Can breast cancer be treated without surgery?

That’s a question Mariola Poss, MD, FACS, a fellowship-trained breast surgical oncology specialist at Breast Care of Western New York, located in Williamsville, NY, hears often.

“For the majority of people, the answer is not yet,” says Dr. Poss, who is also part of Roswell Park Comprehensive Cancer Center’s Cancer Care Network, an affiliation of specialists across Western and Upstate New York that helps patients access comprehensive cancer services developed with the expertise of Roswell Park’s world-renowned physicians.

“Cancer, in general, is a multidisciplinary disease. The majority of people who are diagnosed with breast cancer will receive multiple types of therapies, with plans individualized to their specific needs,” says Dr. Poss. “People generally get a combination of local treatments that directly affect the breast such as surgery and radiation, as well as systemic therapy, or medical treatments that affect the whole body.”

Surgery is often the first recommended step in treating breast cancer

Oftentimes, when small cancers are found, surgery is the first recommended step in a treatment plan. “The information we learn from the surgery is important in that it helps guide what else that patient may need, such as chemotherapy and radiation,” explains Dr. Poss.

There are situations where medical therapies including chemotherapy and immunotherapy might be the first line of treatment. “In those cases, we’ll follow up with new imaging to see if the tumor has shrunk or disappeared. Our challenge is that mammograms and imaging cannot with 100% accuracy show if cancer is still in the tissue, so surgery is still generally recommended.” Dr. Poss notes a recent study that showed patients with certain types of breast cancers who responded well to chemotherapy could proceed without surgery as part of their treatment. “This was a small study and would not yet be standard practice; however, it is very exciting for the future.”

In developing treatment plans, Dr. Poss and her colleagues look to see if the cancer cells are ER (estrogen receptors) or PR (progesterone receptors) positive or negative. ER-positive disease indicates that the cancer cells are stimulated by estrogen while ER-negative disease means that they are not. “Some women have hormone-sensitive cancers, and medical problems that may not make them good candidates for surgery. In some cases, a patient may not want to have surgery. In those cases, we can sometimes treat patients with hormone-blocking medications to control their disease. It doesn't tend to be curative, but it can shrink the tumor and delay progression in certain cases,” says Dr. Poss.

With every treatment plan, surgery is discussed with patients. “It’s a difficult time and we do our best to offer options that will work optimally for each patient while respecting their personal decisions. There are different ways we can do mastectomies, depending on each individual’s situation and their interest in reconstruction. Some people do not elect for breast reconstruction, in which case they’ll have a flat closure with no breast reconstruction. For patients who choose reconstruction, we can offer prosthetic implants as well as using the patient’s own tissue. When patients choose breast reconstruction, our plastic surgeons help for that part of the process.”

Advantages receiving breast cancer care close to home

While surgeries take place at Roswell Park in Buffalo, Dr. Poss notes that patients appreciate having services in their own community. “Having a Roswell Park connection in Williamsville is helpful for people who may have difficulty getting downtown, especially the elderly, who may have transportation and mobility issues. Being able to come to our office, closer to home, is very helpful and I think makes it easier for people to maintain recommended screenings and services.”

Working from her Williamsville practice while being a part of Roswell Park’s Cancer Care Network has provided a helpful advantage in caring for residents in the community, says Dr. Poss. “It’s easier to put things off when it’s not convenient, which is why it’s important to offer services closer to home, including mammogram screening, like we do here at Breast Care. It’s very exciting to be able to offer these services to people in their own community and promote early detection.

“We certainly see cancers, but we see a lot of other things as well, especially with young people who are just getting familiar with breast health. We see patients who want evaluation for concerns like breast cysts or breast pain. We’re open to anyone and offer a full gamut of services, including risk evaluations, genetic counseling, screening services, mammograms and ultrasound biopsies. We want to help with whatever breast health issues someone may have.”