Dr Feldman on the Recognition of Racial Disparities in Breast Cancer

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses the recognition of racial disparities in breast cancer, sharing how oncologists can mitigate treatment-related toxicities in underserved patient populations.

Addressing racial disparities in breast cancer is crucial for optimizing patient outcomes, particularly among underserved populations, Feldman begins. This is due to several factors including cancer biology, individual genetic profiles, and variations in cancer characteristics across racial subgroups, all of which significantly affect treatment efficacy and prognosis, according to Feldman. Among African American women, for example, breast cancer is often diagnosed at a younger age and frequently presents as triple-negative breast cancer, he explains. This form of breast cancer poses unique challenges, as it lacks defined treatment targets; this disease is neither estrogen receptor positive nor progesterone receptor positive, nor is it HER2 positive, making it particularly challenging to manage effectively, Feldman reports.

Acknowledging these disparities has spurred a focus on improving early detection and preventive screening among African American women, especially for those with a familial history of breast cancer, Feldman says. Screening at a younger age is increasingly recommended, and supplemental screening techniques, such as ultrasound and MRI, have proven valuable for younger women with dense breast tissue across all racial groups, he reiterates.

Moreover, there is a growing awareness of the heightened susceptibility of African American women to treatment-related toxicities, Feldman continues. Chemotherapy-induced neuropathy, particularly from taxane-based treatments, has shown a greater prevalence in this population, he emphasizes. Common taxanes include paclitaxel and docetaxel; however, recent research indicates that docetaxel may pose a slightly lower neuropathy risk for African American patients compared with other taxanes, he adds, stating that studies exploring modified chemotherapy dosing schedules have shown promise in mitigating neuropathy risk. This development is significant, given the severe effect of neuropathy on quality of life, he expands. Ongoing research is also revealing genetic markers linked to neuropathy risk, offering potential avenues for targeted preventive strategies, he says. Advances from anti-HER2 therapies hint at future innovations in reducing neuropathy risk in high-risk subgroups, bringing hope for better-tailored interventions that could prevent this debilitating adverse effect, Feldman concludes.

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Sheldon M. Feldman, MD, discusses the recognition of racial disparities in breast cancer, as well as the mitigation of treatment-related toxicities.

Dr Feldman on the Significance of the HER2-Low Classification in HER2+ Breast Cancer

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses 

the significance of the new classification of HER2-low breast

 and how this assists with tailoring treatment approaches for patients with HER2-positive breast cancer.

The use of targeted therapies, particularly anti-HER2 agents, is gaining momentum in treating patients with advanced, stage IV cancer, especially those who have not responded to other treatments, Feldman begins. Traditionally, HER2 status in cancer cells was classified as either overexpressed, amplified, or not expressed/amplified. However, the recognition of a HER2-low category represents a significant advancement in oncology, he reports. Patients in this group, previously classified as HER2–non-overexpressed, are now found to benefit from anti-HER2 therapy, Feldman explains. One such therapy, fam-trastuzumab deruxtecan-nxki (Enhertu; T-DXd), is proving to be highly effective in this subgroup and is seen as a breakthrough for patients with advanced cancer who have exhausted other treatment options, he notes.

Feldman says this reclassification of HER2 status expands treatment eligibility, allowing HER2-low patients to access therapies previously considered unsuitable. The efficacy of T-DXd in this setting underscores the importance of this development, offering a new therapeutic avenue for patients who would not have qualified for treatment with this agent under the previous HER2 criteria. The drug’s success demonstrates the potential of refining cancer treatment by targeting specific biological markers, he emphasizes.

Broadly, the approach of identifying and targeting specific molecular drivers of cancer is pivotal in modern oncology, Feldman expands. When a therapy targets a molecular abnormality responsible for driving cancer cell growth, it can arrest disease progression and potentially lead to a cure, he adds, stating that scientific advancements are accelerating the discovery of such targets, marking substantial progress in reducing breast cancer mortality. As new targets are identified, treatment options expand, transforming cancer therapy and bringing hope to patients previously without effective options. The rapid pace of research in this area is instrumental in achieving better outcomes and advancing cancer treatment, Feldman concludes.

