This issue of Patterns of Care is being mailed at the same time as a sibling education piece, “Second Opinion,” a four-CD audio extravaganza that includes highlights of two satellite symposia our CME group held in December 2008 at the San Antonio Breast Cancer Symposium.

At the center of these complimentary educational activities are 12 cases from the clinics of medical oncologists practicing in a community setting. These were chosen over dozens of others because they typify the most challenging situations medical oncologists currently encounter with regard to breast cancer treatment.

On these pages you will see how 75 randomly selected general oncologists would manage these cases, and in the supporting text, breast cancer clinical investigators weigh in on these patients and the clinical scenarios.

Similarly, on the four-plus-hour monster audio program (good for a slow drive on a Sunday afternoon or 10 short drives to work!) these cases and the issues surrounding them are discussed and rediscussed by the learned faculty members who participated in our recent symposia.

What these integrated activities do besides delivering some thought-provoking and insightful perspectives is provide a snapshot of the relative homogeneity in how US-based oncologists think things through when caring for people with breast cancer at tertiary meccas or down the street. Another unique aspect of this issue is that we have included a “tasting menu” of data collected from surgical colleagues, and presented during a satellite symposium at the 2008 American Society of Breast Surgeons annual meeting in New York. The responses of the breast and general surgeons surveyed are shown in comparison to those of medical oncologists, and while there certainly are discernable differences in how these specialists respond to questions about systemic therapy, the discrepancies are to my eyes not very dramatic.

This suggests that many or most surgeons are following the lead of surgical investigator legend Dr Bernard Fisher who believes that breast cancer is a systemic disease and that physicians caring for these patients must give proper credence to this essential therapeutic approach.

There actually is a theme to this madness. Clinical research information and investigator perspectives are being rapidly and effectively transmitted to physicians caring for people with breast cancer in community practice. That’s a good thing. Now we must provide them much better therapeutic tools to deal with this disease.

— Neil Love, MD
DrNeilLove@ResearchToPractice.com
February 18, 2009

SECOND OPINION: A Two-Night Live Satellite Education Series Focused on the Management of Breast Cancer in the Adjuvant and Metastatic Settings – December 13, 14, 2008, San Antonio, Texas. FACULTY: (Counterclockwise from top left) Sandra M Swain, MD; Kathy D Miller, MD; Eleftherios P Mamounas, MD, MPH; John Crown, MD; Daniel F Hayes, MD; William J Gradishar, MD; Howard A Burris III, MD; Julie R Gralow, MD; Eric P Winer, MD; George W Sledge Jr, MD; Joyce O’Shaughnessy, MD; Peter M Ravdin, MD, PhD

Satellite Education Symposium Held in Conjunction with the 9^th Annual Meeting of The American Society of Breast Surgeons – May 1, 2008, New York, New York. FACULTY: (Row 3, left to right) Mark D Pegram, MD; J Michael Dixon, MD; Pat W Whitworth Jr, MD; Peter M Ravdin, MD, PhD