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Breast Cancer Survivorship Course


     Transcripts: English  |  Español

Course Overview

Today, there are 13.7 million cancer survivors in the United States. By 2022, the number of cancer survivors is expected to surge by a third, to 18 million people. The National Cancer Institute believes that doctors will not be prepared to deal with the problems cancer survivors face. A multidisciplinary team of oncologists, surgeons, radiologists, advanced practice nurses, and pharmacists at The University of Texas MD Anderson Cancer Center provide a course for health care professionals on current practices and the latest guidelines for the management and surveillance of cancer survivors. They review breast cancer survivorship, discuss current management strategies, detail the most common late effects of cancer treatments, and suggest appropriate long-term follow-up care for breast cancer survivors.
     Overview: Español


Accreditation/Credit Designation

The University of Texas MD Anderson Cancer Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Texas MD Anderson Cancer Center designates this enduring material for a maximum of 7.75 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Support for this course was provided by a generous grant from the Cancer Prevention & Research Institute of Texas (CPRIT) PP100157

 

Lectures

Ana C. Nelson, MSN, RN, FNP-BC
Epidemiology   Top of Page
 
Presenter: Ana C. Nelson, MSN, RN, FNP-BC
Advanced Practice Nurse
Cancer Prevention Center
 

Summary: Breast cancer is the second most common cause of cancer death among women in the United States. Ana Nelson, an advanced practice nurse in the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, presents "Breast Cancer Survivorship: Epidemiology." In this lecture, Ms. Nelson identifies trends in breast cancer in the United States, specifically in incidence and mortality rates, survival rates, and ethnic and racial disparities associated with (1) the stage of disease at detection and (2) mortality. She also explains how screening mammograms and improvements in treatment are helping to save lives.
     Summary and Learning Objectives: Español

Tilu Ninan, MSN, RN, ANP-C
Etiology   Top of Page
 
Presenter: Tilu Ninan, MSN, RN, ANP-C
Advanced Practice Nurse
Cancer Prevention Center
 

Summary: Breast cancer is the most commonly diagnosed cancer in women in the United States. Tilu Ninan, an advanced practice nurse in the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, says "Breast cancer development may be a multifactorial interaction between different risk factors such as genetic factors, personal and family history, hormonal factors, and lifestyle factors." In her lecture, "Breast Cancer Survivorship: Etiology," Ms. Ninan reviews the causes, origins, and risk factors that may contribute to the development of breast cancer.
     Summary and Learning Objectives: Español

Robin L. Coyne, MS, RN, FNP-BC
Diagnosis of Masses   Top of Page
 
Presenter: Robin L. Coyne, MS, RN, FNP-BC
Advanced Practice Nurse
Cancer Prevention Center 
 

Summary: Advanced Practice Nurse Robin Coyne, who works in the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, says "There is evidence that breast cancer recurrence continues well beyond 15 years from primary cancer diagnosis and treatment." In her lecture, "Breast Cancer Survivorship: Diagnosis of Masses," Ms. Coyne provides instructions for performing a proper clinical breast examination and for selecting the appropriate diagnostic imaging techniques for masses identified on clinical examination, breast self-examination, and breast imaging. She also stresses the importance of continuity of care for breast cancer survivors when encountering conflicting clinical and imaging findings or benign breast abnormalities.
     Summary and Learning Objectives: Español

Marita Lazzaro, MSN, RN, ANP-BC
Diagnosis of Calcifications   Top of Page
 
Presenter: Marita Lazzaro, MSN, RN, ANP-BC
Advanced Practice Nurse
Cancer Prevention Center
 

Summary: "The majority of calcifications in the breast are benign, which is not what the patient reads on the Internet," says Marita Lazzaro, an advanced practice nurse in the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center. In her lecture, "Breast Cancer Survivorship: Diagnosis of Calcifications," Ms. Lazzaro discusses the association between mammary calcifications and benign, proliferative, and pre-invasive breast disease. She reviews the mammographic terminology associated with benign and suspicious mammary calcifications. Ms. Lazzaro also discusses the importance of concordance of imaging and pathology results and advises on how to handle conflicting results.
     Summary and Learning Objectives: Español

