Dr Naughton on De-escalating Breast Cancer Treatment

Hannah Naughton, MD, explains how breast cancer care has moved toward treatment de-escalation, with less surgery and less chemotherapy. She also explains why the focus now extends beyond survival to how patients are living 5 to 10 years after diagnosis.

Naughton, a breast cancer surgeon at Hackensack Meridian Health, said that breast cancer care has seen many advances over the years. Much of the recent progress has involved doing less: less surgery and less chemotherapy. According to Naughton, this de-escalation has not had a big impact on patient outcomes. Because patients with breast cancer generally do well, attention is increasingly turning to how patients are living after surgery and after their treatments, and how their quality of life can be improved. Survival remains the number one priority, she noted, but the care team is now thinking ahead of it.

That shift is reflected in the expanding role of breast conservation. Naughton said there are now only a few indications in which breast conservation cannot be offered. Previously, a large tumor or cancer in multiple areas of the breast meant a patient had to undergo a mastectomy. She described that as a lot for a patient, particularly for older patients or those who want to preserve their breasts. Today, alternative approaches include chemotherapy that can help shrink the tumor. Surgeons can also coordinate with plastic surgeons to perform a breast reduction at the same time the cancer is removed.

Naughton also shared what drew her to breast cancer surgery. She enjoys working with people and being with patients from the beginning of their diagnosis through the end of treatment and beyond. Working within a multidisciplinary team was equally important to her because she feels it gives patients the most comprehensive care. Although she is a surgeon, she said her thinking goes beyond getting a patient through surgery to what life will look like for that patient years later.

She describes a care team that communicates frequently and stays closely coordinated, with physicians sharing cell phone numbers. She reviews patient charts before seeing patients and calls the medical oncologist directly. At her cancer center, every new cancer diagnosis is reviewed weekly at a tumor board. Radiologists pull up the imaging, and Naughton reviews the pathology slides alongside the pathologist herself.

Naughton believes this comprehensive approach is improving patient outcomes and giving patients alternative routes of treatment. With so much new research being studied, she said conversations about new data, new treatments, and clinical trials benefit from involving the other specialties.