Woodward Laboratory
Wendy A. Woodward M.D., Ph.D.
Principal Investigator
Research Areas
- Radiation Therapy
- Breast Cancer
- Stem Cell Biology
Wendy Woodward, M.D., Ph.D., is a Professor and the Chief of the Breast Radiation Service in Department of Radiation Oncology at The University of Texas MD Anderson Cancer Center. She is a physician-scientist specializing in clinical breast radiation oncology with a lab focused on inflammatory breast cancer, the microenvironment and breast cancer stem cell biology.
Dr. Woodward
She is deputy director of the MD Anderson Inflammatory Breast Cancer Clinic and Research Program and is dedicated to advancing the radiation treatment and biologic understanding of inflammatory breast cancer through laboratory, translational and clinical research. Nationally, she serves as the liaison between the breast working group and the translational research program in the Radiation Therapy Oncology Group devoted to designing translational endpoints for multi-institutional trials in breast radiation therapy. Specific interests include studying molecular determinants of treatment resistance in breast cancer stem cells and novel treatment of inflammatory breast cancer. Woodward has a strong interest in education and mentoring trainees in both clinical and translational breast cancer research and was honored to receive both the James C Cox and Robert Chamberlain awards for mentoring.
MD Anderson Cancerwise
Dr. Woodward has been featured in several blog articles:
Inflammatory breast cancer: 14 things to know
Inflammatory breast cancer (IBC) is a rare subtype of breast cancer whose symptoms typically first appear as breast skin changes. It accounts for only about 2% to 4% of new breast cancer diagnoses annually. But because it’s so aggressive, IBC makes up a disproportionate number of breast cancer-related deaths each year.
Still, there is much cause for hope. We continue to make inroads in the diagnosis and treatment of this disease. And many — though not all — cases of inflammatory breast cancer can be cured.
Here are 14 of the most common questions I hear as executive director of MD Anderson’s Inflammatory Breast Cancer Clinic.
1. What does inflammatory breast cancer look like?
Typically, inflammatory breast cancer presents with both red or discolored breast skin and swelling. So, the skin on or around the breast may look inflamed, or be a different color than the rest.
Depending on your underlying skin tone, the discolored areas could be red, pink, or even purple or brownish. It may also feel like the skin has thickened, and your nipple may be inverted.
2. How is inflammatory breast cancer typically diagnosed?
Unlike other types of breast cancer, inflammatory breast cancer doesn’t usually show up as a lump or appear on a screening mammogram. That is why it’s so often misdiagnosed.
But patients usually notice skin changes and breast swelling that develop fairly quickly and prompt a visit to the doctor.
3. Does inflammatory breast cancer hurt?
It can, but it doesn’t always. Some of our patients do report experiencing pain.
4. Does inflammatory breast cancer itch?
Sometimes, it can. But again, not always.
5. How fast does inflammatory breast cancer spread?
For some people, it can be a matter of weeks between when they first notice a change in their skin and when they realize that their whole breast is now involved. Some report abrupt changes over a matter of days.
To be classified as inflammatory breast cancer, though, the skin changes must:
- have occurred within the last 6 months, and
- involve at least a third of the breast.
6. How is inflammatory breast cancer treated?
Systemic therapies — such as chemotherapy, targeted therapy and immunotherapy — come first, to get the best results from surgery.
After that, inflammatory breast cancer patients undergo a mastectomy, a surgery that removes all of the cancerous tissue involved. That includes any skin that’s affected, so leaving some behind in order to place expanders or do immediate reconstruction is not appropriate.
Finally, we use radiation therapy to target larger areas.
7. Is inflammatory breast cancer curable?
Yes, definitely. Not all of it can be cured, of course. As with all stage IV cancers, we can treat stage IV IBC, and we aim to achieve a prolonged “no evidence of disease” status with ongoing therapy, but we can’t cure it.
Inflammatory breast cancer is always considered at least stage III, though, no matter how early you catch it. So, the sooner you can diagnose it and start treatment before it progresses to stage IV, the better chance you have of a cure.
