Dr. Surupa Sen Gupta and Dr. Colette Magnant represented Maryland Oncology Hematology on Great Day Washington to explain the importance of screenings, self-exams, and living a healthy lifestyle for breast cancer awareness month.
Cancer is a collective term referring to many different diseases. Simply put, cancer is uncontrolled cell growth, which can lead to tumor formation. A non-invasive tumor (in situ cancer) remains within the tissue where it originated. A malignant tumor (invasive cancer) has potential to spread to neighboring tissues and can form new tumors (metastases) elsewhere in the body. Tumors become dangerous when vital organ function is threatened by the overgrowth of cancer cells1.
Breast cancer is expected to affect 1 in 8 women, making it the most common cancer in women, after skin cancer2. This article discusses: diagnosis, treatment, taking proactive steps, and finding support.
In 2019, the US reported 3.8 million breast cancer patients and survivors.
Although breast cancer incidence is slightly higher in white women, breast cancer-related mortality is almost 50% higher in black women3. More than half of breast cancer patients are diagnosed at an early stage; however, men are slightly more likely to be diagnosed at a later stage compared to women. As men make up just 1% percent of all breast cancer patients, there is still much to be learned about male breast cancer2,4.
Breast cancer can be diagnosed by imaging and histology (pathologic review). Imaging techniques help to visualize cancerous growths. Mammography, the most routine imaging technique used in breast cancer diagnostics, uses x-ray imaging5. There are some limitations, such as mild discomfort, very low radiation exposure, and a false positive rate. Ultrasound is often used to further define mammogram findings. Additional imaging techniques (such as MRI breasts) are sometimes used; however, these techniques are expensive and still lack specificity (can have false positive findings).
Histology is the study of cells under the microscope6. Healthy cells usually look very uniform, but cancerous cells vary in shape and size. This is one way that they can be identified under the microscope; however, some non-cancerous diseases can cause cells to ‘look suspicious’. In such cases, cells can be stained for breast cancer-specific biomarkers to clarify the disease diagnosis7.
Once a diagnosis has been made, doctors must determine how far the cancer has progressed. The American Joint Committee on Cancer (AJCC) classifies tumors using the Tumor Node Metastasis (TNM) model. Specifically, this classification describes: the tumor size, the number of lymph nodes involved, and whether the tumor has metastasized. The details of the TNM model can be summarized using a 5-stage system, where stage 0 is in situ (non-invasive) cancer, and stages 1 through 4 are progressive extents of invasive cancer. Cancer staging helps doctors determine how much risk the cancer poses to a patient, and how it should be treated8–10.
When breast cancer is diagnosed at an early stage, surgery can be performed to remove the cancerous tissue. A lumpectomy is surgery that only removes the tumor, while a mastectomy removes the entire breast. The choice of surgery depends on the breast size, tumor size and location, and other factors. Lymph nodes are often also removed to determine the cancer stage, or if they are already known to contain cancer cells11.
Lumpectomy, accompanied by radiation treatment, has become standard practice, as it reduces the risk of local cancer recurrence in both in situ and invasive cancer12.
Radiotherapy uses high doses of radiation to destroy cancer cells by damaging their genetic material. Cancer cells are limited in their ability to repair damage. This makes them more susceptible to radiation than healthy cells, which are better at repairing damage. Nonetheless, healthy cells and tissues within and surrounding the breast can be damaged by radiation. Accordingly, radiation treatments are carefully planned to spare and protect healthy tissue13,14.
Chemotherapy can be used to shrink tumors prior to surgery (neoadjuvant), to prevent recurrence after surgery (adjuvant), or to treat advanced (metastatic) breast cancer15–17. Chemotherapy is a systemic medication that damages the genetic machinery needed for cell division, making it efficient in eliminating rapidly growing cells (such as cancer cells). Healthy cells with a high growth rate, such as those found in hair follicles and the digestive system, are also affected by chemotherapy, and this leads to the well-known side effects of hair loss and nausea18.
