Taking the Lead in Precision Medicine as a Surgeon
How precision medicine is moving oncologists away from population-based treatments to more patient-appropriate care
This episode is Part Two of our discussion with Dr. Peter Beitsch, Chief Physician of the Dallas Surgical Group and an executive with the TME Breast Cancer Network. Here, we learn more about how Dr. Beitsch uncovered flaws in population-based cancer treatments and began to advocate for individualized patient care.
(Listen to Part 1 here to learn more about Dr. Beitsch's JCO study that is changing genetic testing guidelines for hereditary breast cancer.)
Listen to the full episode above and download the full PDF transcript here.
The episode begins with Dr. Beitsch discussing his training and how he became interested in studying the appropriateness of certain cancer treatments. As a member of the American Society of Breast Surgeons, Beitsch helped begin a registry with Agendia, where he learned the importance of sub-typing through BluePrint. He says, “It turns out the subtyping is important for breast cancer, because there are many kinds of cancers. Hundreds.” During a related study, he and his team discovered that in 20% of ER-positive patients, which are classically luminal patients, patient tumors were not turned on by estrogen receptors and were actually a basal type. Immunostaining alone would have suggested that those patients were luminal type and would respond to anti-estrogen therapy, but deeper investigation revealed that, in fact, they needed to be treated for basal cancer.
Breakthroughs like these are what inspired Dr. Beitsch to look more closely at how population-based treatments have been applied in the past, and why they were not working for every patient. He notes that his interest in precision medicine is not uncommon for a surgeon. In fact, the process of tumor profiling in precision medicine was started with surgeons, because the tissue was required to be fresh or flash-frozen and needed to be harvested in surgery for gene sequencing. Therefore, surgeons tended to be the early voices advocating for precision medicine—often clashing with medical oncologists as a result.
The problem with implementing precision medicine in the beginning, he says, is that many oncologists were slow to change their views on genomic testing. However, once they realized that deeper testing could help prevent patients from getting treatments that were not going to work for them—and might actually harm them—they were more receptive. Today, Beitsch believes surgeons and oncologists are on the same page and that the emphasis on precision medicine will continue to grow.
He says, “The more we look at things precisely, the more we find out and the better we get. Just in my 25-year career, survivals in breast cancer have gone up by 50% or maybe more.” He credits these advancements to the move away from population-based treatments and towards genomic testing.
Listen to the full episode of Part Two above.
Be sure to listen to Part 1, where Dr. Beitsch, discusses his study published by the Journal of Clinical Oncology titled, Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle? During the episode, he spoke in-depth about the results of that study and the implications for the future of precision medicine in cancer care.
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About Our Guest
Dr. Beitsch went to medical school at University of Texas Southwestern Medical School in Dallas and finished his general surgery residency at Parkland Hospital in Dallas in 1993. He had a National Cancer Institute fellowship at M.D. Anderson Cancer Center from 1988-90. He completed his training with a surgical oncology fellowship at the John Wayne Cancer Institute in Santa Monica, California, where he trained with the fathers of sentinel lymph node biopsy, Donald Morton,MD and Armando Giuliano, MD. In 1994, he returned to private practice in Dallas where his practice is focused on melanoma and breast cancer.
He has held numerous positions in national surgical societies including at the American Society of Breast Surgeons. At the ASBrS, he was the first Chairman of the Membership Committee 2001-4, Program Director for the 2005 Annual Meeting in Los Angeles, Board of Directors Member from 2006-9 and 2012-15 as well as President of the Society 2013-14.
Dr. Beitsch has given numerous national and international presentations and is actively involved in breast cancer and melanoma research. He has major articles in peer-reviewed medical journals including the New England Journal of Medicine, the Journal of the American Medical Association, the Proceedings of the National Academy of Science, Journal of Clinical Oncology, and the Annals of Surgical Oncology.
TME Breast Cancer Network: https://www.breastcarenetwork.com/