An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state-of-the art breast imaging technologies and laboratory techniques to guide your personalized treatment.
In this segment Dr. Dortha Chu, assistant clinical professor in Division of Surgical Oncology at City of Hope, discusses how you can get a personalized treatment for breast cancer that fits your cancer and lifestyle.
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Personalized Treatment for Breast Cancer
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Learn more about Dortha Chu, M.D., Ph.D
Dortha Chu, MD., Ph.D
Dortha Chu, M.D., Ph.D., specializes in breast cancer surgery and strongly advocates early and regular screenings for all women. She received her medical and doctoral degrees from Washington University School of Medicine in St. Louis, and completed her general surgery training at University of California San Diego.Learn more about Dortha Chu, M.D., Ph.D
Transcription:
Personalized Treatment for Breast Cancer
Melanie Cole (Host): An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state of the art breast imaging technologies and laboratory techniques to guide your personalized treatment. My guest today is Dr. Dortha Chu. She’s an assistant clinical professor in the division of surgical oncology in the department of surgery at City of Hope. Welcome to the show, Dr. Chu. What is meant, people are hearing more and more the term personalized medicine?
Dr. Dortha Chu (Guest): Well, it means that these days with the advances in knowledge as well as technology we’re able to actually determine in many cases the specific treatments that have been shown to be beneficial depending on your specific tumor type and other markers. And so, we can offer you therapy that would give you the maximum benefit and hopefully with the least side effect. We also take into account other factors such as social factors that may impact your overall healing and survival. And the quality of life afterward. So, that allows us to really be able to make the whole process much more personal, and much more effective for the individual patient.
Melanie: So, when it comes to breast cancer, and somebody, a woman is diagnosed and there’s all these different terms in sight too and this, how do you determine what that tumor type is, so that you can give that personalize treatment. What does that mean for women with breast cancer?
Dr. Chu: Well, one of the major advancements that we’ve been able to establish in recent years is with the various types of genetic markers that we can identify and allow us to distinguish different types of breast cancer and in many cases even predict their potential behavior. And now, again, even further in some cases we’re able to predict their possible response to various types of therapy. So, it does become difficult in the beginning, to make sense of all the alphabets that come along with cancer and cancer treatment. But, if we take the time and sort through that, then it really makes sense in the end to allow us to personalize that treatment, and take the most effective treatment for the patient.
Melanie: So how do you do that, do you do that in conjunction with the patient. Or do you as the doctor say, I think this is going to be the best course of treatment for you. Because if the person wants to be their own best health advocate. Then they need to be doing maybe their research, they need to look and see what it is that’s going on. So, how do you approach it with the patient, Dr. Chu?
Dr. Chu: Oh, I believe absolutely that the patient should have full partnership, as a full partner, in determining the best treatment. Because some of the factors that go into effectiveness isn’t just scientific. It also involves how the patient will feel about their overall treatment. So, I very much believe in having a full discussion with the patient before any decision about treatment is made. The challenges in the beginning, the helping the patient to really understand all the complexity of their diagnosis. Because as I mentioned the advances are wonderful for treatment, but they can become very confusing especially if you don’t have a scientific background. And the internet is wonderful, it’s full of information. But it can be very challenging to piece apart what’s really relevant to the individual patient versus just information in general. So, I look at my job as in that initial process is to help the patient understand what their test results demonstrate and how to put that together into a context to understand their particular disease. Once we’re able to do that, then we’ll talk about how the treatments work and which treatments would work best for them. And that is in conjunction with their input as to how they are able to handle the treatment process as well as the side effects and all those other issues that come along with treatment.
Melanie: So, because there are so many tools in your toolbox now. Between surgery and radiation and chemotherapy targeted imunal therapy, you have so many different tools now and even in radiation you’ve got IORT and all of these different types. How do you determine what the patient, based on their cancer and their lifestyle, give us an example, you know for an example, of what you would say to somebody about tissue sparing or nipple sparing mastectomies? Give us an example of something of personalize medicine.