Targeted therapy, often used in combination with chemotherapy, focuses on specific molecules that stimulate growth or survival in cancer cells19. Hormone therapy is used in specific breast cancers where growth is stimulated by the hormones estrogen or progesterone. When cells are prevented from interacting with these hormones, hormone-induced growth is inhibited20. Some therapies are targeted at proteins that are associated with the growth of certain breast cancers. Tumors with high expression of HER2 can be treated with anti-HER2 therapies, which inhibit the function of this protein21. The choice of targeted therapy is dependent on the molecule that a particular type of breast cancer ‘responds to’. This is an important step towards personalized medicine: profiling a specific patient’s cancer and treating it accordingly to maximize treatment efficacy22.
Interestingly, when a tumor first forms, the immune system recognizes this as a strange event and tries to oppose tumor formation. Some cancer cells develop mechanisms that make them undetectable to immune cells. This is called immune tolerance. Immunotherapy aims to re-establish the immune system’s ability to detect cancer cells and combat immune tolerance23,24.
Altogether, breast cancer treatment is a multidisciplinary approach that benefits from the combination of different therapies. Besides increasing treatment efficacy, combination therapy can allow for the use of lower doses, which reduces adverse effects and delays drug resistance25.
What you should do:
Women are encouraged to take a proactive approach to their health, especially as it relates to breast cancer. Primary breast cancer prevention is the avoidance of known risk factors. Secondary prevention is early detection26. The American Cancer Society recommends that women can choose mammogram screening starting at age 40, but that all women should start annual mammogram screening by age 45. Also, adult women should consider performing monthly self-exams. Forty percent of breast cancers are detected by the patients themselves27,28.
When breast cancer is familial, or has an early age of onset, genetic testing is often advised. If genetic testing suggests a high possibility for breast cancer development, preventative treatments, such as medications or risk-reducing mastectomy, are available. Also, enhanced screening for cancer is considered for some genetic testing results. In all cases, the psychological effects of genetic testing should be taken into account. The cancer risk should be well examined in order to avoid unnecessary interventions29.
Breast cancer treatment extends well beyond the confines of the doctor’s office. Support groups, hosted by mental/medical healthcare professionals or cancer survivors, can offer shared experiences/education and can provide a sense of community and comradery30. Psychoeducational support groups provide patients and their families with the knowledge and psychological tools they need to move forward in a holistic manner31.
Cancer, of any kind, is a difficult road to travel; access to the right people and the right information can provide fuel for the journey.
About the Author
Carol Tweed, MD joined Maryland Oncology Hematology in our Annapolis division October 2020. Dr. Carol Tweed attended Duke University, where she was inducted into Phi Beta Kappa. She graduated summa cum laude with a degree in Biology, and a concentration in molecular biology. She received her medical degree from Washington University in St. Louis, where she was elected to Alpha Omega Alpha. She then completed her Internal Medicine Residency and Hematology/Oncology Fellowship at the University of Pennsylvania.
From 2006-2012, Dr. Tweed was an Assistant Professor on faculty at the University of Pennsylvania’s Abramson Cancer Center. During this time, she practiced as a breast oncology specialist and enthusiastically educated medical students, residents, and fellows.
In 2012, she moved to Annapolis, MD, and joined AAMC Oncology & Hematology, before joining Maryland Oncology Hematology in October 2020. Dr. Tweed passionately cares for patients with a broad range of hematologic and oncologic disorders. Her work as a breast medical oncology expert continues. She is a regional speaker on the topics of breast cancer and cancer genomics. She is co-founder and co-director of the Maryland Breast Cancer Consortium.
Dr. Tweed is an active clinical researcher; she has served as principal investigator on numerous national and international clinical trials. She also is an Instructor of Medicine/preceptor for Johns Hopkins School of Medicine, educating medical students.
Dr. Tweed is board certified in Hematology and Medical Oncology.
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- Rojas, K. & Stuckey, A. Breast Cancer Epidemiology and Risk Factors. Clin. Obstet. Gynecol. 59, 651–672 (2016).
- Baquet, C. R., Mishra, S. I., Commiskey, P., Ellison, G. L. & DeShields, M. Breast cancer epidemiology in blacks and whites: Disparities in incidence, mortality, survival rates and histology. J. Natl. Med. Assoc. 100, 480–489 (2008).
