Breast Cancer Question-and-Answer Session With Charles Vogel, MD
(Image courtesy of Dr. Charles Vogel)
Charles Vogel, MD, is a medical oncologist at the University of Miami Miller School of Medicine in Miami, FL. His clinical and research interests involve all medical aspects of breast cancer treatment including anti-hormonal therapy, chemotherapy, and targeted therapy.
He has more than 40 years of breast cancer research experience and has participated in clinical trials of virtually every medical breast cancer treatment currently available.
Dr. Vogel was one of the clinical trial pioneers for several drugs including trastuzumab, bevacizimab, and lapatinib. Despite witnessing so many advances, he believes the best is yet to come.
What do you think of the American Cancer Society's recent cancer screening guidelines update?
Dr. Vogel: I think that unfortunately it's probably not a good idea and it's going to do more harm than good. These guidelines are going to get adopted by insurance programs, which are going to stop paying for annual mammography in women under 55.1 Because insurance won't pay for it, there will be a drop-off in screening and we're going to see an increase in deaths.
Overdiagnosis—I don't necessarily think that there is such a thing. If you diagnose something it's because it's there. There's a lot of talk about overdiagnosis, and indeed, we are picking up smaller and smaller tumors. But the question is “are we overtreating?” That answer is yes.
There's a difference between overdiagnosis and overtreatment. Let's say you pick up a very small tumor. Is it necessary for all those women to undergo aggressive treatment? The answer is no.
Women with small, low grade ductal carcinoma in situ (DCIS) could be followed by active surveillance. We can move in the direction we have with prostate cancer. Women would benefit from active surveillance as men do with prostate cancer.
If you had to pick the most important advance in the treatment of breast cancer in the past 10 years, what would it be?
Dr. Vogel: The Herceptin Adjuvant trial was one of the most important advances because it was proof-of-principle, targeted, and non-toxic.2
Beyond that, I would say sentinel nodes replacing removal of all axillary lymph nodes has been a major surgical advance. That's really the most morbid part of breast cancer surgery is axillary dissection. There has been more widespread use of sentinel nodes in the past 10 years.