Dr. Chu: Sure. So, I think, if I may, I think the best way to put it would be if I had a hypothetical patient that came to me in my clinic. At our first visit, presumably she’s known about her diagnosis, we would go over all the tests that have been done. I should say there’s a lot of testing that goes along with getting that initial diagnosis, from imaging to biopsy etc. So, I feel that it is important that we start first by establishing a good understanding of what exactly her cancer entails. This includes things like the receptor status and what does it again, predict about the particular behavior of her cancer. Once we’ve established that. I explain to the patient that these days, breast cancer is treated, I should say, with multiple modalities, as you mentioned surgery, radiation and medicine and that just about every patient unless it’s a widely metastatic, then we’re kind of limited in our options, but if it’s early enough, then they have all those options all available to them. It’s just how do we package it in a way that’s specifically targeted to them. Then I break it down and we start talking about initially how surgery works, because typically the first step of early breast cancer is surgery. And at that point is when I would talk about the differences between a lumpectomy or partial mastectomy or breast conservation, they all mean sort of the same thing. Maintaining some portion of the breast versus a full mastectomy. And the medical advantages and disadvantages if you will, of the two options. Then I would break it down in terms of how that would apply to this particular patient in terms of her tumor size, how big are her breasts. Is it going to be cosmetically advantageous to maintain the breast, given those parameters? Or would she be better off with something like a mastectomy that would be give her both treatment as well as better cosmesis. If mastectomy is an option she seems to be interested in, or something that she wants pursue then we’ll talk about the different types of mastectomy’s that are available. Nipple sparing, skin sparing being some of the more recent developments that we’ve been able to offer patients. Then again, how does that apply to her with her specific cancer size, size of her breasts all of those physical factors that would play into those over all cosmetic approach and effectiveness of that treatment. And once we establish that, and the patient’s understanding of the surgical options to her. Then I would talk about how radiation comes in, in terms of what option she chooses. Generally speaking, for most patients, mastectomies don’t require radiation, accept under some specific cases. But with a partial breast resection, for example, a lumpectomy, typically radiation is included as part of the package to really get the full effectiveness, so, I encourage them to think of it that way. And then once we finish that part, then we talk about how medical therapy would impact on their ultimate adjuvant response as well as potentially prevention of the recurrence and decreased risk of recurrence and or future new cancer. So, that’s sort of more or less the steps that I would go through with a patient. You know, stopping at each step of course, making sure they understand how it all fits together. And then once we sort of have that global view, then we break it down to a little bit even further as to how, again specifically how each of those parts would be relevant to that particular patient. And at that point I usually will give the patient some time to think about it, to process. And then we come back to any additional tests that might be indicated at this point for staging or other purposes, and then we meet again and that’s when we really tease the part, now that she’s had time to think about it, what does she want, in terms of cosmesis, in terms of future risk reduction and so that’s when we sort of formally put it all together and come up with an actual plan for her.
Melanie: So, Dr. Chu in just the last few minutes, where do you see this field of personalized medicine in specifically for breast cancer going? What are you doing exciting at City of Hope that you want listeners to know about?
Dr. Chu: Well, I think the most exciting part is all the genetic advances that we’ve been able to make in identifying markers in cancers and specific tumors. That allows us to provide targeted therapy, especially in the form of various types of medications, various categories of medications that can be used to really target specific tumors and also decrease the potential side effects of the more traditional chemo therapy agents that we’ve used effectively in the past. And City of Hope has been on the forefront of helping to develop those kinds of treatments and establish the safety and ethicacy of those treatments. I see that in some not too distant future, we would actually be able to specifically offer the sort of the recipe, if you will, of what medical therapy, radiation therapy, etc. Would be the most effective in the patient based on these kinds of genetic and DNA markers that we are constantly discovering. I think it’s just going to become even more personal and more individual as time goes on and the goal being maximum benefit with the least amount of side effects. And I think that’s where treatment for breast cancer is going and I think that’s exciting for patients.