Aysegul Sahin, M.D.
Pathology of Breast Cancer   Top of Page
 
Presenter: Aysegul Sahin, M.D.
Professor
Department of Pathology
 

Summary: An accurate diagnosis and pathological assessment of breast cancer tissue are essential in order for the treating physician to provide an effective multidisciplinary treatment plan. Aysegul Sahin, M.D. and Professor of Pathology at The University of Texas MD Anderson Cancer Center, presents "Breast Cancer Survivorship: Pathology of Breast Cancer." In her lecture, Dr. Sahin describes the basic principles of breast pathology, discusses the diversity of breast tumors and their pathological features, and explains how to integrate clinical and histopathological features of breast cancer into the decision-making process to provide optimal care for the patient. Dr. Sahin discusses pathologists&apos responsibilities of establishing definitive diagnoses and classifying tumors; she also elaborates on the critical role of pathologists in providing accurate information on staging and in evaluating prognostic and predictive factors to promote the best outcome for the patient.
     Summary and Learning Objectives: Español

Michelle O. Butaud, MSN, RN, ANP-BC, AOCNP
Staging   Top of Page
 
Presenter: Michelle O. Butaud, MSN, RN, ANP-BC, AOCNP
Advanced Practice Nurse
Breast Medical Oncology
 

Summary: Michelle Butaud, advanced practice nurse in the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, says it is important to be accurate when staging breast cancer patients at diagnosis because the stage guides the treatment plan. In her lecture, "Breast Cancer Survivorship: Staging," Ms. Butaud identifies different types of cancer staging. She discusses the TNM staging system, as defined by the American Joint Committee on Cancer (AJCC), and advises on how to apply TNM values to the correct stage group.
     Summary and Learning Objectives: Español

Bonnie M. Brice, MS, RN, ANP-C, AOCNP
Common Sites of Metastasis   Top of Page
 
Presenter: Bonnie M. Brice, MS, RN, ANP-C, AOCNP
Advanced Practice Nurse
Breast Medical Oncology
 

Summary: Although most cancers can spread to many different parts of the body, they usually spread to one site more often than to others. Common sites of breast cancer metastasis are the lungs, liver, bones, and sometimes the brain. Bonnie Brice, an advanced practice nurse in the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, stresses that "the disease process poses life-threatening complications." In her lecture, "Breast Cancer Survivorship: Common Sites of Metastasis," Ms. Brice describes how cancer cells can invade nearby normal tissue or blood vessels, a process known as "the metastatic cascade." She reviews recent data on common sites of metastasis and directs physicians to symptoms that can signal that the breast cancer has spread.
     Summary and Learning Objectives: Español

Isabelle Bedrosian, M.D.
Role of Surgery   Top of Page
 
Presenter: Isabelle Bedrosian, M.D.
Associate Professor
Department of Surgical Oncology
 

Summary: "Surgical intervention remains a cornerstone of breast cancer treatment," says Dr. Isabelle Bedrosian, Associate Professor in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center. In her lecture, "Breast Cancer Survivorship: Role of Surgery," Dr. Bedrosian explains why surgery is fundamental to breast cancer treatment. She examines different surgical options for managing the primary tumor, reviews recent data on the effect of locoregional recurrence on death from breast cancer, and identifies when sentinel node biopsy is appropriate for women with breast cancer.
     Summary and Learning Objectives: Español

Karen Hoffman, M.D.
Role of Radiation Therapy   Top of Page
 
Presenter: Karen Hoffman, M.D.
Assistant Professor
Department of Radiation Oncology
 

