J. Michael Dixon, MD, professor of Surgery, consultant surgeon, and clinical director of the Breakthrough Breast Cancer Research Unit at the University of Edinburgh in Scotland, discusses the prevalence of and risk factors for breast cancer in males.

For every 100 to 200 female patients with breast cancer, there is 1 male diagnosed with the same disease, Dixon explains. Male breast cancer tends to present in older patients, and they often have estrogen-receptor—positive disease.

Risk factors for male breast cancer include family history, especially if the 

 gene is present, he adds. Frequently, a male patient's initial visit to an oncologist will be due to breast enlargement.

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Dr. Dixon on Prevalence and Risk Factors of Male Breast Cancer

J. Michael Dixon, MBChB, MD, Professor of Surgery, Consultant Surgeon, University of Edinburgh, Clinical Director of the Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, discusses the need for physicians to inform patients of the pros and cons before having a mastectomy.

Many patients, Dixon says, are unhappy with their breasts, want to improve them, and come into a physician's office with their mind made up. It is important to inform patients that reconstructive surgery is not just one operation, has a high complication rate, and is not simple.

Physicians and surgeons in general, Dixon says, are not good at writing down all the negative aspects of a mastectomy for a patient. Dixon says that it is crucial for physicians to bear in mind that if they cannot do any good, they must not do anything to harm a patient.

J. Michael Dixon, MBChB, MD, discusses the need for physicians to inform patients of the pros and cons before having a mastectomy.

Dr. Dixon on Informing a Patient Before Mastectomy

J. Michael Dixon, MBChB, MD, Professor of Surgery, Consultant Surgeon, University of Edinburgh, Clinical Director of the Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, discusses the discrepancy in the rate of mastectomies.

In the right patient with breast cancer, Dixon says, mastectomy is the right treatment. He says that it is difficult to understand why there are less mastectomies being performed in Europe compared to the U.S. There is recent evidence that shows survival may be better with breast-conserving surgery and radiotherapy, suggesting that fewer mastectomies need to be performed.

It has always been thought that mastectomy is the safer option in patients with breast and that rates of mastectomies have been so high due to fear of recurrence. Dixon says that there have been dramatic reductions in recurrence after breast-conserving surgery.

Finally, Dixon says that over-treatment is a problem: screening is diagnosing more women with early-stage disease and the question remains as to whether or not it makes sense to treat them with mastectomy when a large portion will never have problems.

Dr. Dixon on the Discrepancy in the Rate of Mastectomies

J. Michael Dixon, MBChB, MD, Professor of Surgery, Consultant Surgeon, University of Edinburgh, Clinical Director of the Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, discusses the need to develop a better way of informing women with breast cancer of the potential risks entailed by a mastectomy, including mastectomy with breast reconstruction.

Dixon explains, in the UK approximately 10% of women receiving breast reconstruction following mastectomy experienced a complication that resulted in the loss of their implant. Readmission following mastectomy reaches 10-20%, he notes, this number is exceptionally high when you consider the procedure has not been associated with a reduced rate of local recurrence.

The need for education is an ongoing item, as is the need to increase awareness in the US. Dixon notes, there is currently a large disparity between the UK and the US. He adds that more women in the US are needlessly receiving mastectomy causing additional risks when breast-conserving surgery is the better option.

Dr. J. Michael Dixon, from Western General Hospital, Scotland, Advises Against Mastectomies

Dr. Dixon Advises Against Mastectomies

J. Michael Dixon, MBChB, MD, Professor of Surgery, Consultant Surgeon, University of Edinburgh, Clinical Director of the Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, discusses the challenges facing patient choice in the mastectomy decision process.

Dixon explains that the common perception is that patient choice leads to better results, however, there is a lack of supporting evidence in the literature for this theory. In an examination of the decision making process it was found that when surgeons alone chose the treatment it resulted in approximately 5% of patients receiving mastectomy. In joint decisions, 15%-18% of patients received mastectomy and when patients chose nearly 30%-40% received mastectomy.

Women who face the choice of breast-conserving surgery over mastectomy are making the decision based on fear of cancer recurrence and death. However, Dixon notes, a significant different is not observed in a comparison between mastectomy and breast-conserving surgery.