Melanie: It is exciting. And thank you so much for being with us today. It is such interesting information and exciting for the listeners to here. And thanks for being with us Dr. Chu. You’re listening to City of Hope Radio and for more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole, thanks so much for listening.
Personalized Treatment for Breast Cancer
Melanie Cole (Host): An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state of the art breast imaging technologies and laboratory techniques to guide your personalized treatment. My guest today is Dr. Dortha Chu. She’s an assistant clinical professor in the division of surgical oncology in the department of surgery at City of Hope. Welcome to the show, Dr. Chu. What is meant, people are hearing more and more the term personalized medicine?
Dr. Dortha Chu (Guest): Well, it means that these days with the advances in knowledge as well as technology we’re able to actually determine in many cases the specific treatments that have been shown to be beneficial depending on your specific tumor type and other markers. And so, we can offer you therapy that would give you the maximum benefit and hopefully with the least side effect. We also take into account other factors such as social factors that may impact your overall healing and survival. And the quality of life afterward. So, that allows us to really be able to make the whole process much more personal, and much more effective for the individual patient.
Melanie: So, when it comes to breast cancer, and somebody, a woman is diagnosed and there’s all these different terms in sight too and this, how do you determine what that tumor type is, so that you can give that personalize treatment. What does that mean for women with breast cancer?
Dr. Chu: Well, one of the major advancements that we’ve been able to establish in recent years is with the various types of genetic markers that we can identify and allow us to distinguish different types of breast cancer and in many cases even predict their potential behavior. And now, again, even further in some cases we’re able to predict their possible response to various types of therapy. So, it does become difficult in the beginning, to make sense of all the alphabets that come along with cancer and cancer treatment. But, if we take the time and sort through that, then it really makes sense in the end to allow us to personalize that treatment, and take the most effective treatment for the patient.
Melanie: So how do you do that, do you do that in conjunction with the patient. Or do you as the doctor say, I think this is going to be the best course of treatment for you. Because if the person wants to be their own best health advocate. Then they need to be doing maybe their research, they need to look and see what it is that’s going on. So, how do you approach it with the patient, Dr. Chu?
Dr. Chu: Oh, I believe absolutely that the patient should have full partnership, as a full partner, in determining the best treatment. Because some of the factors that go into effectiveness isn’t just scientific. It also involves how the patient will feel about their overall treatment. So, I very much believe in having a full discussion with the patient before any decision about treatment is made. The challenges in the beginning, the helping the patient to really understand all the complexity of their diagnosis. Because as I mentioned the advances are wonderful for treatment, but they can become very confusing especially if you don’t have a scientific background. And the internet is wonderful, it’s full of information. But it can be very challenging to piece apart what’s really relevant to the individual patient versus just information in general. So, I look at my job as in that initial process is to help the patient understand what their test results demonstrate and how to put that together into a context to understand their particular disease. Once we’re able to do that, then we’ll talk about how the treatments work and which treatments would work best for them. And that is in conjunction with their input as to how they are able to handle the treatment process as well as the side effects and all those other issues that come along with treatment.
Melanie: So, because there are so many tools in your toolbox now. Between surgery and radiation and chemotherapy targeted imunal therapy, you have so many different tools now and even in radiation you’ve got IORT and all of these different types. How do you determine what the patient, based on their cancer and their lifestyle, give us an example, you know for an example, of what you would say to somebody about tissue sparing or nipple sparing mastectomies? Give us an example of something of personalize medicine.
