How the Experts Treat Cancer Module 3 (Breast Cancer)

Approach to Abnormal Mammogram from a Surgeon’s Point of View

Laura Kruper, MD 
Assistant Professor
General & Oncologic Surgery

Surgeon, Division of General Oncologic Surgery

Department of Surgery
City of Hope
Duarte, CA

Personalized Therapy for Breast Cancer

Thehang Luu, MD
Assistant Professor, Surgery
Department of Medical Oncology &
 Therapeutics Research
City of Hope

Duarte, CA

Adjuvant Therapy of Early-Stage Breast Cancer in the Elderly: A Case-Based Approach

Arti Hurria, MD
Associate Professor
Department of Medical Oncology
 & Therapeutics Research
Director, Cancer and Aging Research Program
City of Hope

Duarte, CA

Release date: November 30, 2010

Expiration date: November 29, 2011

Estimated time to complete activity: 1.5 hours

Target Audience

This program has been designed for medical oncologists, radiation oncologists, OB/GYNs, and other medical professionals who treat patients with breast cancer.

Statement of Need
Breast cancer is the second most common cancer and the second highest cause of cancer death of women in the U.S. The incidence of breast cancer in women in the U.S. is 1 in 8 (about 13%). In 2009, it was estimated 192,370 new cases of invasive and 62,280 new cases of non-invasive (in situ) breast cancer were diagnosed. Approximately 40,170 women were expected to die in 2009 from breast cancer, though death rates have been decreasing since 1990 due to treatment advances, earlier detection through screening, and increased awareness.

Approximately 20-30% of women diagnosed with breast cancer will have a family history of breast cancer. It is estimated 5-10% of breast cancers are caused by gene mutations inherited from one’s mother or father, with mutations of the BRCA1 and BRCA2 being the most common. Women with these mutations have up to an 80% risk of developing breast cancer during their lifetime and are often diagnosed before age 50. About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general.

Significant advances in the prevention, diagnosis and management of breast cancer have been made in recent years based on the clinical application of scientific discoveries. However, breast cancer remains a complex disease affecting millions worldwide. A 2008 article discussed a gap analysis that was conducted to determine which areas of breast cancer research could produce the greatest impact on patients if targeted by researchers and funding bodies. The aims of the analysis were to determine the gaps in breast cancer knowledge that could result in benefits to patients; to encourage breast cancer researchers and funding bodies worldwide to focus their resources on specific research areas in order to achieve a substantive impact for patients; and to make recommendations for priority action.

Gaps were identified in seven areas (genetics of breast cancer; initiation of breast cancer; progression of breast cancer; therapies and targets in breast cancer; disease markers in breast cancer; prevention of breast cancer; and psychosocial aspects of breast cancer). From the analysis it was found the general barriers to progress were lack of financial and practical resources and poor collaboration between disciplines. In addition, critical gaps in each of the seven areas included: (1) genetics (knowledge of genetic changes, their effects and interactions); (2) initiation of breast cancer (how developmental signaling pathways cause ductal elongation and branching at the cellular level and influence stem cell dynamics, and how their disruption initiates tumor formation); (3) progression of breast cancer (deciphering the intracellular and extracellular regulators of early progression, tumor growth, angiogenesis and metastasis); (4) therapies and targets (understanding who develops advanced disease); (5) disease markers (incorporating intelligent trial design into all studies to ensure new treatments are tested in patient groups stratified using biomarkers); (6) prevention (strategies to prevent estrogen-receptor negative tumors and the long-term effects of chemoprevention for estrogen-receptor positive tumors); (7) psychosocial aspects of cancer (the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds).

Learning Objectives

At the conclusion of this educational activity, participants should be able to:

  • Discuss diagnostic, surgical and medical aspects of breast cancer management in pregnancy
  • Assess risks and benefits of adjuvant therapy in the elderly early stage breast cancer patient
  • Define personalized therapy for breast cancer
Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of City of Hope and Carden Jennings Publishing Co., Ltd. City of Hope is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

City of Hope designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


The City of Hope adheres to ACCME Essential Areas, Standards for Commercial Support, and Policies regarding industry support of continuing medical education. Disclosure of the commercial relationships of everyone in a position to control content of an educational activity will be made at the activity. Speakers are also required to openly disclose discussion of any off-label, experimental, or investigational use of drugs or devices in their presentations.

The following City of Hope National Medical Center CME Committee members/planners have indicted they have nothing to disclose: Lucille Leong, MD, Crystal Saavedra, Anna Pawlowska, MD, Karl Gaal, MD, Mary Mendelsohn, Jo Hanson, Christina Eckhart, Khanh Nguyen, MD, Paul Lin, MD, and Teresa Ball.

The following CME Committee Members/planners have indicated a conflict with the following corporate organizations:

  • Jean Kagan discloses that she is a stock shareholder with Amgen/Zimmer
  • Robert Morgan, MD, discloses that he is a stock shareholder with Abbott
  • Fouad Kandeel discloses that he is a consultant for MicoCHIPS, Inc. and he has other financial or 
material interest with Medtronic Minimed
  • Ravi Bhatia, MD, discloses that he is a consultant with Novartis
  • J. Martin Hogan, MD, discloses that he has other financial or material interest with Johnson & Johnson
  • Matthew Loscalzo discloses that he is a member of the speakers bureau with Lilly Pharma

Any potential conflicts relative to the previous disclosure have been resolved.

CJP Medical Communications Disclosure

The employees of CJP Medical Communications have no financial relationships to disclose.

Faculty Disclosures

In accordance with the ACCME’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

  • Arti Hurria, MD, discloses she has received research funding from Abraxis and Pfizer, and is a consultant to Amgen and GenenTech
  • Laura Kruper, MD, does not have any relevant financial disclosures
  • Thehang Luu, MD, does not have any relevant financial disclosures
Commercial Support

This activity has been developed through independent educational grants received from Pfizer, Ethicon Endosurgery, and Centocor Ortho Biotech.

Method of Participation

There are no fees for participating in this CME activity. To receive credit during the period November 30, 2010 to November 29, 2011, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.

The posttest can be accessed at the end of the activity. Please e-mail any questions to


The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.


Carden Jennings Publishing and the City of Hope present this resource for educational purposes only. Participants are expected to use their own expertise and judgment while engaged in the practice of medicine. Please consult full prescribing information for any drugs or procedures discussed within this activity. The views and opinions expressed in these presentations are those of the authors and do not necessarily reflect the views of the co-sponsors, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this publication to ensure accuracy, the authors, City of Hope and Carden Jennings Publishing and their servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this publication, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

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