Summary: Radiation treatment is an important component of multimodality cancer treatment for many women with breast cancer. Dr. Karen Hoffman, Assistant Professor in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center, says, "Radiation therapy can improve both local cancer control and breast cancer survival." In her lecture, "Breast Cancer Survivorship: Role of Radiation Therapy," Dr. Hoffman explains the role of radiation therapy in breast cancer treatment for women who undergo breast-conserving surgery and women who undergo mastectomy. She also describes how radiation therapy works and lists the steps that are taken to initiate breast cancer radiation treatment.
     Summary and Learning Objectives: Español

Diane P. Hecht, Pharm.D., RPh
Role of Chemotherapy   Top of Page
 
Presenter: Diane P. Hecht, Pharm.D., RPh
Clinical Pharmacy Specialist
Division of Pharmacy
 

Summary: Breast cancer is not one disease but a diverse or heterogeneous group of diseases. Treating it requires tailored treatment that may include more than one type of drug. Dr. Diane Hecht, Clinical Pharmacy Specialist at The University of Texas MD Anderson Cancer Center, says the treatment plan is based on the risk-versus-benefit principle. In her lecture, "Breast Cancer Survivorship: Role of Chemotherapy," Dr. Hecht describes current predictive factors of breast cancer and discusses how biologic features play a role in systemic treatment decisions. Dr. Hecht evaluates recent clinical trials of adjuvant chemotherapy and biotherapy and explains how both are helping to prevent breast cancer recurrence and death.
     Summary and Learning Objectives: Español

Melissa A. Crosby, M.D.
Role of Plastics and Reconstruction   Top of Page
 
Presenter: Melissa A. Crosby, M.D.
Associate Professor
Department of Plastic Surgery
 

Summary: At The University of Texas MD Anderson Cancer Center, breast reconstruction makes up about 30%-50% of the 1400 plastic surgery cases performed each year. Dr. Melissa Crosby, Associate Professor in the Department of Plastic Surgery at MD Anderson, says, "Approximately 80% of our patients undergo immediate reconstruction, and about half will receive some form of an implant-based reconstruction." In her lecture, "Breast Cancer Survivorship: Role of Plastics and Reconstruction," Dr. Crosby examines the benefits of reconstruction to breast cancer patients. She compares the most common techniques of reconstruction and details the risks associated with each. Dr. Crosby illustrates different methods of reconstruction and advises which is considered the best for a patient.
     Summary and Learning Objectives: Español

Chad Barnett, Pharm.D., BCOP
Role of Endocrine Therapy   Top of Page
 
Presenter: Chad Barnett, Pharm.D., BCOP
Clinical Pharmacy Specialist
Division of Pharmacy
 

Summary: The use of endocrine treatments for breast cancer has increased substantially during the last three decades. Endocrine therapy drugs can add, block, or remove hormones to slow or prevent cancer cell growth. Dr. Chad Barnett, a clinical pharmacy specialist in the Division of Pharmacy at The University of Texas MD Anderson Cancer Center, says that endocrine therapy choices depend on whether the patient is pre-menopausal or post-menopausal and whether their tumor is invasive or non-invasive. In his lecture, "Breast Cancer Survivorship: Role of Endocrine Therapy," Dr. Barnett lists available adjuvant endocrine therapy options for specific patient populations. He also analyzes the recent data supporting the benefits of adjuvant endocrine therapy.
     Summary and Learning Objectives: Español

Isabelle Bedrosian, M.D.
Late Effects of Surgery   Top of Page
 
Presenter: Isabelle Bedrosian, M.D.
Associate Professor
Department of Surgical Oncology
 

Summary: Lymphedema is the most feared complication of breast cancer surgery. Dr. Isabelle Bedrosian, Associate Professor in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center, says that while there is no cure or prevention for lymphedema, exercise can help. In her lecture, "Breast Cancer Survivorship: Late Effects of Surgery," Dr. Bedrosian assesses recommendations on how quality of life can be improved for breast cancer survivors with lymphedema. She also explains other common late effects of breast cancer surgery, including chronic pain, and how to best manage such effects.
     Summary and Learning Objectives: Español

