ASBD, an Interdisciplinary Group, Fights Breast Cancer

NEW YORK—The American Society of Breast Disease (ASBD) began in 1976 as a relatively small group of physicians interested in studying diseases of the breast. It soon expanded into a multi-disciplinary organization whose stated mission is “to provide a forum for learning and sharing new developments related to breast disease.” The operative word for this group is “multidisciplinary.”

Today, the Society draws its membership from a broad spectrum of disciplines, including oncology subspecialties as well as the primary care community and allied health professionals involved in patient care and research.

This makes sense, according to ASBD president Andrew D. Seidman, MD, because breast disease runs the gamut from conditions that will never be cancerous to treatable forms of early breast cancer to advanced incurable cancer, and draws upon the expertise of people from many different professional backgrounds.

Dr. Seidman, associate attending at Memorial Sloan-Kettering’s Breast Cancer Medicine Service, believes that any health care professional interested in increasing his or her knowledge about the management of breast disease should consider membership in the ASBD. In an interview with ONI, he explains why.

ONI: What distinguishes the American Society of Breast Disease from other professional oncology organizations?

Dr. Seidman: The structure and philosophy of ASBD represent a unique conceptual prototype. The inclusion of physicians from the world of medical oncology, surgical oncology, radiation oncology, pathology, and radiology, to name a few, has created a forum that is quite unusual in the medical community. It’s really uncommon for physicians from so many different subspecialties to gather to share their own perspectives on a specific disease. Very few other organizations strive to be so inclusive in terms of the various modalities in treating a particular disease.

ONI: When did you become aware of ASBD, and what drew you to the organization?

Dr. Seidman: I became aware of the ASBD in 1990 during my fellowship at Memorial Sloan-Kettering Cancer Center. At that time, the president was Dr. Gabriel Hortobagyi, chief of the Breast Service at M.D. Anderson Cancer Center. I began to attend meetings and became active as a board member about 5 years ago.

It struck me when I first became involved with this organization that there was a great amount of untapped potential. The organization had only grown to approximately 500 members, which I found somewhat odd given the cross-disciplinary focus and the tremendous potential for drawing in people from various disciplines who share this common interest in breast disease.

ONI: Have you established any membership goals?

Dr. Seidman: ASBD has over 700 members right now. We would like to see our membership essentially triple to more than 2,000 members by the year 2005. I think this goal is very realistic, given the diversity of health care professionals and also the inclusion of advocates and consumers in our organization, and reaching it will make ASBD even more vibrant and foster new initiatives.

I especially anticipate membership expansion among primary care physicians. Again, this largely relates to the appropriate emphasis on early detection and prevention, and management of premalignant lesions of the breast. I’m really talking about internal medicine, family practice, and gynecology.

I truly believe that primary care physicians, my colleagues on the front lines, are under-represented in the strategic effort to defeat breast cancer. These groups play an important part in ASBD, and I hope they will become increasingly active in coming years.

ONI: What are some of the benefits of ASBD membership?

Dr. Seidman: We publish an official journal, The Breast Journal, and also offer a second journal for our members, Breast Diseases: A Year Book Quarterly.

Through our website, we try to keep our membership advised about new and noteworthy reports regarding the management of breast disease, and in the future we would like to see this expand to provide a real interactive forum for the exchange of ideas and also for addressing difficult questions that might not be easily answered through conventional means, such as letters to the editor.

ONI: How does ASBD’s multidis-ciplinary model translate into better care?

Dr. Seidman: The representation of many different subspecialties with various specific interests such as genetics, nutrition, surgery, pathology, and imaging, all force us to know a little bit more about what our colleagues are doing. Therefore, we serve our patients well in the end by broadening our own knowledge base about the management of breast disease.

By bringing different perspectives together, physicians may make connections that might not otherwise be established. I think this concept of “cross-fertilization” is very real, and some of the informal discussions that take place among the various specialists at our meetings are the seeds for future research.

