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Breast Cancer Course


     Introductory video transcript:
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Course Overview

Welcome to The University of Texas MD Anderson Cancer Center Professional Oncology Education Web site, dedicated to sharing our experiences and best practices in preventing, diagnosing and treating breast cancer. This frequently updated series of faculty lectures features information on the identification of women at high risk, psychosocial support, palliative care, inflammatory breast cancer, nursing management, diet and exercise, and survivorship. We hope you will enjoy the series. Please let us know if it is useful to you. We look forward to partnering with you, and we welcome your suggestions for other topics that we can present to aid in your patients' care
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Lectures

Banu Arun, M.D.
Risk Assessment and Management of High Risk Women   Top of Page
 
Presenter: Banu Arun, M.D.
Professor, Department of Breast Medical Oncology
Co-Medical Director for Clinical Cancer Genetics
 

Summary: Dr. Banu Arun, Professor of Breast Medical Oncology and Co-Director of Clinical Cancer Genetics at The University of Texas MD Anderson Cancer Center, presents the lecture, "Risk Assessment and Management of High-Risk Women." Dr. Arun begins her presentation with an overview of the risk factors that contribute to the development of breast cancer, including age, gender, endocrine factors, benign high-risk breast lesions, dietary factors, and lifestyle. Dr. Arun focuses her lecture on the significance of a patient’s personal and family history of breast cancer and breast cancer-associated hereditary genes. Detailing the increased individual breast and ovarian cancer risk for a woman with a deleterious germline mutation in either the BRCA1 or BRCA2 gene, Dr. Arun explains which patients should be referred for genetic counseling and testing. She emphasizes the need for additional research to refine risk models and for coordinated multidisciplinary assessment and management. Dr. Arun enumerates risk management options that are available for high-risk patients, including surveillance (including guidelines for breast screening with magnetic resonance imaging), chemoprevention (including the results of trials with tamoxifen and raloxifene), and preventative surgeries (including prophylactic mastectomy and oophorectomy). Dr. Arun highlights the need for short-term pilot prevention trials to identify effective new chemopreventative agents that are more effective and less toxic than currently available agents, and she emphasizes the need to identify agents that will benefit patients with estrogen receptor-negative breast cancer. Dr. Arun concludes her lecture with advice for health professionals who, in addition to seeing high-risk patients, are asked to provide advice for family members of patients with identified breast cancer-associated heredity.
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Lakshmi Naik, MA, LCSW
Psychosocial Impact of Breast Cancer: Hoping and Coping   Top of Page
 
Presenter: Lakshmi Naik, MA, LCSW
Assistant Director
Department of Social Work
 

Summary: Psychosocial care encompasses the social, psychological, emotional, spiritual, quality of life, and functional aspects of a patient’s life. Caring for cancer patients is multidimensional and should be provided in the cultural and social context of the cancer patient’s life. Not only do health care professionals provide physical care, but they also provide respectful and compassionate emotional comfort to cancer patients. Lakshmi Naik, Assistant Director of the Department of Social Work at The University of Texas MD Anderson Cancer Center, presents a lecture titled, "Psychosocial Impact of Breast Cancer: Hoping and Coping" in which she discusses the psychosocial impact of breast cancer on patients and survivors. She outlines the need for integration of appropriate assessment and intervention tools to optimize health care through psychosocial support. Ms. Naik discusses ways that health care providers and multidisciplinary teams can effectively and directly meet specific emotional and relationship needs of cancer patients. She discusses the available resources to increase psychosocial awareness, professional education, and the process and importance of timing for appropriate referrals. Additionally, Ms. Naik provides resources for psychosocial services, including counseling, transition of care, and patient safety. An underlying theme of Ms. Naik’s discussion is the need for establishing a culture of compassion within the environment of cancer care. Ms. Naik concludes by outlining the psychosocial resources available to cancer patients and survivors at The MD Anderson Cancer Center.
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Eduardo Bruera, M.D.
Palliative Care   Top of Page
 
Presenter: Eduardo Bruera, M.D.
Professor and Chair
Department of Palliative Care and Rehabilitation Medicine
 