Dr. Chu: Sure. So, I think, if I may, I think the best way to put it would be if I had a hypothetical patient that came to me in my clinic. At our first visit, presumably she’s known about her diagnosis, we would go over all the tests that have been done. I should say there’s a lot of testing that goes along with getting that initial diagnosis, from imaging to biopsy etc. So, I feel that it is important that we start first by establishing a good understanding of what exactly her cancer entails. This includes things like the receptor status and what does it again, predict about the particular behavior of her cancer. Once we’ve established that. I explain to the patient that these days, breast cancer is treated, I should say, with multiple modalities, as you mentioned surgery, radiation and medicine and that just about every patient unless it’s a widely metastatic, then we’re kind of limited in our options, but if it’s early enough, then they have all those options all available to them. It’s just how do we package it in a way that’s specifically targeted to them. Then I break it down and we start talking about initially how surgery works, because typically the first step of early breast cancer is surgery. And at that point is when I would talk about the differences between a lumpectomy or partial mastectomy or breast conservation, they all mean sort of the same thing. Maintaining some portion of the breast versus a full mastectomy. And the medical advantages and disadvantages if you will, of the two options. Then I would break it down in terms of how that would apply to this particular patient in terms of her tumor size, how big are her breasts. Is it going to be cosmetically advantageous to maintain the breast, given those parameters? Or would she be better off with something like a mastectomy that would be give her both treatment as well as better cosmesis. If mastectomy is an option she seems to be interested in, or something that she wants pursue then we’ll talk about the different types of mastectomy’s that are available. Nipple sparing, skin sparing being some of the more recent developments that we’ve been able to offer patients. Then again, how does that apply to her with her specific cancer size, size of her breasts all of those physical factors that would play into those over all cosmetic approach and effectiveness of that treatment. And once we establish that, and the patient’s understanding of the surgical options to her. Then I would talk about how radiation comes in, in terms of what option she chooses. Generally speaking, for most patients, mastectomies don’t require radiation, accept under some specific cases. But with a partial breast resection, for example, a lumpectomy, typically radiation is included as part of the package to really get the full effectiveness, so, I encourage them to think of it that way. And then once we finish that part, then we talk about how medical therapy would impact on their ultimate adjuvant response as well as potentially prevention of the recurrence and decreased risk of recurrence and or future new cancer. So, that’s sort of more or less the steps that I would go through with a patient. You know, stopping at each step of course, making sure they understand how it all fits together. And then once we sort of have that global view, then we break it down to a little bit even further as to how, again specifically how each of those parts would be relevant to that particular patient. And at that point I usually will give the patient some time to think about it, to process. And then we come back to any additional tests that might be indicated at this point for staging or other purposes, and then we meet again and that’s when we really tease the part, now that she’s had time to think about it, what does she want, in terms of cosmesis, in terms of future risk reduction and so that’s when we sort of formally put it all together and come up with an actual plan for her.
Melanie: So, Dr. Chu in just the last few minutes, where do you see this field of personalized medicine in specifically for breast cancer going? What are you doing exciting at City of Hope that you want listeners to know about?
Dr. Chu: Well, I think the most exciting part is all the genetic advances that we’ve been able to make in identifying markers in cancers and specific tumors. That allows us to provide targeted therapy, especially in the form of various types of medications, various categories of medications that can be used to really target specific tumors and also decrease the potential side effects of the more traditional chemo therapy agents that we’ve used effectively in the past. And City of Hope has been on the forefront of helping to develop those kinds of treatments and establish the safety and ethicacy of those treatments. I see that in some not too distant future, we would actually be able to specifically offer the sort of the recipe, if you will, of what medical therapy, radiation therapy, etc. Would be the most effective in the patient based on these kinds of genetic and DNA markers that we are constantly discovering. I think it’s just going to become even more personal and more individual as time goes on and the goal being maximum benefit with the least amount of side effects. And I think that’s where treatment for breast cancer is going and I think that’s exciting for patients.
Melanie: It is exciting. And thank you so much for being with us today. It is such interesting information and exciting for the listeners to here. And thanks for being with us Dr. Chu. You’re listening to City of Hope Radio and for more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole, thanks so much for listening.