Karen Hoffman, M.D.
Late Effects of Radiation Therapy   Top of Page
 
Presenter: Karen Hoffman, M.D.
Assistant Professor
Department of Radiation Oncology
 

Summary: Side effects such as fatigue, arm lymphedema, and skin changes can develop during radiation treatment. Dr. Karen Hoffman, Assistant Professor in the Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center, says more severe late effects, such as brachial plexus injury, radiation pneumonitis, and cardiac injury can also develop. In her lecture, "Breast Cancer Survivorship: Late Effects of Radiation Therapy," Dr. Hoffman identifies common side effects of breast radiation therapy. She describes factors that can contribute to the development of late effects of radiation and illustrates how careful radiation planning that limits radiation dose to the tissues can minimize the risk of late effects. Dr. Hoffman also counsels on the importance of proper skin care during and after radiation therapy.
     Summary and Learning Objectives: Español

Diane P. Hecht, Pharm.D., RPh
Late Effects of Chemotherapy   Top of Page
 
Presenter: Diane P. Hecht, Pharm.D., RPh
Clinical Pharmacy Specialist
Division of Pharmacy
 

Summary: Dr. Diane Hecht, clinical pharmacy specialist in the Division of Pharmacy at The University of Texas MD Anderson Cancer Center, says, "You need to pay attention to very subtle signs and symptoms of heart failure." In her lecture, "Breast Cancer Survivorship: Late Effects of Chemotherapy," Dr. Hecht says that anthracycline-induced cardiotoxicity is a potential toxicity of adjuvant or neoadjuvant chemotherapy and biotherapy. She reviews the current AHA/ACC guidelines on anthracycline-induced toxicity and advises on how to recognize and manage other possible late effects of chemotherapy, including cognitive dysfunction, fatigue, impaired fertility, and ovarian dysfunction.
     Summary and Learning Objectives: Español

Melissa A. Crosby, M.D.
Late Effects of Reconstruction   Top of Page
 
Presenter: Melissa A. Crosby, M.D.
Associate Professor
Department of Plastic Surgery
 

Summary: Capsular contracture, implant failure, malposition, rippling, scarring, and shoulder or abdominal weakness are all common late effects that can develop after breast cancer reconstruction. Dr. Melissa Crosby, Associate Professor in the Department of Plastic Surgery at The University of Texas MD Anderson Cancer Center, says that late effects are dependent on the type of reconstruction. In her lecture, "Breast Cancer Survivorship: Late Effects of Reconstruction," Dr. Crosby lists common late effects of implant reconstruction, latissimus flap reconstruction, and abdominal flap reconstruction and advises on how to address each effect. She also discusses adjuvant therapies and how they affect reconstruction long term.
     Summary and Learning Objectives: Español

Chad Barnett, Pharm.D., BCOP
Late Effects of Endocrine Therapy   Top of Page
 
Presenter: Chad Barnett, Pharm.D., BCOP
Clinical Pharmacy Specialist
Division of Pharmacy
 

Summary: Several possible late effects can be triggered by endocrine therapy, including hot flashes, osteoporosis, and endometrial cancer. Dr. Chad Barnett, a clinical pharmacy specialist at The University of Texas MD Anderson Cancer Center, says the type of endocrine therapy or chemotherapy, menopausal status, and medical history can help determine which toxicities to watch for. In his lecture, "Breast Cancer Survivorship: Late Effects of Endocrine Therapy," Dr. Barnett describes how to identify, appropriately monitor, and manage the most clinically relevant late toxicities associated with adjuvant endocrine therapy.
     Summary and Learning Objectives: Español

