Accreditation/Designation of Credit

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

PER® designates this enduring material for a maximum of 33.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physicians' Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669 for 33.0 Contact Hours.

Acknowledgement of Commercial Supporter

This activity is supported by educational grants from AstraZeneca; Celgene Corporation; Genomic Health, Inc; Eisai, Inc; Lilly; and Novartis Pharmaceuticals Corporation.

For further information concerning Lilly grant funding, visit

15th Annual School of Breast Oncology® Online

Release Date: January 31, 2018
Expiration Date: January 31, 2019
Media: Internet - based


Activity Overview

An increasing number of oncologists are focusing their clinical practices on the treatment of breast cancer, creating a need for specialized education. The School of Breast Oncology®, which has been held annually since 2003, was developed to advance patient care by providing a curriculum-based program focused exclusively on breast cancer clinical management. This intensive 3-day interactive program will provide a comprehensive review of data on the most important aspects of breast cancer biology, diagnostics, prevention, and treatment, with lectures emphasizing the clinical implications presented by leading clinical investigators. The School of Breast Oncology® both provides a comprehensive overview for fellows or oncologists who are new to practice and serves as a valuable refresher course, with updates on the latest data and changes to standards of care for oncologists who have been in practice for several years or more. This online activity captures all of the lectures presented at the live 2017 School of Breast Oncology®, organizes them in a convenient modular format, and summarizes the existing data for each topic, with an emphasis on the evidence-based foundations for optimal, individualized decision making in the clinic.

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca; Celgene Corporation; Genomic Health, Inc; Eisai, Inc; Lilly; and Novartis Pharmaceuticals Corporation.

For further information concerning Lilly grant funding, visit


Instructions for This Activity and Receiving Credit

In order to receive a CME/CE certificate, participants must complete the pretest, view any number of the 10 slide modules, and complete the posttest (with a passing score of 70% or higher), evaluation, and request for credit. Participants may immediately download a CME/CE certificate upon completion of these steps.

Target Audience

This educational program is directed toward medical, radiation, and surgical oncologists whose primary practice focus is breast cancer and who intend to reinforce their knowledge base and expand their expertise in breast cancer diagnosis, treatment, and management. Participants will be primarily oncologists or fellows in training whose practice requires mastery and a critical understanding of the fundamental principles, pivotal published studies, and emerging information on the pathogenesis and management of breast cancer.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  • Review breast cancer pathology, tumor biology, and prognostic/predictive markers in order to stratify risk among patients with breast cancer
  • Discuss currently accepted diagnostic standards and imaging modalities for breast cancer
  • Integrate biomarkers, molecular assays, and other risk assessment tools into clinical practice to optimize clinical decision making for patients with breast cancer
  • Describe current treatment standards concerning the use of surgical, radiation, and medical therapies for patients with breast cancer
  • Describe strategies for the management of early-stage or locally advanced breast cancer
  • Review methods to individualize the application of systemic therapies for patients with advanced breast cancer
  • Discuss strategies to proactively mitigate predictable treatment-related toxicities to optimize outcomes for patients with breast cancer
  • Determine recent practice-changing results from clinical trials and facilitate discussions with patients concerning their eligibility for clinical trial opportunities

Faculty, Staff, and Planners' Disclosures

Program Director

Joyce O'Shaughnessy, MD
Celebrating Women Chair in Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology
Co-Chair, Breast Cancer Research Program,
The US Oncology Network
Dallas, TX

Disclosure: Consultant: Novartis, AstraZeneca, Celgene, Lilly, Merck, Pfizer, Seattle Genetics.

Curriculum Development Committee

William J. Gradishar, MD, FASCO, FACP
Betsy Bramsen Professor of Breast Oncology & Professor of Medicine
Deputy Director, Clinical Network
Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Director, Maggie Daley Center for Women's Cancer Care
Interim Chief, Division of Hematology/Oncology
Northwestern University Feinberg School of Medicine
Chicago, IL

Disclosure: No relevant financial relationships with commercial interests.

Frankie Ann Holmes, MD, FACP
Associate Director, Breast Oncology Research
Texas Oncology
Houston, TX

Disclosure: No relevant financial relationships with commercial interests.

Eleftherios Mamounas, MD, MPH, FACS
Medical Director
Comprehensive Breast Program
UF Health Cancer Center -- Orlando Health
Orlando, FL

Disclosure: Consultant: Genomic Health, Inc; Genentech; Biotheranostics; Cellucity; Speakers Bureau: Genomic Health Inc; Genentech/Roche.

Anne Moore, MD
Medical Director, Weill Cornell Breast Center
Weill Cornell Medical College
New York, NY

Disclosure: No relevant financial relationships with commercial interests.