The fear of recurrence appears to be primarily a US related issue. In a comparison, the number of women in the US having mastectomy is increasing while mastectomies in Europe are decreasing.

Dr. J. Michael Dixon, from the University of Edinburgh, Discusses Making the Decision to have a Mastectomy

Dr. Dixon Discusses Making Mastectomy Decisions

J. Michael Dixon, MBChB, MD, Professor of Surgery and Consultant Surgeon of the University of Edinburgh; and Clinical Director of the Edinburgh Breast Unit at the Western General Hospital in Edinburgh, Scotland, provides insight into exploiting systems biology to create new single agent therapy combinations for endocrine resistant breast cancer.

There are multiple pathways that are active in endocrine resistance therapy; these pathways are variable based upon whether the tumor forms resistance early or late in the cycle.

Dixon explains that combining one single agent with letrozole (Femara) will not create a drastic enough effect, or could result in undue toxicity. By examining the individual systems biology of the tumor it may be necessary to combine 2-3 different agents to letrozole.

Dr. Michael Dixon from University of Edinburgh on Systems Biology Determining Therapy Combinations

Dr. Dixon on Systems Biology for Combination Therapy

J. Michael Dixon, MBChB, MD, Professor of Surgery and Consultant Surgeon of the University of Edinburgh; and Clinical Director of the Edinburgh Breast Unit at the Western General Hospital in Edinburgh, Scotland, explains the potential to combine letrozole with targeted therapies.

Dixon cites a neoadjuvant trial that examined the mTOR inhibitor RAD001 (everolimus) plus letrozole. This trial showed benefit, but with too much toxicity. This trial showed it was possible to combine letrozole with targeted agents. This will lead to further investigation in the future.

Dr. J. Michael Dixon from University of Edinburgh on Letrozole Used in Combination With Pathway Inhibitors

Dr. Dixon on Letrozole With Pathway Inhibitors

J. Michael Dixon, MBChB, MD, Professor of Surgery and Consultant Surgeon of the University of Edinburgh; and Clinical Director of the Edinburgh Breast Unit at the Western General Hospital in Edinburgh, Scotland, describes all of the recent advances in breast cancer systemic therapy.

Dixon explains that in the hormonal systemic therapy there has been an advance in the treatment of postmenopausal women using aromatase inhibitors.

Chemotherapy and targeted agents have advanced considerably with the increased use of taxane drugs, anthracyclines, and anti-HER2 drugs such lapatinib and pertuzumab.

Dr. J. Michael Dixon from University of Edinburgh on Advances in Breast Cancer Systemic Therapy

Dr. Dixon on Systemic Advances in Breast Cancer

J. Michael Dixon, MBChB, MD, Professor of Surgery and Consultant Surgeon of the University of Edinburgh; and Clinical Director of the Edinburgh Breast Unit at the Western General Hospital in Edinburgh, Scotland, discusses how a shift in axillary lymph node procedures has positively affected breast cancer patients.

Since the advent of the sentinel node biopsy there has been a dramatic movement away from routinely removing axillary nodes. Focusing primarily on the sentinel nodes as the only axillary node procedure has increased recovery time and reduced the risk of lymphedema for breast cancer patients.

It is becoming even more clear that node dissection is often not necessary after completing a sentinel node biopsy, even if some of the nodes are positive.

Dr. J. Michael Dixon from the University of Edinburgh on Advances in Breast Cancer Axillary Node Procedures

Dr. Dixon on Advances in Axillary Node Procedures

J. Michael Dixon, MBChB, MD, Professor of Surgery and Consultant Surgeon of the University of Edinburgh; and Clinical Director of the Edinburgh Breast Unit at the Western General Hospital in Edinburgh, Scotland, discusses how breast cancer treatments have advanced in the past few years.

Dixon explains that because of better screening and increased patient education breast cancer is being caught at an earlier stage, which is improving treatment. Surgical improvements have also lead to better outcomes. The use of breast conserving surgery has greatly improved, which in turn improves the quality-of-life of breast cancer survivors.

Dr. J. Michael Dixon from the University of Edinburgh Discusses Advances in Breast Cancer Treatment

J. Michael Dixon, MD

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