Summary: Dr. Eduardo Bruera, Professor and Chair of Rehabilitative Medicine at The University of Texas MD Anderson Cancer Center, presents the lecture, "Palliative Care." Poignantly discussing the privilege, opportunities, and challenges of treating breast cancer patients who experience significant symptom distress and who cannot be cured of their disease, Dr. Bruera broadly defines the goals of palliative care. These goals include providing symptom assessment, symptom management, psychosocial support for patients and their families, complex discharge planning, education, and current research in the field. Recognizing that physical, emotional, and financial distress may be profound for both cancer patients and their families, Dr. Bruera broadens the window for palliative care from end-of-life care to the management of severe symptoms at any time during the trajectory of the disease. Dr. Bruera discusses tools for symptom assessment and details ways to measure and maximize symptom control. His lecture addresses pain, fatigue, weight loss, loss of appetite, nausea, vomiting, anxiety, shortness of breath, and the confusion-agitation that often occur at the end of life. Referencing the MD Anderson model of palliative care, Dr. Bruera accentuates the importance of multidisciplinary management to reduce patient suffering and emphasizes the diverse expertise required for interdisciplinary teams to meet the patient’s and family’s needs. Dr. Bruera portrays the palliative care unit as the intensive care unit for patients with symptom distress, contrasting it with a regular hospital unit. He emphasizes the importance of setting different expectations for patient outcomes when the disease progresses and curative options decrease. Dr. Bruera concludes by illustrating how oncology and palliative care teams might interact for the benefit of patients in providing timely referrals, maximizing comfort measures, and maintaining hope to enhance the quality of life for patients and their families.
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Wendy Woodward, M.D., Ph.D.
Introduction to Inflammatory Breast Cancer: Clinical Diagnosis   Top of Page
 
Presenter: Wendy Woodward, M.D., Ph.D.
Associate Professor
Department of Radiation Oncology
 

Summary: One of the major difficulties in effectively diagnosing IBC is recognizing the signs and symptoms of this complex disease. Patients are frequently misdiagnosed, often because no clinical mass is apparent, or signs of a rash-like symptom appear and are inappropriately treated with antibiotics for a long period of time, ultimately delaying treatment. In this lecture, “Inflammatory Breast Cancer: Clinical Diagnosis,” Dr. Wendy Woodward, Associate Professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, says a comprehensive baseline assessment and timely initiation of appropriate therapy is essential for improved patient outcomes. Dr. Woodward reviews the epidemiology, etiology, biology, pathologic features, screening techniques, and presenting signs and symptoms of IBC.
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Jennifer McKenzie, M.S.N., RN, OCN, CBCN
Introduction to Nursing Management of the Breast Cancer Patient   Top of Page
 
Presenter: Jennifer McKenzie, MSN, RN, OCN, CBCN
Senior Nursing Instructor
Nursing Workforce Development
 

Summary: Jennifer McKenzie, Senior Nursing Instructor for the Breast Cancer Center and Nursing Professional Development at The University of Texas MD Anderson Cancer Center discusses symptom management of breast cancer in her lecture, "Introduction to Nursing Management of the Breast Cancer Patient." Ms. McKenzie identifies common symptoms experienced by patients with breast cancer, including pain, lymphedema, chemotherapy-induced nausea and vomiting, fatigue, cognitive dysfunction, hot flashes, and osteoporosis. Ms. McKenzie describes risk factors, assessment, management, and nursing implications of each of these common symptoms.
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Wendy Demark-Wahnefried, Ph.D., RD
Diet and Exercise in Breast Cancer   Top of Page
 
Presenter: Wendy Demark-Wahnefried, Ph.D.
Adjunct Professor, Department of Behavioral Science
 

Summary: Dr. Wendy Demark-Wahnefried, Adjunct Professor of Behavioral Science at The University of Texas MD Anderson Cancer Center, presents a lecture entitled, "Diet and Exercise in Breast Cancer." The number of cancer survivors has grown to over 25 million worldwide, and breast cancer survivors make up a large percentage of that population. Substantial improvements in early detection and treatment of breast cancer have increased the 5-year overall survival to almost 80%, and this number is higher in most developed nations. As cancer survivors age, diet and exercise have a great impact on their quality of life; this is especially true in breast cancer survivors, as research has documented a high incidence of depression and fatigue in these patients. They are also at risk for functional decline and other cancers as well as other diseases, including cardiovascular disease and diabetes. Dr. Demark-Wahnefried focuses her talk on the evidence supporting the need for diet and exercise interventions, and she presents the recommendations for diet and exercise from The World Cancer Fund- American Institute for Cancer Research and the benefits of following these recommendations. Dr. Demark-Wahnefried reviews current research on the impact of diet and exercise throughout the course of breast neoplasia and discusses the most effective interventions to promote energy balance for cancer survivors.
     Summary and Learning Objectives: Español    Português    中文    Arabic Transcript

