Summary of "유방암을 치료하는 외과의사 한원식 교수 | #지켜보다"

Breast cancer diagnosis and treatment principles

Breast cancer surgery as standard care (early-stage)
- Most breast cancers require surgery, especially when localized or early-stage.
- Surgery may offer limited benefit in late-stage cases with metastasis.
Disease staging details
- “Early stage” examples include tumors that are still small or nascent, and may be difficult to palpate.
- Recurrence is common: subtitles indicate ~2–3 out of every 10 patients experience recurrence (depending on stage/subtype).
Biopsy and pathological evaluation
- Needle localization can be used when tumors are not palpable on the skin surface.
- Frozen-section biopsy is used intraoperatively to check whether cancer cells are present near the nipple, which determines whether nipple-sparing approaches/reconstruction are possible.

Breast cancer is described as having multiple types/subtypes, requiring different approaches.
Potential treatment modalities mentioned:
- Surgery (e.g., partial mastectomy vs total mastectomy variants)
- Radiation therapy (when needed)
- Chemotherapy (anticancer chemotherapy)
- Targeted therapy for HER2-positive breast cancer (noted as “HART-positive” in subtitles)
- Hormone therapy for hormone-positive breast cancer
Neoadjuvant drug treatment (drug-first strategy)
- A strategy described as giving drug treatment before surgery to reduce tumor size.
- Subtitles note a risk of overtreatment, since cancer biology may not be fully understood before complete workup.

Oncoplastic surgery / symmetry preservation
- Techniques intended to prevent breast collapse and maintain symmetry while removing cancer.
“Seongsu method” (as referenced in subtitles)
- A tailored approach considering segmental vs total mastectomy, alongside reconstructive strategies to address expected outcomes.
Breast “preservation total mastectomy” (simultaneous oncologic + reconstructive approach)
- Perform total mastectomy while leaving most skin intact, then reconstruct using implants.
- Simultaneous procedure coordination
  - Breast surgeon removes cancer tissue.
  - Plastic surgeon performs reconstruction (“crafting the treasure” for breast restoration).
- If nipple-area cancer is found
  - Use a skin expander for months, then later insert implants and reconstruct the nipple.
- If nipple-area cancer is absent
  - Proceed directly with plastic reconstruction.
Future augmentation
- Possibility of later augmentation/repair surgery is mentioned.

Breast Cancer Research Laboratory (Seoul National University Hospital)
- Conducts basic research to support advances alongside or before clinical work:
  - Development of diagnostic markers and prognostic markers
  - Development of new drugs
- Notes that some marker-related outputs have been commercialized.
Neutrophils and CT scans
- Subtitles claim that, along with recruitment of neutrophils, CT scans induce network formation, suggesting a mechanistic link between imaging/biological response and microenvironmental formation (presented as an active research topic).
“HIT” prognosis prediction tool
- A breast cancer prognosis prediction tool using next-generation sequencing (NGS).
- Purpose:
  - Identify patients more likely to need chemotherapy after surgery versus those who may avoid it.
- Clinical decision impact:
  - Support recommending chemotherapy for patients predicted to have a poor prognosis.
  - Support advising against chemotherapy for patients predicted not to benefit.
- Next step goal:
  - Conduct more multi-center clinical trials to potentially change breast cancer treatment guidelines.
- Broader objective:
  - Find therapeutic targets and improved diagnostic/prognostic markers for more personalized diagnosis and treatment.

When tumors are not palpable
- Place a needle localization marker prior to surgery.
- Perform partial mastectomy to remove the marked area.
Intraoperative decision workflow for reconstruction
- Remove tumor(s) during mastectomy.
- Send tissue to pathology for frozen-section biopsy of the nipple base area.
- If no cancer near nipple
  - Proceed immediately with plastic reconstructive surgery.
- If cancer near nipple
  - Use a skin expander over several months.
  - Insert implants later and reconstruct the nipple.
Prognosis-guided treatment selection (HIT tool)
- Use NGS-based genetic analysis.
- Predict prognosis category.
- Recommend:
  - Chemotherapy if predicted poor prognosis
  - Avoid chemotherapy if predicted not to require it
Research-to-clinic strategy
- Basic research → develop diagnostic/prognostic markers.
- Translational/clinical validation → expand with multi-center trials.

Han Won-sik (Professor, Department of Breast and Endocrinology, Seoul National University Hospital)
Jin Woong-sik (Professor, Department of Plastic Surgery)
Seoul National University Hospital Breast Research Laboratory (institutional research group)
“HIT” (next-generation sequencing-based prognosis prediction tool developed by Professor Han Won-sik)