Behind The Knife: The Surgery Podcast

Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer

Aug 2, 2021

The podcast discusses the multidisciplinary management of triple negative breast cancer. Topics covered include diagnostic workup, chemotherapy regimens and immunotherapy, surgical approaches and breast reconstruction, and surveillance and follow-up recommendations for patients.

26:17

Creator website

AI Summary

AI Chapters

Episode notes

Podcast summary created with Snipd AI

Quick takeaways

Triple negative breast cancer is a subtype that lacks estrogen receptor, progesterone receptor, and HER2 receptor, and is more aggressive in younger women.

Patients with triple negative breast cancer typically receive neoadjuvant chemotherapy before surgery and may benefit from additional systemic treatments if residual disease is present.

Deep dives

Key Point 1: Evaluating a Breast Lump and Imaging Workup

When evaluating a patient with a new breast lump, it is important to assess the patient's baseline risk of developing breast cancer. This can be done by asking specific questions about the patient's medical history, family history, and risk factors. Imaging workup typically includes a breast ultrasound and, if the patient is over 30 years old, a diagnostic mammogram. The diagnostic workup helps to determine the characteristics of the breast lump and guide further evaluation.

Introduction

3min

Evaluation and Diagnostic Workup of a Breast Lump

12min

Chemotherapy Regimens and Immunotherapy in Triple Negative Breast Cancer

3min

Options for Surgical Approach and Breast Reconstruction After Neoadjuvant Therapy

9min

Surveillance and Follow-up Recommendations for Breast Cancer Patients

3min

A young woman is referred urgently to your breast surgical oncology clinic for a second opinion. She has been told that she needs to have an urgent mastectomy for a palpable triple negative breast cancer with suspicious axillary lymphadenopathy. Are there other options she should consider? Join Drs. Michael Alvarado, Rita Mukhtar, and Alexa Glencer as they discuss the multidisciplinary management of a patient with triple negative breast cancer.

In this episode, we review the diagnosis and classification of triple negative breast cancer, its biologic implications, surgical management including the role of sentinel lymph node biopsy vs axillary dissection, and the role of targeted chemotherapy including the recent FDA approval of immunotherapy for triple negative breast cancer in the neoadjuvant setting and indication for adjuvant chemotherapy for patients with residual disease following neoadjuvant therapy.

Links:
Enhanced recurrence and survival benefit of adjuvant chemotherapy for hormone receptor negative breast cancer compared to hormone receptor positive breast cancer
Berry et al (2006). Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA; 295(14): 1658-1667.

https://jamanetwork.com/journals/jama/fullarticle/202666

Neoadjuvant pembrolizumab for triple negative breast cancer
Schmid et al (2020). Pembrolizumab for early triple negative breast cancer. New England J of Medicine; 382(9): 810-821.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1910549?articleTools=true

ACOSOG 1071: Sentinel lymph node biopsy for patients who received neoadjuvant chemotherapy
Boughey at al (2013). Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG 1071 (Alliance) clinical trial. JAMA; 310(14): 1455-1461.

https://jamanetwork.com/journals/jama/fullarticle/1748149

Adjuvant capecitabine for triple negative breast cancer patients with residual disease following neoadjuvant chemotherapy:
Masuda et al (2017). Adjuvant capecitabine for breast cancer after preoperative chemotherapy. New England J of Medicine; 376(22): 2147-2159.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1612645?articleTools=true

FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLSfxhjxgCE9Ek263XuGkpqqbaNiK9sVnu3M7_LFYUZxhr38SZw/viewform

Get the Snipd
podcast app

Unlock the knowledge in podcasts with the podcast player of the future.

AI-powered
podcast player

Listen to all your favourite podcasts with AI-powered features

Discover
highlights

Listen to the best highlights from the podcasts you love and dive into the full episode

Save any
moment

Hear something you like? Tap your headphones to save it with AI-generated key takeaways

Share
& Export

Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more

AI-powered
podcast player

Listen to all your favourite podcasts with AI-powered features

Discover
highlights

Listen to the best highlights from the podcasts you love and dive into the full episode

Behind The Knife: The Surgery Podcast

Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer

Podcast summary created with Snipd AI

Quick takeaways

Deep dives

Key Point 1: Evaluating a Breast Lump and Imaging Workup

Key Point 2: Triple Negative Breast Cancer

Key Point 3: Surgical Approach and Adjuvant Therapy

Get the Snipd
podcast app

AI-powered
podcast player

Discover
highlights

Save any
moment

Share
& Export

AI-powered
podcast player

Discover
highlights

Behind The Knife: The Surgery Podcast

Clinical Challenges in Breast Surgery: Triple Negative Breast Cancer

Podcast summary created with Snipd AI

Quick takeaways

Deep dives

Key Point 1: Evaluating a Breast Lump and Imaging Workup

Key Point 2: Triple Negative Breast Cancer

Key Point 3: Surgical Approach and Adjuvant Therapy

Get the Snipdpodcast app

AI-poweredpodcast player

Discoverhighlights

Save anymoment

Share& Export

AI-poweredpodcast player

Discoverhighlights

Get the Snipd
podcast app

AI-powered
podcast player

Discover
highlights

Save any
moment

Share
& Export

AI-powered
podcast player

Discover
highlights