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   Alicia C. Staley@stales

   And…. welcome to Monday night! #bcsm

   Mon, Mar 17 2014 18:00:31

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   Dr. Deanna Attai@DrAttai

   Welcome to the chat everyone! Tonight we’ve got some medical meeting highlights from @SocSurgOnc #SSO2014 #bcsm

   @FollowHeidi

   ·

   Mon, Mar 17 2014 18:01:36

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   Dr. Deanna Attai@DrAttai

   @MikeCowher and @dianeradford - both breast surgeons - attended the meeting and will be sharing their insights #bcsm

   Mon, Mar 17 2014 18:02:01

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   Michael S. Cowher MD@MikeCowher

   Hola everyone! Breast surgeon, Cleveland, recently somewhat tanned and educated at #SSO2014 in Phoenix. #bcsm

   Mon, Mar 17 2014 18:03:23

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   Diane Radford MD@dianeradfordmd

   Hello @DrAttai @stales @jodymes. Looking forward to tweeting about #SSO2014. I’m a breast surgeon with @mercysaintlouis #bcsm

   Mon, Mar 17 2014 18:02:33

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   Dr_Dana@Dr_Dana

   Hello!Breast surgeon in Little Rock.Very excited about tonight’s chat! #bcsm

   Mon, Mar 17 2014 18:01:50

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   Eric Manahan MD MBA@Ermanmd

   Listening in again - from Ga! #bcsm

   Mon, Mar 17 2014 18:02:47

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   Matthew Katz@subatomicdoc

   Good evening #bcsm. Matt Katz, radiation oncologist joining a bit late. I hope you’re all well!

   @LifePowerBlogCa

   ·

   Mon, Mar 17 2014 18:12:29

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   Dr. Deanna Attai@DrAttai

   Huge welcome to chat newbies, especially those docs who attended @MikeCowher talk on social media #SSO2014 #bcsm

   Mon, Mar 17 2014 18:03:02

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    Alicia C. Staley@stales

    Hi to all the lurkers #bcsm

    Mon, Mar 17 2014 18:04:39

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    MMCarpenterMD@Ladysurg

    Thanks…I am a lurker! I attended SSO and Dr. Cowher was nice enough to teach me twitter! #bcsm

    Mon, Mar 17 2014 18:05:27

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    Angela Alexander@thecancergeek

    @Ladysurg welcome. It is a hard to be a lurker for long on #bcsm! #bcsm

    Mon, Mar 17 2014 18:06:14

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    Dr. Deanna Attai@DrAttai

    Our guests are chat regulars @MikeCowher  http://my.clevelandclinic.org/staff_directory/staff_display.aspx?DoctorID=15145 … and @dianeradfordmd  http://www.dianeradfordmd.com  #bcsm

    Mon, Mar 17 2014 18:09:19

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    Dr. Deanna Attai@DrAttai

    new to the chats: another breast surgeon @Ladysurg who was also at #SSO2014 #bcsm

    Mon, Mar 17 2014 18:09:48

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    Dr. Deanna Attai@DrAttai

    @SocSurgOnc  http://surgonc.org  covers surgical treatment of all cancers, so only part of the meeting was devoted to breast cancer #bcsm

    @AmyBlackTattoos

    ·

    Mon, Mar 17 2014 18:08:31

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    Dr. Deanna Attai@DrAttai

    Please realize this meeting covered specific topics - we will try to provide highlights #bcsm

    Mon, Mar 17 2014 18:13:39

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    Diane Radford MD@dianeradfordmd

    Q1 Margins: big news with the publication in Annals of Surgery 2/10/2014 #bcsm

    Mon, Mar 17 2014 18:15:11

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    Michael S. Cowher MD@MikeCowher

    Def: Margin: Location of cancer cells in relation to ‘edge’ of cut tissue. positive - at edge. #bcsm

    @zmadak

    ·

    Mon, Mar 17 2014 18:16:54

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    Matthew Katz@subatomicdoc

    @DrAttai @MikeCowher @dianeradfordmd Yes, margins have been important for deciding surgery is complete #bcsm

    @zmadak

    ·

    Mon, Mar 17 2014 18:15:16

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    Diane Radford MD@dianeradfordmd

    Adequate margin debated for years. Meta-analysis states “no ink on tumor” is the margin to obtain #bcsm

