Seema A. Khan, MD | Authors

Articles

Local Therapy for Breast Cancer in the Molecular Era: Relevant or Relic?

November 15, 2014

This article reviews the current status of local therapy for breast cancer and the likely impact of evolving molecular data on the present paradigm.

A Fitting Prescription for All:Whole Soyfoods as Part of aVaried Plant-Based Diet

May 15, 2013

Until better evidence is available for the effects of soy on women from non–soy-consuming countries, it seems reasonable to limit consumption to soyfoods, and to avoid high-dose supplements of processed soy components.

Hepatic Metastasectomy for Breast Cancer and Melanoma: Trends in Highly Selected Patients

November 15, 2011

Hepatic metastases remain a lethal and recalcitrant problem in the management of malignant disease, and the review by Drs. Zani and Clary of the role of hepatic metastasectomy for patients with stage IV melanoma or breast cancer is timely and welcome.

What Are Safe Margins of Resection for Invasive and In Situ Breast Cancer?

September 15, 2011

The safety and efficacy of breast-conserving therapy (BCT) for women with early-stage breast cancer are well established. BCT entails wide excision of the tumor and appropriate nodal evaluation, followed by radiation therapy to the breast.

Does Resection of an Intact Breast Primary Improve Survival in Metastatic Breast Cancer?

July 01, 2007

The recommended primary treatment approach for women with metastatic breast cancer and an intact primary tumor is the use of systemic therapy. Local therapy of the primary tumor is recommended only for palliation of symptoms. However, a series of retrospective studies examining practice patterns for this problem show that about half the women presenting with de novo metastatic disease undergo resection of the primary tumor, and suggest that women so treated survive longer than those who do not undergo resection of the intact primary. In analyses that adjust for tumor burden (number of metastatic sites), types of metastases (visceral, nonvisceral), and the use of systemic therapy, the hazard ratio for death is reduced by 40% to 50% in women receiving surgical treatment of the primary tumor. The benefit of surgical treatment appears to be confined to women whose tumors were resected with free margins. However, these results may simply reflect a selection bias (ie, younger, healthier women with a smaller tumor burden are more likely to receive surgical treatment). In addition, the role of other locoregional therapy such as axillary dissection and radiotherapy is not addressed in these studies. In view of these data, the role of local therapy in women with stage IV breast cancer needs to be reevaluated, and local therapy plus systemic therapy should be compared to systemic therapy alone in a randomized trial.