Lori J. Pierce, MD, FASTRO
Professor of Radiation Oncology
University of Michigan School of Medicine
Vice Provost for Academic and Faculty Affairs
University of Michigan
Ann Arbor, MI

Disclosure: Shareholder: PFS Genomics (founder's shares); Other: UpToDate (royalties).

Hope S. Rugo, MD
Professor of Medicine
Director, Breast Oncology and Clinical Trials Education
University of California San Francisco
Helen Diller Family Comprehensive Cancer Center
San Francisco, CA

Disclosure: Grant/Research Support: Genentech/Roche, Novartis, Merck, Pfizer, OBI, Macrogenics, Lilly, Eisai (for research studies, all funding to UCSF regents)


Douglas W. Arthur, MD
Professor and Vice-Chairman
Natalie N. and John R. Congdon, Sr. Endowed Chair of Cancer Research
Department of Radiation Oncology
Virginia Commonwealth University School of Medicine
Massey Cancer Center
Richmond, VA

Disclosure: Other: Advanced radiation therapy - scientific advisor

David M. Euhus, MD, FACS
Professor (PAR) of Surgery
Chief, Breast Surgery Section
Division of Surgical Oncology
Johns Hopkins Hospital
Baltimore, MD

Disclosure: No relevant financial relationships with commercial interests.

Carol Fabian, MD
Morris Family Endowed Chair in Cancer Prevention
Director, Breast Cancer Prevention and Survivorship Centers
Professor of Medicine
Division of Clinical Oncology
The University of Kansas Medical Center
Westwood, KS

Disclosure: Grant/Research Support: No monetary grants other than the Breast Cancer Research Foundation and Komen. Institution receives Duavee (conjugated estrogens/bazedoxifene) from Pfizer for a clinical prevention trial and omega-3 fatty acids and placebo from DSM for a clinical trial; Other: DSM provides study agent (DHA and placebo) for clinical trial.

Karin Hahn MD, MSc, MPH
Senior Medical Director (Oncology)
Associate Professor, Dept. of Oncology
University of Western Ontario
London Regional Cancer Program
Ontario, Canada

Disclosure: No relevant financial relationships with commercial interests.

Syed A. Hoda, MD
Professor of Pathology
Weill Medical College of Cornell University
Attending Pathologist
New York-Presbyterian Hospital
New York, NY

Disclosure: No relevant financial relationships with commercial interests.

Gabriel N. Hortobagyi, MD, FACP, FASCO
Professor, Department of Breast Medical Oncology
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosure: Grant/Research Support: Novartis; Consultant: Agendia, Lilly, Merck, Novartis, Peregrine, Roche.

Claudine Isaacs, MD
Medical Director, Fisher Center for Familial Cancer Research
Co-Director, Breast Cancer Program
Georgetown University
Washington, DC

Disclosure: Grant/Research Support: Tesaro, Pfizer; Consultant: Pfizer, Astra Zeneca, Novartis, Nanostring; Speakers Bureau: Genentech, Pfizer, AstraZeneca.

Henry Kuerer, MD, PhD, FACS
Professor of Surgery and Director, Breast Surgical Oncology Training Program
Medical Director, Clinical Expansion, MD Anderson Cancer Network
University of Texas MD Anderson Cancer Center
Houston, TX

Disclosure: Consultant: Gerson Lehrman Group; Other: Editor New England Journal of Medicine Medical Group and McGraw-Hill Publishing.

Charles Loprinzi, MD
Regis Professor of Breast Cancer Research
Mayo Clinic
Rochester, MN

Disclosure: Grant/Research Support: Bristol-Myers Squibb, Pfizer, Janssen; Consultant: Cubist; Mitsubishi Tanabe Pharma; Coronado Biosciences, Inc; Lpath; Mundipharma; PledPharma.

Jun J. Mao, MD, MSCE
Laurance S. Rockefeller Chair in Integrative Medicine
Chief, Integrative Medicine Service
Memorial Sloan Kettering Cancer Center
Bendheim Integrative Medicine Center
New York, NY

Disclosure: No relevant financial relationships with commercial interests.

Michelle E. Melisko MD
Associate Clinical Professor of Medicine
Medical Director UCSF Breast Cancer Survivorship
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California

Disclosure: Grant Research Support: Genentech, Lilly, Novartis-all funding to UC Regents; Shareholder: Merrimack (spouse); Other: Genentech, Pfizer (spouse), honorarium; Agendia (self), honorarium.

Ruth O'Regan, MD
Chief, Division of Hematology/Oncology
University of Wisconsin
Carbone Cancer Center
Madison, WI

Disclosure: Grant/Research Support: Eisai, Pfizer, Novartis; Consultant: Pfizer, Lilly, Biotheranostics.