    @jodyms

    ·

    Mon, Mar 17 2014 18:16:17

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    Michael S. Cowher MD@MikeCowher

    what has been debated for years is if there should be a ‘distance’ from closest tumor cell to edge of tissue removed. #bcsm

    @FollowHeidi

    ·

    Mon, Mar 17 2014 18:17:45

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    Surgical Oncology@SocSurgOnc

    @dianeradfordmd @subatomicdoc @stales @DrAttai @ASTRO_org You can access the summary here:  http://surgonc.org/margins-study  #bcsm #SSO2014

    @subatomicdoc

    ·

    Mon, Mar 17 2014 18:20:48

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    Alicia C. Staley@stales

    -> RT @DrAttai and @ASBrS also has a margin statement  https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/Lumpectomy_Margins.pdf … #bcsm

    Mon, Mar 17 2014 18:16:53

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    Diane Radford MD@dianeradfordmd

    Not having to go back to re-excise will save not only time, worry etc but about $18M per year healthcare $ #bcsm

    Mon, Mar 17 2014 18:17:56

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    Michael S. Cowher MD@MikeCowher

    what new guidelines say - for invasive BC (not DCIS), any number / distance of cells between tumor and edge is acceptable #bcsm

    Mon, Mar 17 2014 18:19:05

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    Maria Fowler@machfowlerBC

    @DrAttai I only kind of understand what “no ink on tumor” would mean… what ink? What is the ink for? #bcsm

    Mon, Mar 17 2014 18:20:41

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    Dr. Deanna Attai@DrAttai

    DEFINITION: Ink - when the pathologist gets the tissue from the OR, they use different color inks on the margins - this marks the edge #bcsm

    Mon, Mar 17 2014 18:21:19

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    Maria Fowler@machfowlerBC

    @DrAttai Can you always SEE the tumor to mark the edge? #bcsm

    Mon, Mar 17 2014 18:21:52

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    Dr. Deanna Attai@DrAttai

    @machfowlerBC you don’t mark the tumor, you mark the tissue that gets removed.. Path measures tumor distance from ink = margin #bcsm

    Mon, Mar 17 2014 18:22:44

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    picture of inked lumpectomy for those who learn visually:  http://commons.wikimedia.org/wiki/File:Inked_Lumpectomy_Specimen_(6464023675).jpg … #bcsm

    Michael S. Cowher MD@MikeCowher

    @SurvivorRunner

    ·

    ·

    Mon, Mar 17 2014 18:22:58

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    Dr. Deanna Attai@DrAttai

    But there may still be a role to take more tissue - cases need to be reviewed at multidisciplinary conf with surgeon, rad onc, med onc #bcsm

    Mon, Mar 17 2014 18:20:50

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    Liza Bernstein@itsthebunk

    So great to have the docs who attended the meeting give us their debrief. Helps to be able to feel part of process. #bcsm

    @SurvivorRunner

    ·

    Mon, Mar 17 2014 18:25:48

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    #BCSM Chat@BCSMChat

    moving on to T2 - triple negative breast cancer a huge concern - @MikeCowher @dianeradfordmd @Ladysurg: anything new?? #bcsm

    Mon, Mar 17 2014 18:25:58

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    Diane Radford MD@dianeradfordmd

    Q2 TNBC, about 40,000 cases USA annually, accounting for 14,000 deaths #bcsm

    @SurvivorRunner

    ·

    Mon, Mar 17 2014 18:26:46

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    Michael S. Cowher MD@MikeCowher

    T2: data from Cedars Sinai that change what I ‘thought i knew’ - that TNBC is NOT associated with increased risk of nodal mets #bcsm

    @zmadak

    ·

    Mon, Mar 17 2014 18:27:29

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    Jody Schoger@jodyms

    Surprising; biology trumps all @MikeCowher T2: data from Cedars Sinai that …TNBC is NOT associated with increased risk of nodal mets #bcsm

    @MikeCowher

    ·

    Mon, Mar 17 2014 18:28:45

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    Maria Fowler@machfowlerBC

    @MikeCowher What are nodal mets? I understand METS but Nodal? #bcsm

    Mon, Mar 17 2014 18:28:12

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    Michael S. Cowher MD@MikeCowher

    @machfowlerBC def Nodal mets - involved axillary lymph nodes. Not distant (beyond there). #bcsm

    Mon, Mar 17 2014 18:28:43

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    Dr. Deanna Attai@DrAttai

    DEFINITION: Nodal mets - when the cancer has spread to the lymph nodes. “mets” commonly refers to other-organ spread bone, liver etc #bcsm

    @AmyBlackTattoos

    ·

    Mon, Mar 17 2014 18:29:32

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    FollowHeidi@FollowHeidi

    “@DrAttai:”mets” typically means stage IV. However spread to nodes is also called “metastatic”, stage II-III #bcsm” (thank you!)

