Improving Early Detection and Treatment for Breast Cancer Patients

In this interview, Jane L. Meisel, MD, discusses advancements in early breast cancer detection, the integration of standard and emerging treatments, strategies for improving patient adherence, and opportunities for optimizing care through clinical pathways.

Please introduce yourself by stating your name, title, and any relevant clinical experience.

Jane L. Meisel, MD: I’m Jane Meisel. I’m a professor of Hematology and Medical Oncology and codirector of the Glenn Family Breast Center at the Winship Cancer Institute of Emory University. I have a very busy breast cancer practice at Emory, where I see patients with all stages of breast cancer. I also have the opportunity to teach medical students, residents, and fellows in the clinic.

What advancements in diagnostic tools are most promising for improving early breast cancer detection?

Dr Meisel: Three-dimensional mammograms are more sensitive and specific for diagnosing breast cancer, resulting in better early detection and fewer false-positive results. I also think increased awareness about breast cancer is helpful as well, particularly among young women. Breast cancer, as well as other cancers, is on the rise in younger populations. Because of this, many younger women who, 20 years ago, might have dismissed a lump thinking they were too young for breast cancer are now more likely today to bring an abnormality to the attention of a physician. This leads to earlier-stage diagnoses, where the disease is more likely to be cured, often with less aggressive treatment.

How do you balance standard treatments with emerging therapies for early-stage breast cancer patients?

Dr Meisel: The care of breast cancer patients is very personal. I always talk to patients about the pros and cons of each potential treatment option, including side effects, duration of treatment, treatment schedule, and the data that we have to support the therapy. I always try to use the patient’s breast cancer characteristics, other medical conditions, and personal preferences to guide them in making the best decision about the treatment path that makes the most sense for them.

How do current clinical pathways optimize care for patients with early breast cancer, and where do you see room for improvement?

Dr Meisel: We’ve come a long way in optimizing care for patients with early-stage of breast cancer over the past 5 years, with treatments that are both more effective and often less toxic now becoming standard of care. In the future, I think we will see further optimization of treatment, with more personalized strategies for patients who do not respond as well to neoadjuvant chemotherapy and potentially less aggressive treatment strategies for patients with the earliest stages of disease.

What are the primary barriers to patient adherence in early-stage breast cancer treatment, and how can they be addressed?

Dr Meisel: Sometimes patient with the earliest stages of breast cancer may not understand the risk of recurrence that still exists. While patients are usually very compliant with intravenous therapies, adherence to oral therapies, such as anti-estrogen pills that need to be taken for years to maximize effectiveness, can be more challenging due to bothersome daily side effects. To optimize adherence, it is important to educate patients about the importance of staying on treatment and to maintain open communication about side effect management. There are often many strategies to help patients with issues such as hot flashes, vaginal dryness, depression, insomnia, and joint pain. Sometimes more frequent visits within the first year of treatment can also be helpful. There are some centers that are exploring the use of smartphone apps to help educate patients and enhance communication about side effect management for patients requiring long-term treatment for early-stage disease.