P. K. Morrow, M.D.
Breast Cancer Survivorship   Top of Page
 
Presenter: P. K. Morrow, M.D.
Assistant Professor
Department of Breast Medical Oncology
 

Summary: Breast cancer is the most commonly diagnosed cancer in women, yet a decrease in the overall rate of breast cancer deaths has led to more women living longer after being diagnosed with breast cancer. Consequently, primary care providers will be asked to assume expanded roles in the care of breast cancer survivors. In her lecture, "Breast Cancer Survivorship," Dr. P. K. Morrow, Assistant Professor of Breast Medical Oncology and Associate Medical Director for Breast Cancer Survivorship at The University of Texas MD Anderson Cancer Center, discusses recommendations and guidelines for the assessment and management of long-term complications from breast cancer and its treatments. Dr. Morrow describes breast cancer surveillance, monitoring for second primary cancers, and screening schedule recommendations. In discussing the late effects of breast cancer, Dr. Morrow introduces assessment and treatment for bone, cardiovascular, and sexual health. Patients who have a history of breast cancer frequently exhibit symptoms of anxiety, depression, and fear of recurrence. Dr. Morrow addresses the assessment and management of psychosocial issues. Dr. Morrow also presents special recommendations for decreasing the incidence of lymphedema and managing its symptoms.
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Surgical Treatment Approaches   Top of Page
 
Presenter: Kelly K. Hunt, M.D.
Professor
Department of Surgical Oncology
 

Summary: Breast cancer is the most common cancer in women, affecting one in eight American women. Surgery is a key component of multidisciplinary treatment of breast cancer. Dr. Kelly Hunt, Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center, says that multiple factors must be considered in surgical planning. In her lecture, "Breast Cancer: Surgical Treatment Approaches," Dr. Hunt discusses these factors. She reviews recent data that influence surgical treatment and discusses options for surgical treatment of the primary tumor. Further, she details different oncoplastic techniques used for reconstruction after partial mastectomy, advises on the best integration of reconstruction for patients undergoing mastectomy, and concludes with the most up-to-date information about nodal staging for breast cancer.
     Summary and Learning Objectives: Español    Português    中文    Arabic Transcript  |  日本語


Radiotherapy Treatment Approaches   Top of Page
 
Presenter: Wendy Woodward, M.D., Ph.D.
Associate Professor
Department of Radiation Oncology
 

Summary: "Across cancer subsites, the first principles of radiation are the same. Greater volume of disease requires greater dose for control,” says Dr. Wendy Woodward, Associate Professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center. In her lecture, “Breast Cancer: Radiotherapy Treatment Approaches," Dr. Woodward highlights the role of radiation in breast cancer, including how patients are selected for the therapy, how the appropriate dose is determined, and technical issues that arise. She also emphasizes the importance of targeting the disease while sparing normal tissue. Dr. Woodward assesses recent data from the literature, which demonstrate why patients should not be given a higher or lower dose of radiation than is required, inform current radiation treatment planning, and discuss fractionation, volume, and new technologies.
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Wei Yang, M.D.
Diagnostic Breast Imaging   Top of Page
 
Presenter: Wei Tse Yang, M.D.
Professor
Department of Diagnostic Radiology
 

Summary: Dr. Wei Tse Yang, Professor of the Department of Diagnostic Radiology, Chief of the Section of Breast Imaging, and Medical Director of the Ben and Julie Rogers Breast Diagnostic Clinic at The University of Texas MD Anderson Cancer Center, says that imaging of breast tissue is a vital component in detecting and evaluating the extent of breast cancer. In her lecture, “Diagnostic Breast Imaging,” Dr. Yang evaluates the major imaging modalities available today, including mammography, high-resolution sonography, and magnetic resonance imaging, for their indications and role in breast cancer diagnosis, staging, and management. She discusses common benign and malignant breast conditions that imaging can elucidate. Dr. Yang also advises when an image-guided biopsy should be performed.
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