Christi Bowe, MSN, RN, ANP-C, ACONP
Surveillance after Treatment   Top of Page
 
Presenter: Christi Bowe, MSN, RN, ANP-C, ACONP
Advanced Practice Nurse
Breast Medical Oncology
 

Summary: With improved treatment regimens, women are living much longer after breast cancer diagnoses. Christi Bowe, an advanced practice nurse in the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, says, "As these patients transition back to the community, their primary care provider should be knowledgeable regarding follow-up care." In her lecture, "Breast Cancer Survivorship: Surveillance after Treatment," Ms. Bowe reviews the American Society of Clinical Oncology's current follow-up guidelines for breast cancer survivors. She talks about how too many unnecessary imaging tests can be harmful to survivors. She evaluates appropriate components of the follow-up exam. She also instructs on effective communication strategies that providers can use during patient visits.
     Summary and Learning Objectives: Español

Suzanne Day, MS, RN, FNP-BC
Assessing Risk and Preventing Second Primary Breast Cancers   Top of Page
 
Presenter: Suzanne Day, MS, RN, FNP-BC
Advanced Practice Nurse
Cancer Prevention Center
 

Summary: Suzanne Day, an advanced practice nurse in the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, says "Breast cancer survivors are at a much higher risk for developing a contralateral or second primary breast cancer than women without breast cancer are of developing an initial breast cancer." In her lecture, "Assessing Risk and Preventing Second Primary Breast Cancers," Ms. Day reviews recent studies outlining the risk for developing a contralateral or second primary breast cancer. She also advises how to evaluate, identify, and understand this risk. She evaluates how lifestyle modifications, such as a healthy diet, 30 minutes of exercise, and eliminating alcohol and/or tobacco can help breast cancer survivors live longer.
     Summary and Learning Objectives: Español

Banu Arun, M.D.
Identification of High-risk Patients and Genetic Testing   Top of Page
 
Presenter: Banu Arun, M.D.
Professor, Breast Medical Oncology
Co-Medical Director, Clinical Cancer Genetics
 

Summary: Women known to have a BRCA1 or BRCA2 gene mutation have a much higher risk of developing breast cancer than does the general population. Dr. Banu Arun, Professor in the Department of Breast Medical Oncology and Co-Medical Director of Clinical Cancer Genetics at The University of Texas MD Anderson Cancer Center, says BRCA gene carriers are also at increased risk of developing other cancers, including melanoma, colon, prostate, larynx, and esophageal cancers. In her lecture, "Breast Cancer Survivorship: Identification of High-Risk Patients and Genetic Testing," Dr. Arun demonstrates how family history plays a key role in identifying women with hereditary breast and ovarian syndrome. She reviews several risk models used at MD Anderson, including the Myriad® Genetic Laboratory Prevalence Table, the BRCAPRO model, the BOADICEA model, the Tyrer-Cuzick model, and the Gail and Claus models. Dr. Arun advises on how to identify appropriate genetic testing candidates, the available tests and the reason for selecting each, and how to interpret testing results.
     Summary and Learning Objectives: Español

Therese B. Bevers, M.D.
Second Primary Cancers   Top of Page
 
Presenter: Therese B. Bevers, M.D.
Professor, Clinical Cancer Prevention
Medical Director, Cancer Prevention Center
 

Summary: Breast cancer survivors are at increased risk of second primary cancers, including ovary, uterine, and colon cancers. Dr. Therese Bevers, Professor of Clinical Cancer Prevention and Medical Director of The Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, says, "You may be surprised to learn that, excluding non-melanoma skin cancers, second primary cancers are actually the fifth most commonly occurring type of cancer among Americans." In her lecture, "Breast Cancer Survivorship: Second Primary Cancers," Dr. Bevers identifies the risk of second primary cancers after breast cancer and explains how to modify these risks. She also counsels on how to implement appropriate screening strategies to detect second primary cancers early.
     Summary and Learning Objectives: Español

 

 

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