ITHACA, N.Y. -- Gladys Rosenthal, a genetic counselor, opened Weill Cornell Medical College's (WCMC) seventh annual Breast Cancer Symposium with the good news that breast cancer is becoming a manageable disease, with new knowledge pointing the way toward a cure. 

Geneticists, she said, have pegged the gene mutation (BRCA1) as responsible for a predisposition to breast cancer, passed on in certain families, because it compromises the gene's ability to suppress tumors. BRCA mutations are more likely to occur in women of Ashkenazi Jewish heritage, along with ovarian cancer and with early onset breast cancer. "Genetic testing has implications for all family members," she said. 

Experts from several WCMC departments spoke to a general audience at the symposium last month at Weill Medical College about the latest breakthroughs, treatments and therapies for breast cancer, presenting the full range of comprehensive care at the Weill Cornell Breast Center. The many developments on the horizon are ushering in a new era that holds promise for a cure, said Alexander Swistel, director of the center and associate professor of clinical surgery, who moderated the discussion.

Mia Talmor, assistant professor of plastic surgery, spoke of breakthrough techniques in breast reconstruction, with smaller incisions and skin-sparing techniques yielding more cosmetically acceptable results. Rates of recurrence and disease-free survival are all equivalent to traditional breast cancer surgery. In a close collaboration, the oncology surgeon and reconstructive surgeon work together before, during and after operations. 

Improved technologies in breast imaging were discussed by Michele Drotman, assistant professor of radiology. Mammography remains the best imaging tool to search for calcifications and masses; it's the standard method of screening on an annual basis for women over 40. Digital imaging, displayed and stored electronically, has improved mammography much as digital pictures have advanced photography, with advantages in the speed of visualization, manipulation of images and magnification. More sensitive mammograms and ultrasounds allow for the detection of tumors when they are smaller and less advanced -- making breast cancer easier to treat and aiding breast surgery.

Eleni Tousimis, assistant professor of surgery, discussed advances in surgical techniques, calling attention to the radical evolution over the past 100 years, from when mastectomy was the only option to the breast conservation therapy that enables sentinel lymph node biopsy, lumpectomy, partial breast irradiation and tumor ablation -- the future of noninvasive breast cancer surgery. WCMC has been among the first to attempt to destroy tumors with minimally invasive techniques, such as killing tumors through freezing and heating techniques.

Updates in medical oncology were outlined by Ellen Gold, assistant professor of medicine. She emphasized the need for radiation therapy to prevent recurrence, even after the tumor has been extracted with surgery. Called adjuvant therapy, this is given after curative therapy to improve the chance of a cure. Hormonal therapy is an effective approach, since a receptor on the breast cancer cell is stimulated by estrogen to grow. Therefore, blocked estrogen production leads to regression of advanced tumors. The traditional breast cancer drug tamoxifen blocks the estrogen receptor and is the only such drug approved by the Food and Drug Administration. But in addition to or instead of tamoxifen, a new class of drug -- aromatase inhibitors, which decrease the estrogen produced by the body in post-menopausal women -- is being studied for its therapeutic potential. 

Drugs alone are only supplements, not substitutes, for radiation therapy, said Gold. The next advancement in radiation therapy involves irradiating only part of the breast. Potential benefits of partial breast irradiation include decreased downtime, cost and inconvenience, with more targeted results. 

But there are strict selection criteria. Suitable patients are those with minimal risk of multicentric disease, with the cancerous cells at single and isolated sites, and with tumors with low probability of extension. WCMC is at the forefront of new techniques, which concentrate irradiation to the tumor area and away from the normal tissue.