Lori J Goldstein, MD

Medical Oncology

Director, Breast Evaluation Center

Meet other members of the breast cancer team.

Dr. Lori Goldstein talks about living with breast cancer on National Public Radio (NPR), March 22, 2007.

Fox Chase Cancer Center
333 Cottman Avenue
Philadelphia, PA 19111-2497

To make an appointment, call:
215-728-2570.

For general information, call:
1-888-FOX CHASE.
An oncology certified nurse will assist you.

Clinical Expertise:

Breast Cancer; Breast Evaluation Center; Novel Therapeutics; Translational Research

Medical Education:

State University of New York Upstate College of Medicine, Syracuse, NY, 1982

Residency:

Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

Fellowship:

Oncology, Division of Cancer Treatment, National Cancer Institute, Division of Cancer Biology and Diagnosis, National Cancer Institute, Washington, D.C.

Certifications:

American Board of Internal Medicine;
Medical Oncology

Philadelphia Magazine
Top Doctors 2008
Medical Oncology

Remarks by Lori J. Goldstein, MD,
Director of the Breast Evaluation Center and Breast Cancer Research Program, Fox Chase Cancer Center
at the Many Faces of Cancer conference, May 1, 2008, New York

Good morning and thank you for inviting me to speak to you and address survivorship issues as part of the Many Faces of Breast Cancer event.

The selection of the title of this program is apropos since the more we learn about breast cancer, the more we understand that individual tumors have individual characteristics as do the individual women who are at risk for and are diagnosed with breast cancer. In addition, as you heard from both Phyllis Allen and Heather Jose, the journey through survivorship is specific to each person.

Understanding the specific molecular characteristics of breast tumors has resulted in state-of-the-science tailored therapies or personalized medicine.

We are reaping the benefits of our investment in both basic and clinical research, which provides substantial evidence to continue support of rigorous and robust scientific investigation in our efforts to reduce the burden of breast cancer.

As you know the mortality secondary to breast cancer has significantly decreased over the last 15 years. Contributing factors leading to this increase in survival include increased adherence to mammographic screening leading to earlier stages at diagnosis and therapeutic improvements.

Let’s start by defining survivorship. The Institute of Medicine defines a survivor as an individual with cancer from the time of diagnosis through the balance of the individual’s life. In addition, survivorship issues concern family members and caregivers.

Let’s now review some of the areas of promise, which may enhance survivorship.

Screening
With regard to screening, we are now moving toward digital mammography. Currently being investigated is digital tomosynthesis. Breast MRIs are currently being used for high-risk individuals and are used in addition to ultrasound for diagnostic purposes.

One area that continues to be of concern, however, is access and adherence to mammography in underserved populations.

Prevention
Genetic counseling is now widely available for individuals with a familial risk for breast cancer, and interventions with regard to medical treatment and prophylactic surgery have been demonstrated to reduce the risk of developing breast cancer.

Breast Surgery
Over the past 20 years, surgery for breast cancer has become less disfiguring starting from the days of radical mastectomy to options for lumpectomy and sentinel lymph node mapping as well as improvements in reconstructive surgery for those women requiring or selecting mastectomy.

Radiation
New techniques for partial breast radiation, shorter courses of radiation and intensity-modulated radiation are currently under investigation and all may potentially reduce the morbidity associated with therapeutic radiation.

Systemic Therapy
The selection of appropriate systemic therapy has been greatly enhanced by new molecular tools such as OncoType DX™, which is used to determine which node-negative, hormone-receptor-positive, early stage breast cancers benefit from the addition of chemotherapy to hormonal therapy. In addition, the development of biologic agents such as trastuzumab, or Herceptin, has increased the survival of both early stage and advanced stage Her 2 positive breast cancers. The recently-approved bevacizumab, or Avastin, has also led to improvements in the management of advanced breast cancer and is now being evaluated in early stage breast cancer. Moreover, there are an increasing number of new biologically targeted agents currently being investigated with the goal of rational delivery of therapy which may ultimately improve the therapeutic index. In addition to understanding the biology of the tumor, we are learning about how individuals metabolize drugs differently. This field is called pharmocogenetics and it will likely play a role in the appropriate selection of optimal therapy.

With these advances, even patients with recurrent or advanced breast cancer may look forward to treating their disease as a chronic disease and adjust to what we call living with disease.

You will learn more about these specific topics from the next two speakers, Dr. Gradishar and Dr. Lake.

Taken together, our goal as a breast cancer community is to increase survival, decrease morbidity, and increase the quality of life for all survivors of breast cancer.

Issues of diet, exercise, general health maintenance and psychosocial issues also contribute to improvement in outcomes. In addition, we are also improving access to information to aid in shared decision-making.

We must continue to invest in research and exploit the relationship between basic laboratory research and clinical investigation to bring new discoveries to patients, individuals at risk for breast cancer and the people who care for them.

I want to give special thanks to all of the breast cancer survivors and participants who have generously enrolled in clinical trials. These trials are critical in advancing the field and prolonging survivorship.