8. What causes inflammatory breast cancer?
Nobody really knows for sure, but some risk factors are thought to overlap with those of regular breast cancer. Risk factors that may influence IBC include:
- race: Black women have a higher incidence of IBC
- high body weight: can increase your risk
- breastfeeding: reduces risk
- age at first pregnancy: being younger may increase your risk
9. Is inflammatory breast cancer hereditary?
It can be hereditary in the same way that non-inflammatory breast cancer is. So, if breast cancer runs in your family, you may be at higher risk of developing it yourself one day. But just because your mom had IBC doesn’t make it more likely that you’ll have that same type, too.
As far as we know, there’s no inheritable component of inflammatory breast cancer that’s useful for genetic testing right now.
10. Does inflammatory breast cancer show up in bloodwork?
No. Not in a way that would be helpful to anyone as a patient. Liquid biopsies are starting to look more at circulating tumor material. But could I do a test right now and find IBC? No.
11. Are some people more likely to develop inflammatory breast cancer than others?
Yes. Although IBC can happen at any age, IBC is more common among women who:
- are under the age of 40
- have high body weight
- have Black ancestry.
Development seems to be influenced by the normal changes that take place in breast tissue after childbirth (from dormancy to active milk production and back again) and that is actively being studied.
12. What should patients look for when deciding where to seek IBC treatment?
Because this disease is so rare and aggressive, where you go first for your inflammatory breast cancer treatment makes a big difference. To ensure you get an accurate diagnosis and the correct treatment from the beginning, it’s critical to go to a large, comprehensive cancer center like MD Anderson.
Here, we offer patients two important benefits: specialized clinical trials and high-volume experience. Our physicians see multiple patients with inflammatory breast cancer every week, so we are the experts. Our results demonstrate that. We have some of the best published results in the country for treating inflammatory breast cancer.
Our multidisciplinary approach also enables patients to visit with all three types of specialists (breast oncology, radiation oncology and surgical oncology) quickly. They work closely with our pathologists, radiologists and other specialists to provide the best treatment possible for each patient.
That means patients can find everything they need right here. And that doesn’t just include your clinical care. It also includes support services such as social work counselors, support groups and even one-on-one support from other survivors.
13. Why are the chances of recurrence so much higher with inflammatory breast cancer?
Inflammatory breast cancer has specific features that drive progression, resistance and the migration of cancer cells, so it has a high rate of spreading and recurrence. It’s very aggressive.
14. Is there anything you can do to lower your risk of IBC recurrence?
The best way to reduce your chances of recurrence is to have the key therapies in the right order from the very beginning. That means systemic therapies first, followed by a modified radical mastectomy, and then comprehensive post-mastectomy radiation tailored to the original site of the disease. That also means taking advantage of any adjuvant therapies that may be offered.
Inflammatory breast cancer is not a disease for diluting therapies or using less rigorous methods to try to reduce side effects. So, you want to avoid things like skin-sparing mastectomies, sentinel lymph node biopsies, and immediate reconstructions. With inflammatory breast cancer, the only role for non-guideline-based care is through a clinical trial.
Wendy Woodward, M.D., Ph.D., is a radiation oncologist and researcher who specializes in the treatment of inflammatory breast cancer. She also serves as ad interim chair of the Breast Radiation Oncology department and executive director of MD Anderson’s Inflammatory Breast Cancer Clinic.
Request an appointment at MD Anderson online or call 1-877-632-6789.
Side effects of radiation therapy for breast cancer
If you need radiation therapy as a part of your breast cancer treatment, you may have questions about side effects.
What are the most common side effects, for instance? How long will they last? And, is there any way to prevent or reduce them?
To learn more, we went to Wendy Woodward, M.D., Ph.D., a radiation oncologist and researcher who specializes in breast cancer.
What side effects does radiation therapy typically cause in breast cancer patients?
There are two “flavors” of side effects from radiation therapy, regardless of what type of cancer is being treated: early and late. The early side effects appear toward the end of treatment or within a few weeks of finishing it, while the late ones can appear anywhere from six months to a year after you’ve completed treatment.
The most common early side effects of radiation therapy in breast cancer patients are skin irritation and fatigue. Radiation therapy can last anywhere from one to six weeks. As you get farther into treatment, the skin on the breast or chest that’s repeatedly exposed to radiation can start to look dry or red and feel irritated. It may sometimes even peel.
