Providing the Best Care for Patients with Breast Cancer Through Use of the Multidisciplinary Team

The 15th Annual Meeting of the American Society of Breast Surgeons (ASBrS) held in May in Las Vegas was host to an audience of 1,460, including 1,370 physicians (187 from 35 countries outside of the US) as well as an esteemed panel of experts in breast surgery and across the multidisciplinary field of breast diseases. There was extensive discussion on surgical issues, such as the utility of axillary dissection, management of ductal carcinoma in situ, new surgical techniques, and appropriate margin status. The expertise imparted by many of our non-surgical colleagues highlighted the importance of a strong multidisciplinary team in order to provide the best care to our cancer patients. Multidisciplinary care is a critical part of the clinical practice for breast patients. Classically, when thinking about multidisciplinary teams for breast cancer the make-up can vary but commonly includes input from breast surgery, medical oncology, radiation oncology, pathology, and breast imaging, as represented in the always popular ‘community tumor board’. However, expertise from other fields can also augment and improve care of breast patients. The recent meeting included input from anesthesiologists, integrative medicine physicians and reconstructive surgeons. Breast radiologists are an integral part of screening and diagnostic work-up of breast patients. The debate surrounding mammograms for screening continues and was eloquently reviewed by a panel of experts. In 2009, the US Preventative Services Task Force (USHPTF) recommended that screening for breast cancer in the US should start at 50 years of age and continue every other year thereafter. Many breast surgeons agree that starting annual screening in every patient at 40 years of age is unnecessary, expensive, and associated with some risk; however, most medical organizations, including the ASBrS, continue to recommend annual mammography for all women starting at 40 years of age. This is because there is no current, compelling risk model that can accurately stratify young women into a high or low risk group. Moving forward, it may well be that a one size fits all approach is not ideal and consideration is underway for a risk-stratified approach to screening, so women at higher risk of breast cancer development start screening earlier and potentially more frequently than women at average or below-average risk. Breast surgeons work closely side by side with plastic and reconstructive surgeons. Some oncoplastic procedures can be performed by breast surgeons, such as local tissue rearrangements, the round block resection (donut mastopexy) lumpectomy, and parallelogram mastopexy lumpectomy. Experience with and indications for nipple-sparing mastectomy has grown over the last 5–10 years and the group from the University of California San Franciso (USCF) presented the evolution of their techniques over 986 cases, with the article included in this issue of Annals of Surgical Oncology. Immediate or delayed lipofilling is a newer technique used to improve both postmastectomy and postlumpectomy deformities. This simple technique performed without creating a visible scar brings fat removed by liposuction from the subcutaneous tissue from the abdomen or other donor sites on the patient’s body to fill the defects after surgery. The degree of reabsorption of the injected adipose tissue is unpredictable. Long-term oncologic follow-up related to lipofilling is not available; however, early studies indicate that lipofilling seems to be a safe procedure for breast cancer patients. Plastic and reconstructive surgeons offer a whole variety of procedures from immediate and delayed Society of Surgical Oncology 2014