Mayo Clinic, Rochester, USA
Judy C. Boughey, M.D., is a Chair of the Division of Breast and Melanoma Surgical Oncology, in the Department of Surgery at Mayo Clinic in Rochester, Minnesota. Dr Boughey serves as enterprise co-deputy director for Cancer Practice in Mayo Clinic Comprehensive Cancer Center as well as chair of the Mayo Clinic Enterprise Wide Breast Cancer Disease Group. She holds the academic rank of Professor of Surgery. Dr Boughey is recognized with the distinction of the W.H. Odell Professorship in Individualized Medicine.
Dr Boughey earned her B.A. and M.A. in physiology and her M.B. B.Chir. at the University of Cambridge. She trained in general surgery residency at the University of South Carolina and completed a fellowship in breast surgical oncology at University of Texas M.D. Anderson Cancer Center.
Dr Boughey’s work has focused on minimizing the extent of surgery for women treated with neoadjuvant chemotherapy and advancing individualized medicine and drug development in breast cancer. Dr Boughey is principal investigator on three national clinical trials funded by the National Institutes of Health and Alliance for Clinical Trials in Oncology. Dr Boughey has authored over 365 papers as well as numerous book chapters and regularly presents at national meetings. Her work has been published in prominent peer-reviewed journals.
Dr Boughey is program director for the Breast Surgical Oncology Fellowship at Mayo Clinic. Dr Boughey is a fellow of the American College of Surgeons and the American Surgical Association. She is chair of the American College of Surgeons Clinical Research Program; vice chair of the Breast Disease Site Working Group of the Society of Surgical Oncology; a commissioner for the Lancet Breast Commission; and president-elect of the American Society of Breast Surgeons.
Breast and axillary surgery after neoadjuvant chemotherapy – the USA perspective
Neoadjuvant chemotherapy (NAC) is known to decrease the extent of disease in the breast and reduce the likelihood of nodal positivity and thus can increase rates of breast conservation and decrease need for axillary node dissection and its associated morbidities.
Several prospective clinical trials have assessed the false negative rate (FNR) of SLN after NAC for patients with clinically node positive disease at presentation and demonstrated FNRs ranging from 8 to 14%. Multiple ways to decrease the FNR of axillary surgery after NAC have been identified – including use of dual tracer mapping, resection of at least 2 SLNs, placing a marker in the biopsy-proven positive node and ensuring resection of that node at surgery (targetted axillary dissection) and use of IHC to evaluate for residual disease in the SLNs. Surgeons are incorporating SLN after NAC into their clinical practice for patients with a good response to NAC. How this has been implemented and changed practice patterns in the US will be discussed.
Consideration of axillary radiation in place of axillary dissection for patients with residual positive SLNs after NAC is currently being evaluated and slowly being adopted while data is awaited from prospective trials.
Further evolution of surgical management based on response to therapy is being evaluated in terms of exploring the role of omisison of breast surgery for patients with complete imaging response and omission of axillary surgery for patients with excellent response.
Please contact the conference secretariat:
t: 01332 227776
e: ukibcs@kc-jones.co.uk