Sep 30, 2026 · 18 min · 7 segments
In this episode of Scrubcast, breast surgeon and surgical oncologist Dr. Irene Wapnir discusses the evolution of breast cancer care, from the widespread use of mastectomy to breast-conserving…
Well, I trained in an era where we were transitioning from mastectomies for all patients, for all conditions, for all stages of disease, to using breast conserving approaches.
And that came hand in hand with a shift in our understanding of how cancer works, that for many patients, it's largely a systemic disease at the time of diagnosis.
And so I was drawn to this, and the fact that surgery, uh, certainly mastectomy surgery, was a difficult chapter for a lot of women to transition through, that it causes disfigurement, changes in their appearance, poor body self-image, uh, relational difficulty, in addition to facing the diagnosis of cancer.
And so I think that [clears throat] there are always a lot of emotional, psychological components to the interaction with patients.
And I also entered this field in a time where there were relatively few women in surgery, and certainly doing breast cancer surgery.
There were just a couple fellowships that were only focused at that time in breast cancer surgery.
And then I was also fascinated by the fact that clinical research in breast cancer has really led the way in many ways in the field of cancer, through the activation of clinical trials.
And, and so I, I became involved in, in participating in clinical trials in the institutions that I worked at.
Yeah, so about clinical trials, in addition to your regular work on the service, you were co-chair of the CALOR trial.
Uh, you're currently running the NORDIS trial for women with DCIS, and you worked with Dr. Yong Wen, a previous guest on our show, to develop a novel approach for breast reconstruction using omental free flap.
I think it's important to see the breast from its holistic perspective, from as part of an essential part to the survival of the species, right? But sometimes patients develop complications from that process.
So I think that I saw a lot of different aspects to the breast, from the benign, to the infectious, to the malignant process.
And so at different stages, I have encountered situations that have sparked me to think about, you know, what can we do to improve this? And so one of my long-standing interests that came through clinical trials, and that eventually led to the CALOR trial, was my interest in local control of disease and local regional recurrence.
What does it mean when you've treated a woman with breast conserving surgery, and then some years later, you see again, a cancer reappear in her breast? What does it mean? And I've continued to pursue that.
Uh, you know, yes, this led to my work with the NSABP in looking at what are the patterns of local recurrence and how that related to mortality, both in invasive cancer and in, in situ cancer.
And in terms of invasive cancer, that d- led to the CALOR trial, a joint effort with the European, um, Clinical Trials Organization.
And I am continuing now to look at what's the difference between patients who have a recurrence early, close to the time of the original diagnosis, versus many years later.
And so right now, one of our efforts that we're beginning to look at liquid biopsies for circulating tumor DNA in this patient population, that not only have recurrences after breast conservation, but also after mastectomy.
But to dial it back and talk about a very early form of cancer, which is ductal carcinoma in situ or stage zero, um, there's a lot of debate in our field of what that entity represents.
Well, I trained in an era where we were transitioning from mastectomies for all patients, for all conditions, for all stages of disease, to using breast conserving approaches.
And that came hand in hand with a shift in our understanding of how cancer works, that for many patients, it's largely a systemic disease at the time of diagnosis.
And so I was drawn to this, and the fact that surgery, uh, certainly mastectomy surgery, was a difficult chapter for a lot of women to transition through, that it causes disfigurement, changes in their appearance, poor body self-image, uh, relational difficulty, in addition to facing the diagnosis of cancer.
And so I think that [clears throat] there are always a lot of emotional, psychological components to the interaction with patients.
And I also entered this field in a time where there were relatively few women in surgery, and certainly doing breast cancer surgery.
There were just a couple fellowships that were only focused at that time in breast cancer surgery.
And then I was also fascinated by the fact that clinical research in breast cancer has really led the way in many ways in the field of cancer, through the activation of clinical trials.
And, and so I, I became involved in, in participating in clinical trials in the institutions that I worked at.
Yeah, so about clinical trials, in addition to your regular work on the service, you were co-chair of the CALOR trial.
Uh, you're currently running the NORDIS trial for women with DCIS, and you worked with Dr. Yong Wen, a previous guest on our show, to develop a novel approach for breast reconstruction using omental free flap.
I think it's important to see the breast from its holistic perspective, from as part of an essential part to the survival of the species, right? But sometimes patients develop complications from that process.
So I think that I saw a lot of different aspects to the breast, from the benign, to the infectious, to the malignant process.
And so at different stages, I have encountered situations that have sparked me to think about, you know, what can we do to improve this? And so one of my long-standing interests that came through clinical trials, and that eventually led to the CALOR trial, was my interest in local control of disease and local regional recurrence.
What does it mean when you've treated a woman with breast conserving surgery, and then some years later, you see again, a cancer reappear in her breast? What does it mean? And I've continued to pursue that.
Uh, you know, yes, this led to my work with the NSABP in looking at what are the patterns of local recurrence and how that related to mortality, both in invasive cancer and in, in situ cancer.
And in terms of invasive cancer, that d- led to the CALOR trial, a joint effort with the European, um, Clinical Trials Organization.
And I am continuing now to look at what's the difference between patients who have a recurrence early, close to the time of the original diagnosis, versus many years later.
And so right now, one of our efforts that we're beginning to look at liquid biopsies for circulating tumor DNA in this patient population, that not only have recurrences after breast conservation, but also after mastectomy.
But to dial it back and talk about a very early form of cancer, which is ductal carcinoma in situ or stage zero, um, there's a lot of debate in our field of what that entity represents.
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