Bring Your Ideas, Your Obstacles, and Your Enthusiasm - NCoBC 2014

This year, there will be six different Special Interest Group [SIG] Discussions.

The DCIS Dilemma: An Opportunity to Redefine “Cancer”

Sunday, March 16 at 3:15 – 3:45pm during the Plenary Session

E. Shelly Hwang, MD, MPH
Professor of Surgery, Chief Breast Surgical Oncology
Duke University Health Systems & Duke Cancer Center
Durham, NC

Ductal carcinoma in situ (DCIS) is a histologic diagnosis that lies in the continuum between atypia and invasive cancer.  Although it has been recognized and treated for almost three decades, much remains unknown about this disease, its optimal treatment and its natural history.

The incidence of DCIS has increased significantly since it was first described, largely as a consequence of widespread mammographic screening. Accordingly, the presentation pattern has changed from a predominantly palpable lesion to one whose first indication is that of an incidentally discovered mammographic abnormality on routine screening exam. It is plausible that the disease currently detected with screening differs biologically from the disease that historically presented as clinically apparent disease. This shift in presentation has led to debate over whether we are “over-treating” some women diagnosed with DCIS by detecting and treating lesions which may never have resulted in clinical consequences during a patient’s lifetime.

It is believed that DCIS is likely a precursor lesion to invasive breast cancer; however not all DCIS may have the ability to progress to invasive cancer and fewer still will have the ability to metastasize. By examining tumors that contain both an invasive and noninvasive component, studies have demonstrated that the expression of tumor markers is highly similar in both components. Despite significant advances in understanding the human genome, the specific genes that play a role in invasion have yet to be identified, and we are likely to discover that DCIS is the end-product of a series of complex interactions resulting from both endogenous and exogenous influences.

The negligible metastatic potential from DCIS has called into question whether DCIS should even be called a “cancer.”  This has spurred impassioned discussions in the medical, scientific and advocacy communities calling for a reassessment of what constitutes “cancer” and whether treatment recommendations and clinical trials should be altered to reflect a greater understanding of the large spectrum of diseases that fall under this term.  Future management goals for DCIS must include considerations of the context of patient preferences and competing comorbidities when determining optimal treatment options for the individual patient.

Overview of Breast Cancer Survivorship

Saturday March 15 at 8:15 – 9:00am in the All New Survivorship Pre-conference

Anne Katz, PhD, RN
Sexuality Counselor, CancerCare Manitoba
Winnipeg, MD, Canada

Survivorship for women after breast cancer presents unique challenges. The presenter of this session has identified 10 key challenges for living the 'new normal' of life after breast cancer.

  • Fear of recurrence
  • Late effects of treatment
  • Diet and exercise
  • Sexuality
  • Cognitive changes
  • Surveillance
  • Back-to-work
  • Depression
  • Fatigue
  • Fertility

This presentation will highlight these challenges with evidence-based suggestions to help women face these challenges.

My Mastectomy: Make It a Double

Wednesday, March 19 at 10:30 – 11:1:00am during the Plenary Session

Jennifer Gass, MD, FACS
Chief of Surgery & Fellowship Director Breast/General Surgery
Women & Infants Hospital
Warren Alpert Medical School, Brown University
Providence, RI

After decades of research and follow up, and after at least six randomized prospective trials validating that breast conservation is equally effective in assuring a woman will survive breast cancer, there is an upsurge in patients electing mastectomy - even bilateral mastectomy.

  • Is the phenomenon real, or just media hype?
  • Is more surgery a better choice?
  • Why do women choose more aggressive surgery?

Join us at NCoBC where we will explore this trend, and the issues around it.  We will be presenting yet-to-be-published research on the impact of breast cancer surgery on a woman’s sense of sexuality.

Influencing Without Authority: Directing Patients and
Keeping the Team Intact

Tuesday, Monday 18 at 2:10 – 2:40pm during the Navigation breakout track Pre-session

Julie Shisler, LPN, BS, CBPN-IC
Breast Center Coordinator
Windsong Comprehensive Breast Care
Williamsville, NY

Are you frustrated at work when you can’t get what you need for the patient,  wonder if the resources you have could be utilized more efficiently, and wonder where the day goes when you get caught chasing down reports or asking for help?  Do you wonder if anyone is on the same page anymore and where the momentum of the breast program, and taking care of the patients, went.  Do you feel like you are working too hard and still not getting the results that you need?

If this sounds like the questions and thoughts that run through your head at the end of the day, this session is for you.  There will be discussions on what is authority, leadership and influence and how to use all of them for both your patients and your program.  Many of the take-away ideas you can use in your personal life as well.  There will be tips on

  • developing relationships with coworkers and team members
  • utilizing the emotions of the situation to your advantage
  • enhancing your creditability as a care giver and team member

Directing and coordinating care of the breast patient is not easy.  Varied practice styles and expertise often places the navigator in the center of patient preference and desires versus clinical practice and constraints.  Join in to learn a few methods to incorporate into your day that will improve the overall success of your program and your professional growth.

 Technologists’ Role in Genetic Assessment

Monday, March 17 at 10:00 – 10:30am as part of the RT Breakout Track Session

Christine B. Weldon, MBA
Director, The Center for Business Models in Healthcare
Adjunct Faculty at Northwestern University Feinberg School of Medicine
Chicago, IL

Is your breast center actively assessing men and women for genetic/familial risk AND is it referring those patients for further genetic assessment?  Do you provide patients with family and/or personal history information about genetic assessment?

Studies show that while breast centers, and their technologists, consistently inquire about a patient’s family and personal history, less than 10% actually refer indicated patients for further genetic assessment.  It is important to note the following information.

  • Patients with a BRCA mutation have a higher risk of breast cancer and of breast cancer recurrence.
  • Breast cancer patients with a BRCA mutation are more likely to view mastectomy as the best way to reduce future BC recurrence while avoiding multiple surgeries and radiation (Schwartz, JCO-2004).

Clear guidelines exist from the National Comprehensive Cancer Network.  Likewise, the American College of Surgeons – NAPBC, Standard 2.16 recommends “cancer risk assessment, genetic counseling and genetic testing services are provided or referred” on hereditary breast and ovarian risk assessment (BRCA 1-2 and other genetic mutations).

This session will review national guidelines, share case studies of effective and ineffective genetic screening practices, and will review actions YOU and YOUR institution may implement to improve genetic risk screening and access to genetic assessment for your patients.