Breast Surgeon Dr. Dudak Reflects on Tremendous Changes in Breast Cancer Treatment in the Past 20 Years

Image courtesy of Twitter, @MarlaDudakMD

As a surgeon specializing in breast cancer, Dr. Marla Dudak has witnessed the rapid-fire advancements in the identification, prevention and treatment of this disease.

“I think for breast cancer, every few months there’s something new and exciting,” the physician shared. “I think there’s always some new technology, new drugs, or new study that comes out that changes our outlook. This year, we’ll be discussing the TailorX trial, which is showing us that hormone therapy, and not chemotherapy, can be effective alone when treating certain types of cancer.”  

Within her own practice, Dr. Dudak focuses on genetic testing and high-risk counseling to guide her patients to the best options for their own unique care. Many of her patient’s Jewish heritage may put them at risk for breast cancer when combined with their family history, which is why she is such a proponent of genetic testing. This type of screening can help patients make an informed decision based on their personal level of risk.

“Patients often truly overestimate or underestimate their risk of breast cancer and our job is to inform them about the real risk,” said Dr. Dudak. “Women used to be scared of testing not only because of fear of the disease, but because they were afraid identifying their risk-level might impact their ability to get health coverage. This is no longer the case. We also used to have a standard that said someone should get tested if their risk of a mutation is higher than 10 percent, but now any woman with a family history of cancer can get tested.”

Once a cancer risk is identified, treatment options can range from lifestyle changes and enhanced screening to prophylactic surgery and endocrine therapy. “It’s really about disseminating correct information,” stated Dr. Dudak. “A lot of these genetic mutations are brand new, and we don’t know what’s going to happen with them. So it’s about keeping them updated and letting the patients know that just because you have a mutation doesn’t mean you’re going to get cancer.”

She used to be a proponent of a double mastectomy, followed by breast reconstruction, to effectively fight cancer in young women. But the latest studies show that such invasive treatment is unnecessary.

New developments in fighting breast cancer

When surgery is required, there are many new techniques and tools that can treat the cancer while preserving the appearance of the breast. Even the most invasive surgeries of today, such as nipple-sparing mastectomies, still work to improve cosmetic outcomes compared to the destructive techniques of the past. “Many patients with gene mutations are opting for nipple-sparing surgery,” said Dr. Dudak.

MarginProbe is another unique tool that can help reduce the amount of breast tissue that needs to be taken during surgery, while providing assurance that cancer has been fully removed. MarginProbe evaluates the margins, an area of tissue surrounding a tumor, right in the operating room without requiring a pathologist. This device enables the surgeon to ensure a safe margin is removed, but reduces the need to take extra tissue which can negatively impact the appearance of the breast.

Another way MarginProbe helps patients is by reducing the need for additional surgeries by ensuring that all cancer is taken out the first time. Known as re-excision, Dr. Dudak states that her re-excision rate has been reduced by half since she began using MarginProbe.

“Reconstruction for mastectomies have always been a part of my practice since the beginning, for almost every patient,” the physician added. “We also now perform many lumpectomies and, while still in the operating room, the plastic surgeon will do a reduction procedure to achieve breast symmetry. I find that the patients love having the reduction performed at the same time. Our margins are wonderful after reductions. It really helps patients with the psychological impact of surgery if they can get everything done at once, and can look forward to ensuring the best possible appearance for their breasts.”

Marla W. Dudak, M.D., P.A.

  • Currently on staff and performs surgery at Boca Raton Regional Hospital and West Boca Medical Center
  • Board certified in general surgery
  • Fellow of the American College of Surgeons
  • Completed breast oncology fellowship at the University of Texas Southwestern Medical Center in Dallas sponsored by the Susan G. Komen Breast Cancer Foundation
  • Active member in the American Society of Breast Disease and the American Society of Breast Surgeons
  • Five-year general surgery residency completed at University of Miami/ Jackson Memorial Hospital
  • Medical degree from Duke University
  • Graduated with chemistry degree Cum Laude from Duke University

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Dilon.