Soonmyung Paik, MD
National Surgical Adjuvant Breast and Bowel Project
Division of Pathology
Pittsburgh, PA

Disclosure: Grant/Research Support: Leica Biosystems; Consultant: Leica Biosystems; Shareholder: ImmuneOncia.

Elizabeth Rafferty, MD
Staff Radiologist
Avon Comprehensive Breast Center
Massachusetts General Hospital
Boston, MA

Disclosure: Grant/Research Support: Hologic, Inc, investigation of tomosynthesis; Consultant: Hologic, Inc.

Edward H. Romond, MD
Professor of Medicine
Division of Medical Oncology
Markey Cancer Center
University of Kentucky
Lexington, KY

Disclosure: No relevant financial relationships with commercial interests.

Hani Sbitany, MD
Assistant Professor of Surgery
Division of Plastic and Reconstructive Surgery
University of California, San Francisco
San Francisco, CA

Disclosure: Consultant: Allergan, Inc.

David M. Schuster, MD
Associate Professor
Director, Division of Nuclear Medicine and Molecular Imaging
Department of Radiology and Imaging Sciences
Emory University Hospital
Atlanta, GA

Disclosure: Grant/Research Support: Blue Earth Diagnostics Ltd, Nihon Medi-Physics Co Ltd (through Emory Office of Sponsored Projects); Consultant: American Imaging Management.

Lawrence J. Solin, MD, FACR, FASTRO
Chairman, Department of Radiation Oncology
Albert Einstein Healthcare Network
Philadelphia, PA

Disclosure: Other: (Not paid) Member, Advisory Board, GHI.

Joseph Sparano, MD
Professor of Medicine
Professor of Obstetrics, Gynecology, and Women’s Health
Albert Einstein College of Medicine
Associate Chairman
Department of Oncology
Montefiore Medical Center
Bronx, NY

Disclosure: Grant/Research Support: Deciphera, Prescient Therapeutics; Consultant: AstraZeneca, Novartis, Celgene, Genentech/Roche, Eli Lilly, Celldex, Merrimack; Shareholder: MetaStat.

Catherine Van Poznak, MD
Associate Professor
Division of Hematology Oncology
Department of Internal Medicine
University of Michigan
Ann Arbor, MI

Disclosure: Grant/Research Support: Bayer; Other: Novaritis (uncompensated), phase IV study steering committee, UpToDate royalties for writing.

Jeffrey N. Weitzel, MD
Professor of Oncology and Population Sciences
Chief, Division of Clinical Cancer Genetics
City of Hope Cancer Center
Duarte, CA

Disclosure: No relevant financial relationships with commercial interests.

The staff of Physicians' Education Resource®, LLC have no relevant financial relationships with commercial interests to disclose.

The staff of PER® have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME/CE activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME/CE activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME/CE activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME/CE activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse Recap™

PER Pulse Recap (1 of 3)

Evolving Standards in the Treatment of Early-Stage Breast Cancer
The School of Breast Oncology® provides oncologists with a curriculum-based program focused exclusively on the clinical management of breast cancer. It offers a comprehensive review of data on the most important aspects of breast cancer biology, diagnostics, prevention, and treatment (including surgery, radiation therapy, and systemic therapy), with accompanying expert perspectives on how to apply these data in the clinic. The 15th Annual School of Breast Oncology® was held November 2 to 4, 2017, in Atlanta, Georgia, and featured internationally recognized experts in breast cancer who discussed best practices and key advances for the treatment of patients across all stages of disease. This first of 3 PER Pulse™ Recaps centers on current standards and emerging trends in the treatment of early-stage disease.
  • Joyce O’Shaughnessy, MD, reviewed data supporting current paradigms in adjuvant chemotherapy, including the utility of multigene signatures such as Oncotype DX and Mammaprint for estimating risk and potential chemotherapy benefit in hormone receptor–positive breast cancers. She also reviewed recent data from the ABC trials, which showed that standard anthracycline/taxane regimens improved invasive disease-free survival in patients with high-risk HER2-negative breast cancer compared with the 6 cycles of docetaxel/cyclophosphamide.
  • Joseph Sparano, MD, discussed preoperative therapy for patients with locally advanced breast cancers, noting the correlation between pathologic complete response and event-free survival in HER2-positive and triple-negative disease. He also highlighted the studies of dual HER2-targeted combination regimens for HER2-positive disease, platinum agents for triple-negative cancers, and emerging data with investigational agents such as immune checkpoint inhibitors, PARP inhibitors, and PI3K inhibitors. Finally, he discussed the potential role of continued cytotoxic therapy for patients with residual disease at surgery following a course of neoadjuvant therapy.
  • William Gradishar, MD, and O’Shaughnessy reviewed standards in adjuvant endocrine therapy for postmenopausal and premenopausal patients, respectively. Topics that generated significant discussion in both lectures centered on the selection of patients for extended duration endocrine therapy and optimizing strategies for integrating aromatase inhibitors.
  • Anne McTiernan, MD, PhD, discussed the impact of weight loss and exercise on breast cancer recurrence, as well as strategies for helping patients incorporate beneficial lifestyle agents.
  • Frankie Ann Holmes, MD, provided an overview of strategies to mitigate common adverse events such as emesis and myelosuppression, highlighting updated expert guidelines and recently approved agents.

