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To operate, or not? Treating breast cancer with less surgery

Lisa Lai, MD

Upstate breast surgeon Lisa Lai, MD, is involved in a national trial comparing surgery vs. medication and surveillance for patients with stage zero breast cancer called ductal carcinoma in situ, or DCIS. (PHOTO BY ROBERT MESCAVAGE)


Most breast cancers are treated with surgery today, but that may change in the coming years, says breast surgeon Lisa Lai, MD, an assistant professor of surgery and medical director of the breast cancer program at Upstate.

She explains that the trend is to do less surgery whenever possible. In the future, women may be offered procedures to remove breast lumps that don‘t even require incisions.

“Nothing excites me more as a breast surgeon than to be able to offer the patient less surgery,” she says. “We never want to do more than what they need or can have benefit from.”

Forty years ago, women with breast cancer were treated with an operation called a radical mastectomy, in which the breast, muscles and lymph nodes were removed. “That‘s an operation that is almost never done these days,” Lai says.

Today, patients have options. Surgeons offer a variety of techniques, including lumpectomies, mastectomies and reconstruction by a plastic surgeon. The focus is on curing the cancer while preserving the cosmetic appearance of the breast.

In some select cases, patients with the earliest stage of breast cancer may forego surgery by enrolling in a study.

Clinical trial compares surgery to medication, surveillance

Lai is involved in a national trial that focuses on patients with stage zero breast cancer called ductal carcinoma in situ, DCIS.

The trial compares traditional surgery to remove a breast lump with a newer strategy: medication, plus careful surveillance. It‘s called the COMET Trial for Low Risk DCIS. COMET stands for Comparison of Operative to Monitoring and Endocrine Therapy.

“Our overarching hypothesis is that management of low-risk DCIS using an active surveillance approach does not yield inferior cancer or quality of life outcomes,” researchers say in their description of the trial. Among those leading the COMET Trial are researchers from Duke University, the Dana-Farber Cancer Institute, MD Anderson Cancer Center and New York University.

The trial looks at survival time, the number of patients who develop invasive cancer and several other measures, plus coping and quality of life. It began in February and hopes to enroll 1,200 patients before completing data collection in 2021.

To learn more about COMET, contact surgical research coordinator and nurse Linda Ellinwood at 315-464-1852.

Individual treatment plans

As a breast surgeon at the Upstate Cancer Center, Lai appreciates working as part of a team – which includes medical oncologists, radiation oncologists, a plastic surgeon, a pathologist, a genetic counselor and others – to come up with an individual treatment plan for each patient.

Lai says she was drawn to the specialty of breast surgery because of the patients she gets to help.

“I love my patients. We really get to know each other well and form a nice bond,” she says. “Nothing delights me more than them being cancer-free and hearing about how life has moved on after treatment.”

Cancer Care magazine fall 2017 coverHealthLink on Air logoThis article appears in the fall 2017 issue of Cancer Care magazine. To hear Lai further explain the current and future role of surgery for breast cancer, click here.