When breast cancer patients and high-risk patients need expert advice they make an appointment to see Alexandra Heerdt, MD, FACS, a busy breast surgeon at Memorial Sloan-Kettering Cancer Center, and former director of the Center’s Special Surveillance Breast Program. Dr. Heerdt currently sees over 200 new patients a year. Many of her patients have breast cancer, others have a family history and are worried about getting the disease.

Dr. Heerdt’s accomplishments and accolades are numerous. Her name regularly appears in the “Best Doctors in New York,” issue of New York magazine; she has been named one of the best doctors in the country, and is regularly quoted in national publications, cited in medical journals, and interviewed online. Currently, she is involved in several projects attempting to define the appropriate screening and treatment options for women with family histories of breast cancer.

ABCG: “We think of breast cancer as an older woman’s disease. But what are the odds of getting breast cancer if you are young?”

DR. HEERDT: “According to the American Cancer Society, of the 180,000 estimated new cases of breast cancer this year, nearly 2,700 will occur in women of childbearing age. From 30 to 40 years old, according to the National Cancer Institute, your risk of developing breast cancer is 1 out of 257, and the odds go up if you have a strong family history. Young women can and do get it, although it is much rarer under the age of 40. Unfortunately, the exact cause of breast cancer is unknown, and the only thing we do know is that 10% of all breast cancer is hereditary in nature and due to genetic mutations. That leaves 90% of the equation left to chance – which is a scary thought.”

ABCG: “What makes a woman at high risk for the disease?”

DR. HEERDT: “By simply being a female, every woman is at risk. However, a woman is at the highest risk for breast cancer if she’s had multiple, first-degree relatives (mother, daughter, or sister) who have had breast cancer – especially if any of them were diagnosed before menopause. Sally, a high-risk patient of mine, is 39, but started
seeing me when she was 31. Her mother had premenopausal breast cancer and died when she was 42.

Then her sister got breast cancer when she was 36, and died right before her 45th birthday. In addition, both her grandmothers had breast cancer after menopause.”

ABCG: “How do you deal with a high-risk patient?”

DR. HEERDT: “I keep high risk patients up-to-date on the newest studies, tests or drugs. The key thing is that patients be monitored, so that if something is found, it will be found early, and can be taken care of. The biggest way to alleviate a patient’s anxiety is to hear what she is saying and not make her feel it’s inappropriate. For some women, it helps if they come in more frequently for check-ups. Others like getting lots of articles and reading materials dealing with the disease, so that they can understand it better. Still, others benefit from talking to a psychologist, or even getting a prescription for anxiety medication.”

ABCG: “Please describe the Special Surveillance Breast Program.”

DR. HEERDT: “The Special Surveillance Breast Program at Memorial Sloan-Kettering is geared toward women who are at increased risk for development of breast cancer, above and beyond the general population. Patients in the program normally get a physical exam twice (not just once) a year, plus a mammogram once a year, as well as an ultrasound if they need it. The program is coordinated with a nutritionist, a psychologist, and a psychiatrist, and offers patients articles, brochures, and all sorts of information on the disease. We also work together with an integrative medicine department that offers acupuncture, massage therapy, and a mind/body program for stress reduction, which I often recommend to patients.”

ABCG: “What clinical research is taking place in breast cancer treatment/screening?”

DR. HEERDT: “There is a great deal of research activity taking place in the areas of early detection, and to some extent, prevention. While mammograms remain the gold standard in early detection, I also favor using MRIs to screen high-risk women. In an MRI, a doctor injects a dye into the vein, which travels into the breast, highlighting areas of increased blood flow, which can be an early sign of breast cancer. New treatment drugs being investigated include aromatase inhibitors, such as Arimidex, Foslatex, and Herceptin (Tamoxifen is also in this group). These drugs block estrogen, which some types of breast cancer need to grow, but they do not carry Tamoxifen’s potentially dangerous downside (an increased risk of uterine or endometrial cancer). There are also new studies going on that are looking at hormonal approaches to breast cancer. For example, in younger women, there is research on a drug called Zoladex, which puts them into temporary menopause.”

ABCG: “Are there any new inventions we should know about?”

DR. HEERDT: “One development that I find very exciting is a breast cancer vaccine that is in its early trial stages in Europe. The vaccine is intended to stimulate the patient’s own immune system, helping to recognize and wipe out any cells that contain excessive HER-2 (which causes breast cancer to grow uncontrollably). However, the trial is several years away from completion, and we are years away from knowing whether the vaccine will prove effective. Another promising study suggests that a tiny protein called RhoC found in breast tumors could be used as an early warning system, potentially spotting dangerously aggressive breast cancer before it begins to spread. So there’s a lot going on in the field right now.”

ABCG: “What message do you want to give women about breast cancer?”

DR. HEERDT: “If diagnosed early, breast cancer is highly treatable. Women need to partner with their doctors in screening; do self-exams, and stay aware of their risks, without going nuts. Despite all the research being done, the best weapon against breast cancer is a woman’s self-awareness. In the future, breast cancer may no longer be a threat if we continue to be diligent and to push for more education, activism, research and awareness.”

Estelle Sobel is the Editor-in-Chief of The American Breast Cancer Guide,
and a science/health writer based in Fort Lee, NJ.