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>>> DR. JAY K. HARNESS: I often find myself in an interesting discussion with patients
about adjuvant versus neoadjuvant chemotherapy. Now, my medical oncologist colleague, Dr.
David Margileth, has discussed on our breast cancer answers web site the difference between
adjuvant and neoadjuvant chemotherapy. Quite briefly, adjuvant chemotherapy is given after
surgery as an adjunct to the surgery and is part of the systemic treatment, the whole
body treatment of breast cancer. The term neoadjuvant chemotherapy means upfront chemotherapy.
I am often asked the question, “Dr. Harness, is one of these better than the other?”,
and the answer is “No”. It isn’t a question of what’s being better than the other. We
would never make, or certainly I would nor my colleagues, ever make a recommendation
where something is less than. Now, from my perspective as a full time breast surgeon,
neoadjuvant chemotherapy is really helpful in a variety of circumstances. Let me give
you several examples: Number one, a patient presents with a really large breast cancer
even doing a mastectomy would not be possible. These are typically what we call locally advanced
breast cancers. So we go ahead and do the chemotherapy, the neoadjuvant chemotherapy,
as a way of reducing down the size of the cancer so that we can eventually operate,
including, if we have to do a mastectomy. Another advantage is we have got a cancer
that is sort of borderline, as far as the patient being eligible for breast conservation
or not, patients highly motivated for breast conservation. We know that the neoadjuvant
chemotherapy is going to shrink the cancer. What we don’t know upfront is by how much.
In HER-2/neu positive breast cancers, particularly those that are one and half centimeters or
larger in patients highly motivated for a breast conservation, I almost always recommend
neoadjuvant chemotherapy because in the HER2/neu breast cancers, the response to that upfront
chemotherapy can be quite dramatic. In fact, there is a significant percentage of time
that the cancer will actually pathologically disappear in the breast. Another advantage,
if you will, of neoadjuvant chemotherapy is that it tells something about the biology
of the cancer. If there is a really good response or complete pathologic response, the patient
may do better. Now, this is a debatable subject. There are those that say, “Gee, there is
no difference in survival”, but in those who have complete pathologic response, cancer
disappears completely pathologically when you operate in the breast and remove the area
where the cancer was in. Prove that it is gone, and that sub-category of patients, most
of those patients in fact, do better. So it isn’t a question that one is better than
the other. Everything again that we do has advantages and disadvantages. I have tried
to highlight to you my thoughts as a full-time breast surgeon about when I think neoadjuvant
chemotherapy is important. Please also listen to and watch Dr. David Margileth description
of adjuvant versus neoadjuvant chemotherapy and the definition of these two.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
Coree: I am a breast cancer survivor.
Susan Denver: And I want every woman to know…
Katherine Stockton: …about personalized breast cancer treatment…
Susan Denver: …and the genomic test.
Coree: A test that helps guide a woman and her doctor…
Katherine Stockton: …to the best treatment options for her.
Susan Denver: Pass it on!