- Breast Cancer Occurrence 3 Breast Cancer Risk Factors 12 What Is the American Cancer Society Doing about Breast Cancer? 26 Sources of Statistics 30 References 32.
- Gøtzsche, P. C. & Jørgensen, K. J. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews vol. 2013 (2013).
- McDonald, E. S., Clark, A. S., Tchou, J., Zhang, P. & Freedman, G. M. Clinical diagnosis and management of breast cancer. J. Nucl. Med. 57, 9S-16S (2016).
- Jafari, S. H. et al. Breast cancer diagnosis: Imaging techniques and biochemical markers. Journal of Cellular Physiology vol. 233 5200–5213 (2018).
- Cancer Staging – National Cancer Institute. https://www.cancer.gov/about-cancer/diagnosis-staging/staging.
- Breast Cancer: Stages | Cancer.Net. https://www.cancer.net/cancer-types/breast-cancer/stages.
- Hortobagyi, G. N., Edge, S. B. & Giuliano, A. New and Important Changes in the TNM Staging System for Breast Cancer. Am. Soc. Clin. Oncol. Educ. B. 38, 457–467 (2018).
- Riis, M. Modern surgical treatment of breast cancer. Annals of Medicine and Surgery vol. 56 95–107 (2020).
- Castaneda, S. A. & Strasser, J. Updates in the Treatment of Breast Cancer with Radiotherapy. Surgical Oncology Clinics of North America vol. 26 371–382 (2017).
- Bhattacharya, S. & Asaithamby, A. Repurposing DNA repair factors to eradicate tumor cells upon radiotherapy. Translational Cancer Research vol. 6 S822–S839 (2017).
- Boyages, J. Radiation therapy and early breast cancer: Current controversies. Med. J. Aust. 207, 216–222 (2017).
- Anampa, J., Makower, D. & Sparano, J. A. Progress in adjuvant chemotherapy for breast cancer: An overview. BMC Medicine vol. 13 (2015).
- Redden, M. H. & Fuhrman, G. M. Neoadjuvant Chemotherapy in the Treatment of Breast Cancer. Surgical Clinics of North America vol. 93 493–499 (2013).
- Grunfeld, E. A. et al. Chemotherapy for advanced breast cancer: What influences oncologists’ decision-making? Br. J. Cancer 84, 1172–1178 (2001).
- Bagnyukova, T. et al. Chemotherapy and signaling: How can targeted therapies supercharge cytotoxic agents? Cancer Biology and Therapy vol. 10 839–853 (2010).
- Su, H., Gao, Y. J. & Zhang, C. X. Advances in targeted therapy of breast cancer. J. Dalian Med. Univ. 35, 496–501 (2013).
- Puhalla, S., Bhattacharya, S. & Davidson, N. E. Hormonal therapy in breast cancer: A model disease for the personalization of cancer care. Molecular Oncology vol. 6 222–236 (2012).
- Pernas, S. & Tolaney, S. M. HER2-positive breast cancer: new therapeutic frontiers and overcoming resistance. Therapeutic Advances in Medical Oncology vol. 11 (2019).
- Chan, C. W. H., Law, B. M. H., So, W. K. W., Chow, K. M. & Waye, M. M. Y. Novel strategies on personalized medicine for breast cancer treatment: An update. International Journal of Molecular Sciences vol. 18 (2017).
- Gonzalez, H., Hagerling, C. & Werb, Z. Roles of the immune system in cancer: From tumor initiation to metastatic progression. Genes and Development vol. 32 1267–1284 (2018).
- Soysal, S. D., Tzankov, A. & Muenst, S. E. Role of the Tumor Microenvironment in Breast Cancer. Pathobiology vol. 82 142–152 (2015).
- Fisusi, F. A. & Akala, E. O. Drug Combinations in Breast Cancer Therapy. Pharm. Nanotechnol. 7, 3–23 (2019).
- Kolak, A. et al. Primary and secondary prevention of breast cancer. Ann. Agric. Environ. Med. 24, 549–553 (2017).
- Pace, L. E. & Keating, N. L. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA – Journal of the American Medical Association vol. 311 1327–1335 (2014).
- Roth, M. Y. et al. Self-detection remains a key method of breast cancer detection for U.S. women. J. Women’s Heal. 20, 1135–1139 (2011).