When fatigue occurs, it usually appears toward the end of treatment. But many patients report that it’s mild or not as bad as the kind they experienced with chemotherapy.
What are the most common late radiation therapy side effects in breast cancer patients?
The skin of the breast or chest does not always go back to its normal color. So, there can be persistent tanning in the areas exposed to radiation. Daily moisturizing after you’ve finished treatment can help this fade. Radiation can also cause a tightening or hardening of soft tissues, so the exposed areas of the breast or chest wall might not feel as soft or as flexible as they once did. Stretching and physical therapy can be helpful to improve this. You may also notice little spider veins called telangiectasias, where the blood vessels have widened and become more visible under the skin’s surface.
Radiation therapy for breast cancer can slightly increase the risk of developing heart disease if the heart cannot be fully excluded from the treatment field. Exposing the heart to direct radiation can also cause acute pericarditis, which is inflammation of the sac-like structure surrounding the organ. But we really bend over backward to protect and avoid the heart during treatment at MD Anderson. So, I’ve never seen pericarditis from breast radiation even once in my 20 years here.
There’s also a risk of lymphedema, or swelling of the arm or upper body due to the inability of lymphatic fluid to drain properly. This happens sometimes when lymph nodes are removed from the neck, arm or torso. It can be more severe when the remaining lymph nodes are exposed to radiation. Lymphedema can be treated in many cases with surgery – either by surgically bypassing blocked lymph nodes or transferring new nodes into the affected areas.
There’s also a very low risk of developing a secondary cancer due to radiation exposure. But the benefits of getting rid of cancer now usually far outweigh the risks of a second diagnosis later.
How are these radiation therapy side effects treated?
For dryness and tenderness, we evaluate patients weekly. We want to see how their skin is holding up, so they don’t get too uncomfortable. If they start having issues, we can provide non-prescription lotions — or, at times, a topical steroid cream. There’s also a moisturizing gel product sold in sheet form that provides a cooling sensation when applied to the skin, and a number of foam dressings that are very helpful. For patients with skin pain, we recommend mixing a little topical lidocaine cream into their lotions to numb those areas while they heal.
For tightness and hardening, we usually recommend physical therapy. That can help patients regain their flexibility. For patients who choose to have breast reconstruction, our surgeons might replace some tissue in the affected areas with normal, non-irradiated tissue. Some patients have also found relief from pain and discomfort in tight muscles through Botox injections.
We also have clinical trials studying two topical steroids — mometasone and mepitel — to see if they can prevent skin reactions.
Pneumonitis, breast swelling, and other less common side effects
If patients have breast cancer that has spread to the lymph nodes in their necks, they may need radiation therapy to treat those nodes. This can cause a sore throat toward the end of treatment. It generally goes away on its own, but for patients who want immediate pain relief, we usually suggest ibuprofen or something similar.
Pneumonitis is another rare side effect. It may cause coughing or shortness of breath, and patients sometimes mistake it for the flu. It usually occurs between one and six months after finishing radiation therapy. It’s caused by irritation to the lung just under the ribs on the treated side of the body. Pneumonitis usually goes away on its own, but we can also treat it with steroids when needed.
Finally, some patients may experience swelling of the breast tissue. This generally goes away on its own and is fairly mild.
Is there any way to prevent skin-related radiation therapy side effects in breast cancer patients?
We plan our patients’ radiation therapy treatment very carefully to minimize “hot spots,” where particular patches of skin are exposed to higher doses of radiation than others.
Some studies suggest that topical steroids can prevent skin irritation, but it is not completely avoidable. When breast cancer involves the skin, we want to be sure the skin is adequately treated, so it gets a bit red as a result.
What new advances have been made to manage radiation side effects in breast cancer patients?
The Saphire clinical trial is studying whether side effects in breast cancer patients can be reduced by shortening the amount of time they receive radiation therapy.
The most exciting advance might be that we’ve found a mutation in the TGF-beta (transforming growth factor-beta) gene that appears to reveal a greater sensitivity to radiation therapy in some patients. Now, we’re trying to create a test to identify those patients before treatment begins so that we can make modifications to minimize their side effects.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
What does an early inflammatory breast cancer rash look like?
