Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects.

Breast cancer patients are living longer than ever before and as such the population of breast cancer survivors continues to grow. Approximately 80% of breast cancers are hormone receptor-positive (HR+) and most patients will receive neoadjuvant or adjuvant estrogen blockade, referred to as endocrine therapy. Although endocrine therapy reduces HR+ breast cancer recurrence by 30-50%, significant adverse effects pose a threat to treatment adherence. These adverse effects include vasomotor symptoms, colloquially referred to as hot flashes, bone loss, joint arthralgias, genitourinary syndrome of menopause (GSM), previously referred to as vaginal atrophy, and low libido. This review will present the evidence-based treatments available for each of these adverse effects, including clear treatment algorithms for GSM, which is often experienced by patients but overlooked by providers. The most important takeaway is to ask open-ended questions, encourage reporting of these symptoms, and refer patients to specialty providers as needed. Surgeons may be the first to encounter these symptoms, therefore it is critical to remain informed of the treatment options.

Isotope-Only Localization for Sentinel Lymph Node Biopsy - Medium-Term Oncological Outcomes.

AIMS: Isotope and blue dye dual localization in sentinel lymph node biopsy (SLNB) gives localization rates of over 98% and is the recommended technique. However blue dye risks a range of adverse reactions. Since 2010, for clinically node negative disease, we have only used blue dye if there is no clear isotope signal at surgery. METHODS: Electronic records of patients who underwent isotope-only SLN localization between July 2010 and April 2012 were examined. Data were collected on localization and oncological outcomes. RESULTS: 426 patients were included. Isotope-only localization rate was 97.4% (415/426). The median follow-up was 63.5 months (IQR: 60.7-70.9). Median age was 57 (IQR: 48-67). Median SLN yield was 2 (range: 1-5). Axillary recurrence rate was 1.4% with median time to recurrence of 39.3 months. In-breast recurrence, distant disease and contralateral breast cancer rates were 2.8%, 7%, and 1.9% respectively and 15 (3.5%) patients died of metastatic breast cancer. CONCLUSION: Isotope-only SLNB has a comparable localization rate to dual isotope/blue dye SLNB and can spare the risk of blue dye adverse reactions. The low axillary recurrence rate, maintained to more than 5 years, confirms that isotope-only SLNB is a feasible and safe alternative to dual blue dye/isotope localization.