Sheldon M. Feldman, MD, discusses the significance of the new classification of HER2-low breast cancer and how this affects HER2+ breast cancer treatment

Dr Feldman on the Utility of Personalized Medicine in Breast Cancer Management

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses how the use of personalized medicine has evolved in breast cancer management, highlighting the importance of this topic during Breast Cancer Awareness Month.

Patients must recognize that breast cancer is not a single disease; it encompasses various stages and subtypes, each influencing prognosis and treatment, Feldman begins. Cancer stages range from early to advanced, with each stage requiring different treatment approaches, Feldman notes. Additionally, breast cancer subtypes vary greatly in their biological characteristics, which directly affect treatment options, he says.

In breast cancer care, treatment plans consider the cancer’s stage and subtype, as well as the patient’s unique medical factors—such as age, reproductive history, and other health conditions, Feldman continues. For example, a younger woman with early-stage breast cancer may opt for breast conservation, he explains. This typically involves a lumpectomy, which is a minimally invasive surgery preserving most of the breast, followed by adjuvant radiation therapy to reduce recurrence risk, according to Feldman. However, studies indicate that for older women, particularly those older than 65 or 70 years of age, radiation may be unnecessary, as its benefits do not significantly improve outcomes in this age group, he says. Therefore, non-radiation treatments are a safe option for many patients, he reports.

The complexity of treatment increases across differing tumor types, Feldman expands. Tumor markers, such as estrogen and progesterone receptors, indicate a tumor’s responsiveness to hormones. Tumors expressing these receptors can be treated effectively with hormone-blocking therapies, he adds. Furthermore, approximately 25% of breast cancers involve HER2 overexpression, a genetic mutation previously associated with poor outcomes, he elucidates. Fortunately, advancements in targeted therapies, such as monoclonal antibodies directed against HER2, have significantly improved outcomes for these patients. This diversity in cancer subtypes and stages highlights the need for personalized treatment plans tailored to cancer biology and each patient’s unique medical background, Feldman concludes.

Sheldon M. Feldman, MD, discusses how the use of personalized medicine has evolved in breast cancer management.

Dr Feldman on Breast Cancer Awareness Month and Early Screening/Detection

Sheldon M. Feldman, MD, chief, Division of Breast Surgery and Breast Surgical Oncology, director, Breast Cancer Services, professor, Department of Surgery, Montefiore Einstein, discusses the importance of Breast Cancer Awareness Month, highlighting how awareness efforts encourage timely breast cancer screening and early detection.

Breast cancer is deeply woven into many individuals’ lives and communities; it’s challenging to find anyone who hasn’tbeen affected by it personally, such as through family or friends, Feldman begins. Encouragingly, there have been advances in breast cancer management, leading to more minimally invasive treatment methods and improved patient outcomes, he reports. However, these positive results rely heavily on early disease detection, making breast cancer awareness crucial, according to Feldman. Although the prospect of screening can be daunting for both women and men, the benefits are profound, Feldman emphasizes.

Patients diagnosed through early screening, for instance, often show no symptoms, sometimes being diagnosed with cancer only after a routine mammogram or upon noticing a minor lump, he continues. This distinction—being diagnosed with cancer vs feeling ill with cancer—is vital, he adds. Patients are often reassured when they realize that their treatment aims to preserve their health rather than fight advanced illness, he notes. Receiving a diagnosis of cancer can evoke a sense of dread in patients, yet early detection is powerful and life-changing, Feldman emphasizes.

Raising awareness is essential, especially given that age and being female are primary risk factors for breast cancer, he expands. He notes that it is important for women to understand screening guidelines that facilitate early diagnosis, often through mammography. Additionally, women should recognize that any symptoms, such as a lump, unusual pain, nipple discharge, or a rash, warrant immediate medical attention, he reports.