- Rousset-Jablonski, C. & Gompel, A. Screening for familial cancer risk: Focus on breast cancer. Maturitas vol. 105 69–77 (2017).
- Support Groups. https://www.breastcancer.org/treatment/comp_med/types/group.
- Cipolletta, S., Simonato, C. & Faccio, E. The effectiveness of psychoeducational support groups for women with breast cancer and their caregivers: A mixed methods study. Front. Psychol. 10, (2019).
Dr. Magnant joins Dr. Surupa Sen Gupta at their Rockville Division to offer the community advanced surgical care with the latest breast preservation techniques.
Maryland Oncology Hematology (MOH), the largest independent oncology practice in Maryland and a member of The US Oncology Network, is proud to announce that Dr. Colette Magnant, MD, FACS is joining its Rockville division.
Dr. Magnant has been treating breast cancer for over 34 years and has established herself as one of the premier breast cancer surgeons in the Washington, D.C. metropolitan area. With her extensive training and wealth of experience, she provides her patients with a superior understanding of breast cancer biology, as well as compassionate state of the art breast preservation procedures, and advanced surgical techniques. She will be joining Dr. Surupa Sen Gupta to expand our breast surgical oncology services at our Rockville division, and together they, along with our expert and experienced medical oncologists, will anchor our comprehensive breast cancer program in the Rockville division.
‘We’re thrilled to welcome Dr. Magnant to our experienced breast surgical team. Her stellar reputation as a top breast surgeon is well-deserved and we are fortunate that she has decided to bring her skills to our practice and to our community. She shares our vision of providing state-of-the-art multidisciplinary cancer care, and we are delighted to have her join in our expansion said George Sotos MD, Managing Partner, Rockville Division. ‘With her focus and strong surgical experience in breast cancer treatment, Dr. Magnant is a welcome addition to our team as we dedicate our practice to delivering the very best in comprehensive and integrated care to our breast cancer patients.
Dr. Magnant is board certified in general surgery, specializing in advanced breast surgery techniques, including skin and nipple-sparing mastectomies and minimally invasive breast conserving surgeries. After earning her medical degree from the Medical College of Virginia in Richmond, Dr. Magnant completed her general surgery internship at Indiana University Medical Center and her residency at Georgetown University Hospital in Washington, DC. She is most recently the past director of the Sullivan Center for Breast Health at Sibley Hospital, as well as an assistant professor at John Hopkins University. In addition to teaching, Dr. Magnant has made numerous media appearances and delivered dozens of university lectures.
‘I’m proud to work alongside the dynamic team at Maryland Oncology Hematology, said Dr. Magnant. ‘We’re dedicated to delivering compassionate and comprehensive breast health services to the surrounding community, allowing our patients to receive the best of care, close to home.
Dr. Magnant will be joining Dr. Sen Gupta who is board certified in general surgery, fellowship trained in breast surgical oncology, and specializes in minimally invasive breast-conserving surgeries.
Dr. Magnant will start seeing patients at MOH’s Rockville office on April 1st. Appointments are available for newly referred patients to provide a high level of support and easy access to care. Please call 301.424.6231 to make an appointment.
About Maryland Oncology Hematology
Maryland Oncology Hematology (MOH) is the largest independent oncology practice in the state of Maryland, with more than 45 practicing clinicians devoted exclusively to providing comprehensive, compassionate, and high-quality cancer care. MOH specializes in medical, gynecologic, hematology, cancer genetic risk assessment, clinical trials and research, and patient ancillary programs. MOH believes it is beneficial to provide cancer therapies in a community setting, close to patients’ homes and support systems. The physicians are supported by a talented clinical team sensitive to the needs of cancer patients and their caregivers. For more information, visit MarylandOncology.com.
About US Oncology Network
Maryland Oncology Hematology is a practice in The US Oncology Network (The Network). This collaboration unites the practice with more than 1,380 independent physicians dedicated to delivering value-based, integrated care to patients — close to home. Through The Network, these independent doctors come together to form a community of shared expertise and resources dedicated to advancing local cancer care and to delivering better patient outcomes. The Network is supported by McKesson Corporation , whose coordinated resources and infrastructure allow doctors in The Network to focus on the health of their patients, while McKesson focuses on the health of their practices. MOH also participates in clinical trials through US Oncology Research, which has played a role in more than 100 FDA-approved cancer therapies.