    Mon, Mar 17 2014 18:40:26

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    Dr. Deanna Attai@DrAttai

    @hollyejacobs but when in the lymph nodes, we do say “metastatic to lymph nodes”. Metastatic just means spread from the breast #bcsm

    Mon, Mar 17 2014 18:42:13

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    Michael S. Cowher MD@MikeCowher

    backing up- there is a difference between lymph node metastases and anything beyond that- “metastatic breast cancer pt’ means beyond #bcsm

    Mon, Mar 17 2014 18:42:11

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    Dr. Deanna Attai@DrAttai

    DEFINITIONS: BCT = Breast conserving therapy (lumpectomy / radiation) ; LR = Local Recurrence (cancer comes back in the breast) #bcsm

    @AmyBlackTattoos

    ·

    Mon, Mar 17 2014 18:28:40

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    Dr. Deanna Attai@DrAttai

    MT @MikeCowher: T3: Z10 - registry study involving testing bone marrow for tumor cells, then having sentinel biopsy. #bcsm

    Mon, Mar 17 2014 18:40:10

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    Michael S. Cowher MD@MikeCowher

    t3: z10 cumulative LE incidence subjective 3.7% 1y, 8.9% 3y and 11.9% 5y #bcsm

    Mon, Mar 17 2014 18:40:19

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    Michael S. Cowher MD@MikeCowher

    t3: objective (arm circumf) LE rates 10.5%, 17.4%, 24.1% #bcsm

    Mon, Mar 17 2014 18:40:44

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    Michael S. Cowher MD@MikeCowher

    t3: the point: THIS IS MUCH HIGHER THAN OTHER PUBLISHED SERIES OF LE RATES. #bcsm

    @AnnHealthCare

    ·

    Mon, Mar 17 2014 18:41:03

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    Diane Radford MD@dianeradfordmd

    YES, we were skeptical @MikeCowher T3
    - most I spoke to at #SSO2014 had reservations with such high LE incidence with SLN bx #bcsm

    @PromoMasq

    ·

    Mon, Mar 17 2014 18:44:09

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    Michael S. Cowher MD@MikeCowher

    many other studies (NSABP, etc) show much lower LE rates. many patients in Z10 were lost to follow up. #bcsm

    Mon, Mar 17 2014 18:43:26

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    Diane Radford MD@dianeradfordmd

    Q3 usual rates LE with sentinel node bx 3-5%, so 24% is really high #bcsm

    Mon, Mar 17 2014 18:47:07

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    Michael S. Cowher MD@MikeCowher

    I think imp to mention here: data presented at these meetings is not yet ‘peer reviewed’ for errors in methodology. #bcsm

    @ABHuret

    ·

    Mon, Mar 17 2014 18:44:58

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    Michael S. Cowher MD@MikeCowher

    so, just because it’s reported doesnt mean it’s gospel! #bcsm

    @AmyBlackTattoos

    ·

    Mon, Mar 17 2014 18:45:36

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    Matthew Katz@subatomicdoc

    @MikeCowher Yes, an important caveat for any meeting. More complete vetted answer from publication #bcsm #SSO2014

    @MikeCowher

    ·

    Mon, Mar 17 2014 18:45:55

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    HCA Nurse Nav@HCAOncNurseNav

    @CJMeta absolutely! Timely referral to LE therapist is important. And patient education- all patients with LNs removed are at risk. #bcsm

    @zmadak

    ·

    Mon, Mar 17 2014 18:44:05

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    Chels In Cancerland@ChelseyRHauge

    umm, what does LE mean? #bcsmvocab #bcsm

    Mon, Mar 17 2014 18:46:51

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    Alicia C. Staley@stales

    #BCSMVocab RT @DrAttai DEFINITION: LE = lymphedema. Swelling of arm, usually seen after lymph node removal and/or radiation #bcsm

    Mon, Mar 17 2014 18:48:58

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    Dr. Deanna Attai@DrAttai

    LE can happen other areas in the body as well - leg, etc - depending on type of cancer / area of both treated #bcsm

