Health Expert Kevin Knopf, MD shares health management news and commentary at HealthCentral.com. HealthCentral.com is one of the top health destinations on the Web, with more than 35 condition-specific, wellness and general health Web properties. http://www.healthcentral.com/profiles/c/87/index http://www.healthcentral.com/profiles/c/87/rss self application/xml en-us 15 120 19 http://www.healthcentral.com/images/hc_logo_sm.gif http://www.healthcentral.com/profiles/c/87/index http://www.healthcentral.com/breast-cancer/c/87/58853/disagree Wed, 18 Mar 2009 11:31:00 -0400 Kevin Knopf, MD Data presented at the San Antonio Breast Cancer Symposium show that basically all women with HER2+ breast cancers benefit from adjuvant chemotherapy/Herceptin due to their worse prognosis. In my mind, however, there is no more controversial area in breast cancer than in which patients truly benefit from receiving adjuvant chemotherapy, among women who are (1) postmenopausal and (2) have small, low grade, node negative, ER+ and Her2- breast... http://www.healthcentral.com/breast-cancer/c/87/58853/disagree http://www.healthcentral.com/breast-cancer/c/87/58860/anthracyclines Tue, 10 Mar 2009 12:07:00 -0400 Kevin Knopf, MD After much debate at breast tumor boards throughout the world on the importance of HER2 and topoisomerase II (an enzyme involved in DNA replication) in predicting response to Anthracyclines, it seems that an extra copy of chromosome 17 in the cancer may be predictive. Things change pretty quickly.   We typically don't analyze chromosome 17 status in breast cancer, but depending on final results this may become more a part of our decision... http://www.healthcentral.com/breast-cancer/c/87/58860/anthracyclines http://www.healthcentral.com/breast-cancer/c/87/58858/wait-radiation Wed, 25 Feb 2009 12:05:00 -0500 Kevin Knopf, MD We have previously discussed this question about timing from breast surgery to chemotherapy, with the pat answer that around 2 months or less is safest, and after three months one starts to lose some of the benefit of chemotherapy in terms of increasing cure rate. A similar question can be asked about radiation therapy for women who have had a lumpectomy, or who have reasons to have radiation after a mastectomy (large tumor, multiple positive... http://www.healthcentral.com/breast-cancer/c/87/58858/wait-radiation http://www.healthcentral.com/breast-cancer/c/87/58861/testing-gathers Wed, 11 Feb 2009 12:08:00 -0500 Kevin Knopf, MD Discussed in this blog two years ago, many academicians now recommend testing for CYP2D6 metabolic signature to determine if postmenopausal women should switch from tamoxifen to aromatase inhibitors. However, given that most oncologists offer aromatase inhibitors preferentially to postmenopausal women over tamoxifen the question is still unanswered - should premenopausal women have their CYP2D6 status analyzed?   CYP2D6 variations can... http://www.healthcentral.com/breast-cancer/c/87/58861/testing-gathers http://www.healthcentral.com/breast-cancer/c/87/58852/chemotherapy Mon, 09 Feb 2009 11:28:00 -0500 Kevin Knopf, MD From the San Antonio Breast Conference in December, new data shows a higher than predicted rate of breast cancer recurrence even with very small breast cancers that are HER2 positive. The data is from the first large study to analyze early-stage breast cancer patients with HER2 positive tumors one centimeter or smaller. All these women would benefit from adjuvant Trastuzumab, also known as Herceptin, (for one year, the standard in America) -... http://www.healthcentral.com/breast-cancer/c/87/58852/chemotherapy http://www.healthcentral.com/breast-cancer/c/87/55593/angiolymphatic Wed, 14 Jan 2009 10:43:00 -0500 Kevin Knopf, MD In my previous two posts on understanding your pathology report, we covered histology, margin status, grade, as well as size, lymph node status, Estrogen Receptor and Progesterone Receptor. Now I'll cover just a few more items to finish up our tour of the breast cancer pathology report, including HER2 Status, how fast the cancer is dividing, and "angio invasion" -- or invading blood vessels:   Her2 Status   HER2 is the third... http://www.healthcentral.com/breast-cancer/c/87/55593/angiolymphatic http://www.healthcentral.com/breast-cancer/c/87/55510/involvement-er Tue, 13 Jan 2009 17:25:00 -0500 Kevin Knopf, MD More things to look for on your pathology report - my last post on pathology reports covered histology, margins and grade. Other important things a pathologist will consider:   Size of the Breast Cancer (Measured in cm)   This is somewhat an approximation of the size in diameter of a three dimensional tumor - looking for the widest point. Breast cancer can sometimes be shaped oddly - think of a bow turned on itself in which case... http://www.healthcentral.com/breast-cancer/c/87/55510/involvement-er http://www.healthcentral.com/breast-cancer/c/87/50757/pathology-part Tue, 09 Dec 2008 12:28:00 -0500 Kevin Knopf, MD A large part of the initial consultation with your oncologists (surgeon, radiation oncologist, and medical oncologist) is spent discussing your pathology report. We almost take good pathology for granted but it is unwise to do so; the Pathologist is a crucial member of your breast cancer team who usually goes unsung, and almost never gets their picture on the glossy brochure put out by the breast cancer centers that advertise in the local... http://www.healthcentral.com/breast-cancer/c/87/50757/pathology-part http://www.healthcentral.com/breast-cancer/c/87/47514/personalized Fri, 07 Nov 2008 16:54:00 -0500 Kevin Knopf, MD Personalized medicine actually has two meanings. The first, and probably the one most familiar to us in San Francisco, is the trend to have "concierge" style medicine - usually an internist, family practitioner, or Ob/Gyn who takes a panel of patients for a set fee per patient, rather than taking insurance. This is a prominent phenomena in many cities, for a variety of reasons. We may touch on this in another column.What I want to touch on is... http://www.healthcentral.com/breast-cancer/c/87/47514/personalized http://www.healthcentral.com/breast-cancer/c/87/45849/metastatic-site Wed, 22 Oct 2008 15:09:00 -0400 Kevin Knopf, MD Sometimes, things do not go as we like and breast cancer returns in a different site from the breast - a metastatic site. It's what patients all fear with each little ache and pain, and what your oncologist looks for at each follow up visit. Less common these days is the patient who presents with metastatic disease at the outset - this can be seen with a very aggressive breast cancer, or with a patient who sometimes delays seeking treatment... http://www.healthcentral.com/breast-cancer/c/87/45849/metastatic-site