Company Name: Maryland Oncology Hematology
Contact Person: Mark W Lamplugh Jr
Email: Send Email
Country: United States
Dr. Plate brings a new line of treatment services to the clinic, offering patients cutting-edge breast preservation techniques
Silver Spring, MD- November, 2020 — Maryland Oncology Hematology, the premier provider of cancer services in the Maryland region, announced today it has added a breast surgical oncologist to the practice, enhancing the comprehensive multidisciplinary care it provides to breast patients. Cynthia Plate M.D. F.A.C.S specializes in breast surgery and has extensive training and experience in the field. MOH has been serving cancer patients in the Maryland area for over 40 years, providing patients convenient access to leading cancer experts and the most advanced cancer therapies available today.
Dr. Plate has many years of rigorous education, training, and experience focusing on breast disease and surgery, providing her with a superior understanding of breast cancer biology, genetics, and advanced oncoplastic surgical techniques and breast preservation procedures. By adding Dr. Plate to the practice, MOH’s new White Oak Cancer Center enhances its ability to offer multidisciplinary team care for all types of complex breast issues, including benign breast disease, malignancies, and management of high-risk patients. Seamless high-quality care is provided by a collaborative team of specialists in breast surgery, medical and radiation oncology, diagnostic imaging, pathology, genetic risk evaluation, and supportive care.
“Dr. Plate shares our passion of providing exceptional multidisciplinary cancer care, and we are delighted to have her join our growing practice” said Dr. Joseph Haggerty, President at Maryland Oncology Hematology. “With her focus on new surgical advancements in breast cancer treatment, Dr. Plate will be a great addition to our breast cancer team as we seek to deliver the best breast cancer treatment in the Maryland Region.”
Cynthia Plate M.D. F.A.C.S is board-certified in general surgery and is a breast care specialist. She previously worked with Adventist HealthCare Medical Group.
Dr. Plate graduated from Howard University College of Medicine and completed her internship and residency at Howard University Hospital
“Specializing in women’s breast health, I’m committed to providing my patients with exceptional and compassionate care,” said Dr. Plate. “I’m thrilled to join the MOH team where we can continue to deliver leading-edge cancer care to our community.”
Dr. Plate is currently seeing patients at MOH’s Silver Spring White Oak Cancer Center office. Timely appointments are available for newly referred patients, typically within 24 hours, to provide a high level of support and prompt access to care. Please call 301-933-3216 to make an appointment
About Maryland Oncology Hematology
Maryland Oncology Hematology is an affiliate of The US Oncology Network (The Network). This
collaboration unites MOH with more than 1,400 independent physicians dedicated to delivering value-based, integrated care for patients — close to home. Through The Network, these independent doctors come together to form a community of shared expertise and resources dedicated to advancing local cancer care and to delivering better patient outcomes. The US Oncology Network is supported by McKesson Specialty Health, whose coordinated resources and infrastructure allow doctors in The Network to focus on the health of their patients, while McKesson focuses on the health of their practices. MOH participates in clinical trials through US Oncology Research, which has played a role in more than 70 FDA-approved cancer therapies, approximately one-third of all cancer therapies approved by the FDA to date. For more information, visit www.usoncology.com.
About US Oncology Network
Maryland Oncology Hematology is a practice in The US Oncology Network (The Network). This collaboration unites the practice with more than 1,200 independent physicians dedicated to delivering value-based, integrated care to patients — close to home. Through The Network, these independent doctors come together to form a community of shared expertise and resources dedicated to advancing local cancer care and to delivering better patient outcomes. The Network is supported by McKesson Corporation, whose coordinated resources and infrastructure allow doctors in The Network to focus on the health of their patients, while McKesson focuses on the health of their practices. Maryland Oncology Hematology also participates in clinical trials through US Oncology Research, which has played a role in more than 100 FDA-approved cancer therapies.
Mark W Lamplugh Jr
The US Oncology Network