ONI: Would ASBD have an active role in initiating such research?

Dr. Seidman: Thus far, the Society has not actively supported research, but this is something that we hope to do in the future. For example, we plan to provide support for research fellows and special fellowships that are geared toward fostering true interdisciplinary breast cancer research. This approach would differ from existing research awards by mandating interdisciplinary collaboration.

ONI: As a multidisciplinary organization with an interest in varied perspectives, what is ASBD’s position on complementary or so-called alternative medicine?

Dr. Seidman: Anyone involved in the care of women with breast disease or breast cancer is acutely aware of the need to integrate nonconventional approaches into patient management. We often get specific queries from physicians to our board regarding alternative or complementary medicines.

We have addressed nontraditional approaches in some of our past meetings, and Dr. Barrie Cassileth, who is chief of the Integrative Medicine Service at Memorial Sloan-Kettering, will be discussing some of these issues at our annual meeting next year.

ONI: When will this meeting take place?

Dr. Seidman: Our 25th annual meeting will be held April 27 through 29, 2001, in New York City. The program will address a full spectrum of issues ranging from premalignant breast disease to early breast cancer to advanced breast cancer. We will also be looking toward the future, examining new agents and drugs that are in development for treating breast cancer.

Dr. Larry Norton, our keynote speaker, will provide a personal and historical perspective on the evolution of postoperative adjuvant therapy for breast cancer over the last 3 decades. Other speakers will include Drs. William Gradishar, Gabriel Hortobagyi, Clifford Hudis, and Eric Rowinsky, to name a few.

Additionally, Dr. Edward Stadtmauer, principal investigator for the largest randomized prospective trial of high-dose chemotherapy (HDCT) for breast cancer, will provide his perspective on the current status of HDCT for breast cancer. We’re also fortunate to have Dr. Robert Buckman speak to us on how to break bad news to patients.

ONI: Is ASBD involved in any lobbying or legislative initiatives?

Dr. Seidman: This has not been a focus for our Society historically. Other groups are doing this and doing it quite effectively. I think, though, that we may be able to provide a unique voice on issues, given the nature of our membership, which distinguishes us from, for example, the National Alliance of Breast Cancer Organizations, or the National Breast Cancer Coalition, or the Komen Foundation.

We have a collection of talented, dedicated professionals who have significant knowledge of issues and often of policy as it relates to managing breast cancer. I would like to see us have a voice in legislative and policy issues that could help improve health care for patients with breast disease.

ONI: What objectives did you personally establish for yourself as president of ASBD?

Dr. Seidman: Personally, I thought that the organization was on a very good trajectory in terms of its mission. However, as a medical oncologist, I thought that the Society had much to offer my colleagues in medical oncology and that not many of them were either aware of the Society or knew enough about it to decide whether the group offered something worthwhile for them.

I think that we have recently achieved some measure of success in expanding the representation of medical oncologists within the Society.

For ASBD to grow, we need to achieve a certain critical mass, not only in terms of membership but also in terms of home office strength, within our Dallas office. Further, we need to have the resources to pursue new initiatives. To this extent, I am proud and grateful that many people in the pharmaceutical and biotech industry have recognized the value of the ASBD and have been generous in supporting some of our endeavors.

ONI: What is your vision for the future of ASBD?

Dr. Seidman: I think our greatest strength is that, due to the nature of our membership and our focus, we force ourselves to become more expert in areas and disciplines that we have not been formally trained in, and I think this makes us better health care providers and stimulates new avenues of research.

I believe this will continue, and my hope is that more health care professionals will learn about us and bring their unique talents and their knowledge to us so that we can grow and draw upon the dedication and talents of many of the people who currently aren’t aware of the American Society of Breast Disease.

The American Society of Breast Disease (ASBD) can be reached at PO Box 140186, Dallas, TX 75214; phone: (214)-368-6836; website: www.asbd.org.