PER Pulse Recap (2 of 3)

Evolving Paradigms in the Management of Metastatic Breast Cancer

This second of 3 PER Pulse™ Recaps centers on current standards and emerging data that affect the management of patients with metastatic breast cancer (MBC).
  • Ruth O’Regan, MD, summarized current options for hormone receptor (HR)–positive MBC, including an overview of the data from all the CDK4/6 inhibitor trials in the first- and second-line setting reported to date. She also reviewed results from the SWISH study, which showed that prophylactic use of a steroid-containing mouthwash can reduce the incidence and severity of mTOR-associated stomatitis. Finally, she provided an overview of some of the investigational approaches being studied to reverse resistance to current therapies, including targeting PI3K and histone deacetylase, as well as the implications of ESR1 mutations.
  • Anne Moore, MD, discussed important concepts in managing triple-negative MBC and hormone-independent HR-positive MBC, such as reevaluation of tumor biomarkers and appropriate patient selection for single-agent versus combination chemotherapy. She also reviewed data from trials investigating surgery for stage IV breast cancer and guidelines for treating oligometastatic disease. Patient quality of life was emphasized as a crucial consideration in managing these patients.
  • William Gradishar, MD, reviewed treatment algorithms for patients with HER2-positive MBC, addressing sequencing of HER2-targeted agents based on currently available evidence. He also discussed novel investigational agents targeting HER2, including new tyrosine kinase inhibitors and antibody-drug conjugates that are in later stages of clinical development.
  • Michelle Melisko, MD, addressed the topic of managing central nervous system (CNS) disease, noting that no systemic agents have yet been approved specifically for treating brain metastases, and local therapies (surgery and/or radiation) remain the standard. However, a number of small molecule inhibitors of various signaling pathways may be able to penetrate the CNS and are being investigated in clinical trials.
  • Catherine Van Poznak, MD, reviewed treatments standards for bone metastases, discussing the role of bone-modifying agents for reducing the risk of skeletal complications, as well as potential adverse effects associated with osteoclast inhibitors. In addition, she reviewed the roles of radiation and surgery, as well as ongoing trials investigating the use of bone-targeted radioisotopes.

PER Pulse Recap (3 of 3)

Predictive and Prognostic Biomarkers in Breast Cancer

This third of 3 PER Pulse™ Recaps centers on standard biomarkers, validated prognostic and/or predictive multigene signatures, and investigational uses for mutation testing.
  • Jeffrey Weitzel, MD, discussed the management of patients with germline mutations that increase the risk of hereditary breast and ovarian cancers, including the risks and phenotypes associated with mutations in specific genes. He also described caveats in the interpretation of multiplex genetic testing and strategies for managing patients who display a hereditary risk.
  • Claudine Isaacs, MD, clarified the difference between prognostic biomarkers, which predict outcome in the absence of therapy and may tell when but not how to treat a patient, and predictive biomarkers, which indicate a tumor’s responsiveness to a particular therapy. In addition, she reviewed the data supporting the use of currently available gene expression assays for making decisions about adjuvant chemotherapy, describing how several of these assays are being investigated for use in predicting late-recurrence risk in patients with hormone receptor–positive, HER2-negative breast cancers.
  • Soonmyung Paik, MD, discussed testing for standard predictive biomarkers in breast cancer: estrogen receptor, progesterone receptor, and HER2, as well as emerging markers such as Ki67 and ESR1 mutation. In particular, he described the nuances of interpreting pathological testing results and the application of American Society of Clinical Oncology (ASCO)–College of American Pathologists (CAP) testing algorithms in the clinic, as well as how to address challenges such as multifocal/centric disease, equivocal results, tumor heterogeneity, and biomarker discordance between primary and metastatic samples.
  • Joyce O’Shaughnessy, MD, provided an overview of emerging technologies, such as liquid biopsies to examine circulating tumor cells or circulating tumor DNA, coupled with next-generation sequencing to identify somatic mutations and monitor changes in tumor genotypes over time. Currently, these methods remain investigational in breast cancer, but a number of ongoing clinical trials, such as the NCI-MATCH program, are evaluating the efficacy of targeted agents for patients with specific mutations. These technologies are also being used in clinical trials to help identify patient subsets that may be more responsive to specific therapeutic agents.
For additional commentary about this topic and others, please visit

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