    Mon, Mar 17 2014 18:48:21

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    MMCarpenterMD@Ladysurg

    we do measurements before lymph node surgery and then again at 6-8 weeks after #bcsm

    Mon, Mar 17 2014 18:50:38

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    MMCarpenterMD@Ladysurg

    This gives the PT opportunity for education as well #bcsm

    Mon, Mar 17 2014 18:51:13

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    MMCarpenterMD@Ladysurg

    I can’t say it is the new standard but it really helps patients to feel better and gives us numbers to follow #bcsm

    Mon, Mar 17 2014 18:52:07

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    Michael S. Cowher MD@MikeCowher

    if anyone wants to read EVERY abstract from #sso2014, it’s a free PDF here  http://expo.jspargo.com/exhibitor/web/SSO14AbstractBook.pdf … #bcsm

    @BRCAinfo

    ·

    Mon, Mar 17 2014 18:50:00

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    Dr. Deanna Attai@DrAttai

    Last topic T4 - we’re all living thru the increasing role SM plays at medical conferences. @MikeCowher was part of a #SSO2014 panel #bcsm

    @DrGreene

    ·

    Mon, Mar 17 2014 18:52:52

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    Dr. Deanna Attai@DrAttai

    T4 - so for the docs - how do you see SM at meetings evolving? #bcsm

    Mon, Mar 17 2014 18:53:13

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    Michael S. Cowher MD@MikeCowher

    I find SM more and more integrated into conferences - the ‘behind the scenes’ talk is how to do it right… #bcsm

    Mon, Mar 17 2014 18:53:50

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    Michael S. Cowher MD@MikeCowher

    another ‘behind the scenes talk’ is how to get more SM ‘luddites’ involved, and thats becoming my focus, hence my talk at #SSO2014 #bcsm

    @RussellBrownMD

    ·

    Mon, Mar 17 2014 18:54:55

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    Matthew Katz@subatomicdoc

    @DrAttai T4: It’s exploding. 67M impressions for #ASCO13. More meetings are doing it since last June. #bcsm

    Mon, Mar 17 2014 18:54:10

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    Dr. Deanna Attai@DrAttai

    T4 - and for the patients - what do you want to hear from the medical meetings that will be helpful? #bcsm

    @zmadak

    ·

    Mon, Mar 17 2014 18:53:43

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    katenightingall@katenightingall

    #bcsm @DrAttai what is SM

    Mon, Mar 17 2014 18:55:23

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    Matthew Katz@subatomicdoc

    @katenightingall @DrAttai SM = social media in this case #bcsm

    Mon, Mar 17 2014 18:55:39

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    Michael S. Cowher MD@MikeCowher

    one step is to get publications in the ‘major journals’ regarding the impact of SM. Stay tuned…..mwahahaha. #bcsm

    @ABHuret

    ·

    Mon, Mar 17 2014 18:56:56

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    Diane Radford MD@dianeradfordmd

    Q4 great topics covered including telemedicine, patient info apps etc #bcsm

    Mon, Mar 17 2014 18:57:09

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    Michael S. Cowher MD@MikeCowher

    Thanks all for the chance to educate, and thanks @dianeradfordmd and @Ladysurg for the help and camaraderie at #SSO2014. #bcsm

    Mon, Mar 17 2014 18:59:21

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    Dr. Deanna Attai@DrAttai

    also thanks to docs @Dr_Dana @subatomicdoc @Ermanmd for participating tonight #bcsm

    Mon, Mar 17 2014 18:59:23

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    Dr. Deanna Attai@DrAttai

    and thanks to @SocSurgOnc for chiming in as well! #bcsm

    @MikeCowher

    ·

    Mon, Mar 17 2014 19:00:29

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    Surgical Oncology@SocSurgOnc

    @DrAttai Our pleasure! Thank you for such a stimulating chat. #bcsm #SSO2014

    Mon, Mar 17 2014 19:09:29

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    Alicia C. Staley@stales

    FYI — More on @SocSurgOnc please make sure to check out their site!  http://surgonc.org  #SSO2014 #bcsm

    @SurvivorRunner

    ·

    Mon, Mar 17 2014 18:58:56

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    Alicia C. Staley@stales

    And don’t forget — anytime during the week that you need anything, tweet out #BCSM - that’s our bat signal

    @NancyCastleman

    ·

    Mon, Mar 17 2014 19:02:11

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