. Young, A.E. Giuliano, A.J. Bilchik.  The utility of estrogen receptor, progesterone receptor and Her-2/neu status to predict survival in patients undergoing hepatic resection for breast cancer metastases. The American Journal of Surgery. 2006 Feb.; 191:281-283. 
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Nakagawa, T., S.K. Huang, S.R. Martinez, A.N. Tran, D. Elashoff, X. Ye, R.R. Turner, A.E. Giuliano, D.S.B. Hoon. Proteomic profiling of primary breast cancer predicts axillary lymph node metastasis.  Cancer Research. 2006 Dec.; 66(24):11825-11830. 
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Nakagawa, T., S.R. Martinez, Y. Goto, K. Koyanagi, M. Kitago, T. Shingai, D.A. Elashoff, X. Ye, F.R. Singer, A.E. Giuliano, D.S.B. Hoon. Detection of circulating tumor cells in early-stage breast cancer metastasis to axillary lymph nodes.  Clinical Cancer Research. 2007 July; 13(14):4105-4110.  
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Martinez, S.R., R.J. Hagge, S.D. Christensen, J.M. Webb. Metastatic breast cancer mimicking benign fatty liver infiltration. The Breast Journal. 2008 Jan-Feb;14(1):108. 
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Chen, S.L., S.R. Martinez. The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. American Journal of Surgery. 2008 Oct.; 196(4):495-9. 
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Bowen, S.L., Y. Wu, A.J. Chaudhari, L. Fu, N.J. Packard, G.W.  Burkett, K. Yang, K.K. Lindfors, D.K.  Shelton, R. Hagge, A.D. Borowsky, S.R. Martinez, J.  Qi, J.M.  Boone, S.R.  Cherry, R.D.  Badawi. Initial characterization of a dedicated breast PET/CT scanner during human imaging.  Journal of Nuclear Medicine. 2009 Sept.; 50(9):1401-8. 
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S.H. Beal; S.R. Martinez, R.J. Canter; S.L. Chen; V.P. Khatri; R.J. Bold.  Survival in 12,653 breast cancer patients with extensive axillary lymph node metastasis in the anthracycline rra.  Medical Oncology. 2010 Dec.; 27(4):1420-1424. 
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Martinez, S.R., S.H. Beal, R.J. Canter, S.L. Chen, V.P. Khatri, R.J. Bold. Medullary carcinoma of the breast: A population-based perspective. Medical Oncology. 2010 Apr. 
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W.H. Tseng, S.R. Martinez.  Metaplastic breast cancer: To radiate or not to radiate?  Annals of Surgical Oncology. 2011 Jan;18(1):94-103. 
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Coates, J., S.R. Martinez, R.J. Bold, S.L. Chen. Adjuvant radiation therapy is associated with improved survival for adenoid cystic carcinoma of the breast. Journal of Surgical Oncology. 2010 Sept.; 102(4):342-347. 
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Martinez, S.R., S.H. Beal, S.L. Chen, R.J. Canter, V.P. Khatri, A. Chen, R.J. Bold. Disparities in the use of radiation therapy in patients with local-regionally advanced breast cancer. International Journal of Radiation Oncology, Biology, Physics. 2010 Nov.; 78(3):787-792. 
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W.H. Tseng, Thomas R. Stevenson, R.J. Canter, S.L. Chen, V.P. Khatri, R.J. Bold, S.R. Martinez.  Sacramento Area Breast Cancer Epidemiology Study (SABES): Use of post-mastectomy breast reconstruction along the rural to urban continuum. Plastic and Reconstructive Surgery. 2010 Dec.; 126(6):1815-1824. 
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Your Team

Oncologists Specializing in Breast Cancer

Surgical Oncology

Richard Bold, M.D.
Chief of Surgical Oncology
Professor of Surgery

Robert Canter, M.D.
Assistant Professor of Surgery

Vijay Khatri, M.D.
Professor of Surgery
Director, Faculty Development and Mentoring

Steve Martinez, M.D.
Associate Professor of Surgery

Anthony Yang, M.D.
Assistant Professor of Surgery

Hematology/Oncology

Helen Chew, M.D.
Director, Clinical Breast Cancer Program
Associate Professor of Medicine

Scott Christensen, M.D.
Professor of Medicine
Associate Director, Hospice Program
Medical Director, Cancer Care Network

Tianhong Li, M.D., Ph.D.
Co-Director, Phase I Program
Co-Director, Breast Cancer Research Program
Assistant Professor of Medicine

Diagnostic Radiology

Terry L. Coates, M.D.
Professor of Radiology

Karen K. Lindfors, M.D.
Chief of Breast Imaging
Professor of Clinical Radiology

Pathology

Alexander Borowsky, M.D.
Associate Professor of Medical Pathology

Lydia P. Howell, M.D.
Interim Chair and Director, Anatomic Pathology
Professor of Medical Pathology

Plastic and Reconstructive Surgery

Thomas R. Stevenson, M.D.
Chief of Plastic Surgery
Professor of Surgery

Granger Wong, M.D., D.M.D.
Associate Professor of Surgery

Michael S. Wong, M.D.
Assistant Professor of Surgery

Radiation Oncology

Jyoti Mayadev, M.D. 
Assistant Professor

Allen M. Chen, M.D.
Associate Professor
Director, Residency and Fellowship Training Program