OVERVIEW OF ACTIVITY

It is important for general medical oncologists and surgeons to be aware of similarities and differences between their patterns of cancer care and those of other community practitioners and breast cancer clinical investigators. Additionally, the recognition that heterogeneity exists within the treating oncology community underscores the existence of clinical situations for which there may be suboptimal research evidence to support a single optimal approach. This program focuses on the self-described practice patterns of randomly selected medical oncologists and general surgeons in a variety of key clinical scenarios in breast cancer. Also included are clinical investigator commentary and references addressing these topics. This CME program will provide oncologists and surgeons with information on national cancer patterns of care to assist with the development of best-practice clinical management strategies.

LEARNING OBJECTIVES

• Compare treatment strategies utilized by community oncologists, general surgeons and cancer clinical investigators in the primary, adjuvant and metastatic settings, and apply this information to the routine management of breast cancer.
• Evaluate clinical issues for which relative agreement and heterogeneity exist in patterns of breast cancer care, and make treatment decisions considering this information.
• Counsel patients with breast cancer about the benefits and risks of multiple acceptable treatment options when they exist.
• Recognize the rate at which practice-changing clinical research impacts physician decision-making, and explain how this affects oncology patient access to standard and novel therapies.
• Recall the design and eligibility criteria for ongoing breast cancer clinical trials, and consider appropriate patients for study participation.

ACCREDITATION STATEMENT

Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT

Research To Practice designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

HOW TO USE THIS CME ACTIVITY

This monograph is one issue of a CME series activity. To receive credit for this activity, the participant should read the monograph and complete the Educational Assessment and Credit Form located on our website at www.ResearchToPractice.com/POC/Breast.

COMMERCIAL SUPPORT

This program is supported by educational grants from Abraxis BioScience, AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Genomic Health Inc and Sanofi-Aventis.

PHARMACEUTICAL AGENTS DISCUSSED IN THIS PROGRAM

This educational activity includes discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

CONTENT VALIDATION AND DISCLOSURES

Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

CME DISCLOSURES FOR COMMUNITY ONCOLOGISTS WHO PROVIDED CASES

Drs Bobrow, Hoffman, Levy and Schwartz had no financial interests or affiliations to disclose. Dr Hart — Speakers Bureau: GlaxoSmithKline. Dr Kanner — Advisory Committee: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Eisai Inc, Millennium Pharmaceuticals Inc. Dr Schwarzberg — Advisory Committee: Pfizer Inc; Speakers Bureau: Novartis Pharmaceuticals Corporation, Pfizer Inc.

CME DISCLOSURES FOR QUOTED FACULTY

Drs Dixon and Winer had no real or apparent conflicts of interest to disclose. The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process: Dr Burris — Consulting Agreements: Bristol-Myers Squibb Company, Celgene Corporation, Genentech BioOncology, GlaxoSmithKline, ImClone Systems Incorporated, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc. Prof Crown — Speakers Bureau: GlaxoSmithKline, Pfizer Inc, Sanofi-Aventis. Dr Gradishar — Advisory Committee: Abraxis BioScience, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Eisai Inc, Genentech BioOncology GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc; Consulting Agreements: Abraxis BioScience, Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol- Myers Squibb Company, Eisai Inc, Genentech BioOncology, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc. Dr Gralow — Consulting Agreements: Amgen Inc, Genentech BioOncology, Genomic Health Inc, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Sanofi- Aventis. Dr Hayes — Paid Research: AstraZeneca Pharmaceuticals LP, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc. Dr Mamounas — Advisory Committee: Abraxis BioScience, Bayer Pharmaceuticals Corporation, Bristol-Myers Squibb Company, Eli Lilly and Company, Genentech BioOncology, Genomic Health Inc, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi-Aventis; Consulting Agreement: Roche Laboratories Inc; Speakers Bureau: Eli Lilly and Company, Genentech BioOncology, Genomic Health Inc, Pfizer Inc, Sanofi-Aventis. Dr Miller — Consulting Agreements: Eli Lilly and Company, Genentech BioOncology, Roche Laboratories Inc; Paid Research: Pfizer Inc, Roche Laboratories Inc; Speakers Bureau: Genentech BioOncology, Roche Laboratories Inc. Dr O’Shaughnessy — Consulting Agreements: Biogen Idec, GlaxoSmithKline; Speakers Bureau: Abraxis BioScience, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Sanofi- Aventis. Dr Pegram — Advisory Committee: Amgen Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Genomic Health Inc, GlaxoSmithKline, Pfizer Inc; Speakers Bureau: Genentech BioOncology, GlaxoSmithKline, Sanofi-Aventis. Dr Ravdin — Consulting Agreement: Genomic Health Inc; Speakers Bureau: AstraZeneca Pharmaceuticals LP; Stock Ownership: Adjuvant! Inc, Bristol-Myers Squibb Company, Pfizer Inc, Wyeth. Dr Sledge — Advisory Committee: Genentech BioOncology, GlaxoSmithKline, Novartis Pharmaceuticals Corporation; Consulting Agreement: Genentech BioOncology; Paid Research: Eli Lilly and Company, Sanofi-Aventis. Dr Swain — Foundation Grant: Genentech BioOncology; Paid Research: Bristol-Myers Squibb Company; Paid Travel: Sanofi-Aventis.

EDITOR — Neil Love: Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: Abraxis BioScience, AstraZeneca Pharmaceuticals LP, Aureon Laboratories Inc, Bayer Pharmaceuticals Corporation/Onyx Pharmaceuticals Inc, Biogen Idec, Bristol- Myers Squibb Company, Celgene Corporation, Cephalon Inc, Eisai Inc, Eli Lilly and Company, Genentech BioOncology, Genomic Health Inc, Genzyme Corporation, GlaxoSmithKline, ImClone Systems Incorporated, Merck and Company Inc, Millennium Pharmaceuticals Inc, Novartis Pharmaceuticals Corporation, Ortho Biotech Products LP, OSI Oncology, Pfizer Inc, Roche Laboratories Inc, Sanofi-Aventis, Synta Pharmaceuticals Corp and Wyeth.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

	Samuel N Bobrow, MD Associate Clinical Professor of Medicine Yale University Attending Physician at Yale-New Haven Hospital Attending Physician at the Hospital of St Raphael New Haven, Connecticut		Isaac Levy, MD Memorial Hospital West Pembroke Pines, Florida
	Lowell Hart, MD Research Director Florida Cancer Specialists Fort Myers, Florida		Michael A Schwartz, MD Attending Mount Sinai Medical Center Miami Beach, Florida
	Kenneth R Hoffman, MD, MPH Teaneck, New Jersey		Abraham B Schwarzberg, MD Clinical Instructor Harvard Medical School Consultant in Medicine Massachusetts General Hospital Boston, Massachusetts Medical Director Cancer Center of South Florida West Palm Beach, Florida
	Steven P Kanner, MD Oncology Associates of South Florida Hollywood, Florida