Murtha Cancer Center Hosts 2022 Breast Cancer Summit

Courtesy Photo | Inbasanthi (Shanthi) Durairaj (right), Breast Imaging supervisor and mammographer at Walter Reed National Military Medical Center, guides a Military Health System beneficiary through a mammogram.  

UNITED STATES

11.03.2022

Story by Bernard Little 

Walter Reed National Military Medical Center

The John P. Murtha Cancer Center (MCC) at Walter Reed National Military Medical Center (WRNMMC) hosted its 2022 Breast Cancer Summit virtually Oct. 26. The summit is held annually during Breast Cancer Awareness Month in October.
National Breast Cancer Awareness Month began in 1985 as a collaborative effort between several organizations to raise awareness and funding for breast cancer research, as well as increase early detection of the disease by encouraging women to have mammograms.
Navy Capt. (Dr.) Kelly Elmore, WRNMMC’s chief of staff, provided welcoming remarks at the MCC’s breast cancer summit. In a video filmed in early October, Elmore discussed the importance of mammograms and received hers. “It’s important women get their mammograms annually based on their age,” she said.
Elmore, 46, said she’s been receiving mammograms since she was 35 because that’s when she found a nodule [during a self-examination].
“I’ve been in the Military Health System the entire time, and it’s been an absolutely wonderful experience,” Elmore shared. “The mammogram techs are amazing, [and] my radiologist has been wonderful,” she added.
“I talk to patients [to] tell them exactly what I am doing,” said Shanthi Durairaj, the Breast Imaging Center supervisor at WRNMMC who guided Elmore through her most recent mammogram. Durairaj added that she explains to her patients how they may feel the pressure during the mammogram. “I tell them to take control of the compression and let me know when to stop. This helps a lot.”
“So, if you’re eligible and have not [received a mammogram], do not be afraid,” Elmore said. “It’s very important we detect anything that could be abnormal early. The earlier we detect it, the easier it is for us to figure out what it is and the likelihood for us preventing cancer [spread, if that’s the case],” she added.
Other speakers during the summit addressed additional issues related to breast health and cancer, including integrative epidemiological studies of the disease, omission of adjuvant radiotherapy in breast cancer, better axillary de-escalation surgery, Her2-directed therapy, reconstruction options, and musculoskeletal pain and functional limitations post breast cancer treatments.
Epidemiologist and women’s health researcher Gretchen Gierach, Ph.D., of the National Cancer Institute (NCI), discussed integrative epidemiological studies of breast cancer. According to NCI’s Division of Cancer Epidemiology and Genetics, “Gierach is an expert in the etiology of hormonally-related female malignancies, in particular breast cancer. Her interdisciplinary research program has a special emphasis on the molecular epidemiology of mammographic density, one of the strongest risk factors of breast cancer. [She] employs a range of technologies and approaches to improve the measurement of breast density, delineate risk factors for elevated density, and understand mechanisms that mediate its relationship to breast cancer risk and progression.”
Navy Lt. Cmdr. (Dr.) Anna Torgeson, service chief of radiation oncology at WRNMMC, addressed the omission of adjuvant radiotherapy in breast cancer. Health care providers typically recommend adjuvant therapy for earlier-stage cancers. Extra treatment given after primary therapy is referred to as adjuvant (meaning “helper”) therapy, whereas extra treatment given before primary therapy is referred to as neoadjuvant therapy. The goal of adjuvant radiation therapy (RT) is to get rid of any tumor deposits remaining following surgery for patients treated by either breast-conserving surgery or mastectomy. This reduces the risk of locoregional recurrence and improves breast cancer-specific and overall survivals.
Generally, treatment for women newly diagnosed with non-metastatic breast cancer include a multidisciplinary approach involving input from surgery, radiation oncology and medical oncology, who may recommend adjuvant therapy.
Navy Lt. Cmdr. (Dr.) Matthew Nealeigh, director of the Breast Care and Research Center at WRNMMC, discussed axillary de-escalation surgery. The axillary relates to the armpit area, including the lymph nodes located there. Axillary surgery has evolved over the decades from routine axillary lymph node dissection (ALND) to sentinel lymph node biopsy, to omission of axillary surgery altogether in some patients.
Health care providers note that replacing ALND by less invasive axillary staging procedures may not be beneficial for all patients, whereas some patients may benefit from treatment de-escalation.
Dr. Stanley Lipkowitz, chief of NCI’s Women’s Malignancies Branch, addressed Her2-Directed Therapy. He noted that at one time Her2-positive breast cancer was “the worst of all breast cancers, or as bad as any,” because its aggressiveness. Now, the cancer is very treatable, both in the early stages and metastatic settings, because of therapies disrupting HER2 activity in cancer cells.
According to Lipkowitz, the development of different generations of Her2-Directed therapies, including antibody drug conjugates, are useful in Her2-positive breast cancer treatment. These conjugates act as antibodies that bind to the HER2 protein above the cancer cell’s surface, preventing it from acting or enlisting the immune system to help destroy cells that produce it. Other drugs work by binding to the part of the HER2 protein that is inside the cell and preventing it from sending signals that promote cell growth.
Army Lt. Col. (Dr.) Jennifer Sabino, a WRNMMC surgeon, discussed aesthetic flat closure as a reconstruction option. Aesthetic flat closure is a type of surgery that is performed to rebuild the shape of the chest wall after removal of one or both breasts, according to the NCI. It may also be done after removal of a breast implant used to restore the breast shape.
During an aesthetic flat closure, extra skin, fat and other tissue in the breast area are removed. The remaining tissue is then tightened and smoothed out, so the chest wall appears flat. The procedure is generally for anyone who does not want to have a formal breast reconstruction with implants and/or flaps. In general, the surgery is more straightforward with smaller scars for people with smaller breasts and minimal sagging, but there are options for flat closure in people with larger, heavier breasts as well, according to health providers.
Ellen Levy, a physical therapist with the MCC, explained the musculoskeletal pain and functional limitations of survivors post breast cancer treatments. According to results of a study posted by the National Institutes of Health, “early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles.
Because breast cancer patients can be susceptible to the development of musculoskeletal challenges and pain resulting in fear of movement, physiotherapy aims to improve the functional ability of patients through active, active assisted and passive upper limb and range of motion exercises.
For more information about the Murtha Cancer Center, visit the WRNMMC website at https://walterreed.tricare.mil/MurthaCancerCenter.

• Date Taken: 11.03.2022
• Date Posted: 11.03.2022 17:17
• Story ID: 432615
• Location: US