Although October serves as Breast Cancer Awareness Month, and other months have dedicated cancer focuses, breast cancer’s prevalence and early detectability underscore the importance of vigilance regarding this disease, he says. Breast cancer remains highly treatable when caught early, making awareness efforts during October especially influential, Feldman concludes.

Sheldon M. Feldman, MD, discusses the importance of Breast Cancer Awareness Month as well as timely screening and early detection.

Dr Feldman on the Prevention and Management of Breast Cancer–Related Lymphedema

Sheldon Feldman, MD, chief, Breast Surgery and Breast Surgical Oncology, professor, Department of Surgery, director, Breast Cancer Services, Montefiore Einstein Comprehensive Cancer Center, discusses the strategies to prevent and manage breast cancer–related lymphedema.

Feldman explains that by selectively removing lymph nodes according to the lymphatic drainage patterns and preserving the lymph nodes connected to the arm whenever possible, the risk of lymphedema in patients with breast cancer can be significantly reduced.

Beyond surgical techniques, Feldman also underscores the value of proactive monitoring to detect early signs of lymphedema. Traditional detection methods often rely on patients reporting symptoms such as arm swelling, which could indicate that lymphedema has been ongoing for a period of time, he says. Feldman advocates for a more preemptive approach—known as prospective surveillance—to identify early changes in arm volume before symptoms arise.

This surveillance involves the use of bioimpedance spectroscopy, which is a noninvasive technique that measures fluid levels in the arm. At Montefiore, Feldman notes that this is performed via bioimpedance spectroscopy with the SOZO Digital Health Platform. Feldman explains precise baseline measurements prior to surgery as well as during follow-up visits allow for the detection any changes in arm volume. If an increase is observed, indicating the potential of lymphedema, patients are promptly evaluated for further treatment, Feldman adds.

Feldman notes that early intervention with compression garments has been effective means of reversing early volume changes, thereby preventing the progression to full-blown lymphedema. The combination of selective lymph node removal and vigilant, early detection through advanced surveillance techniques represents a significant advancement in the management of breast cancer­–related lymphedema, he concludes

Sheldon Feldman, MD, discusses prevention and management strategies for breast cancer–related lymphedema.

Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedema

Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedem

Sheldon Feldman, MD, chief, Breast Surgery and Breast Surgical Oncology, professor, Department of Surgery, director, Breast Cancer Services, at Montefiore Einstein Comprehensive Cancer Center, discusses new approaches for decreasing the risk of and managing breast cancer­–related lymphedema.

Feldman explains that being mindful of which patients require surgery of the axilla can help reduce the risk of lymphedema in the breast cancer population. He emphasizes that advances in the understanding of tumor biology and axillary imaging, such as ultrasound, have allowed for more accurate assessment of necessary treatments, including whether the axilla needs to be removed. This approach significantly reduces the risk of lymphedema, since avoiding surgery on lymph nodes entirely eliminates this risk, he says.

For patients who do need axillary surgery, Feldman notes that it is crucial for surgeons to have a thorough understanding of axillary anatomy. Medical education typically covers the anatomy, but practical application requires recognizing that axillary lymph nodes drain both the breast and the arm, he says. Lymphedema occurs when the lymphatic drainage of the arm is disrupted during the removal of lymph nodes.

To mitigate this, Feldman suggests that surgeons identify and preserve lymph nodes that specifically drain the arm during breast cancer surgery. Feldman explains that "smarter axillary surgery" can significantly reduce the incidence of lymphedema.

Reducing the risk of lymphedema in patients with breast cancer involves a more selective approach to axillary surgery, leveraging tumor biology, and using advanced imaging to avoid unnecessary lymph node removal, he continues. Exploring more conservative treatment methods may represent a shift towards more informed and anatomically precise surgical techniques, Feldman concludes.

Sheldon Feldman, MD discusses new approaches for decreasing the risk of and managing breast cancer¬–related lymphedema.