Redness or another change in the skin color of the breast, swelling on one side and/or a rash that appears quickly — sometimes literally overnight — are the hallmark symptoms of inflammatory breast cancer.
But what does that rash actually look like? And how can you distinguish it from other, more benign conditions?
To learn more, we went to Wendy Woodward, M.D., Ph.D., a radiation oncologist and researcher who specializes in the treatment of inflammatory breast cancer.
What does an inflammatory breast cancer rash look like?
That’s kind of hard to say, because not everyone’s rash looks the same. And, it doesn’t always look like a rash. Sometimes, you can just see the breast skin pores very clearly because they look exaggerated due to swelling. Or, there’s redness or some other type of discoloration of one breast.
The rash associated with inflammatory breast cancer can also vary in appearance based on someone’s skin tone. It may look dark or even purple on some women, rather than red. But there’s not a defining skin change that’s the same for everybody. And, no matter how early a rash is diagnosed as inflammatory breast cancer, it is always considered at least stage III.
What characteristics distinguish an inflammatory breast cancer rash from other kinds?
Speed is one factor. Inflammatory breast cancer is quite aggressive, and it can develop very, very quickly. So, if you notice a marked change in the size of your breast or in its color or texture over a few weeks — or even a few days or hours — you should get it evaluated right away.
In addition, though some women describe the rash as starting out small — or even resembling a bug bite — it often involves most of the breast within a very short time frame. So, a spreading rash deserves prompt attention, too.
Are there any other conditions that can cause rashes on the breast?
Yes. Mastitis is the top one. It’s fairly common during breastfeeding, so many people tend to assume that inflammatory breast cancer is just an infection. It gets mistaken for mastitis and abscesses a lot because most health care providers have never seen inflammatory breast cancer before. They tend to err on the side of the rash being caused by something more benign.
The number of people diagnosed with inflammatory breast cancer each year is incredibly small. It’s a drop in the bucket, compared to other types of breast cancer. And most people who notice changes in their breasts will not ultimately have breast cancer.
By the time patients get to MD Anderson’s specialized Inflammatory Breast Cancer Clinic, though, they’ve often already gone through multiple rounds of antibiotics with no improvement.
Have there been any advances in the diagnosis of inflammatory breast cancer, based on rashes?
Yes. We’re working on two different projects right now.
One is an update of the MD Anderson cancer algorithm to help patients obtain a faster diagnosis. If the changes they’ve noticed are enough to point to inflammatory breast cancer, they’ll be able to use this algorithm to back up their request for additional imaging or a breast biopsy.
That way, if a doctor says, “OK, here are some more antibiotics,” patients can say, “Wait. Shouldn’t we try to rule this out first?” and show them the MD Anderson algorithm. A lot of doctors think of a breast biopsy as a really big step. But in this case, it’s not. It’s just the right thing to do.
We’re also in the very early stages of developing of an app that would let patients take a picture of their own breast, upload it and use artificial intelligence to compare it to photos of both healthy breasts and those from patients with confirmed inflammatory breast cancer diagnoses. The hope is to give patients a gauge to determine whether their rash is something to be concerned about and doctors a tool to make a diagnosis right away.
Is there anything else people should know about inflammatory breast cancer rashes?
Yes. Sometimes, it can be hard to distinguish non-inflammatory breast cancer from inflammatory breast cancer, since both can cause redness of the breast and skin changes that might be missed.
But if you notice really rapid changes in one or both of your breasts, try to be seen by a doctor within two weeks. While a short course of antibiotics is not unreasonable when the suspicion of inflammatory breast cancer is low, don’t be afraid to ask for breast imaging or a biopsy if your symptoms don’t fully resolve in less than two weeks. If your condition gets better before the results come in, great. But if not, you’ll be that much closer to a diagnosis.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
What is adjuvant therapy for breast cancer?
Many patients who are diagnosed with breast cancer will hear their doctors use the word “adjuvant” to describe certain treatment options.
But what does "adjuvant” mean, and what does it indicate about the therapies to which it’s applied?
We asked Wendy Woodward, M.D., Ph.D., a radiation oncologist and researcher who specializes in breast cancer. Here’s what she had to say.
What is adjuvant therapy and how does it differ from neo-adjuvant therapy?
The simplest way to define it is any kind of treatment that comes after breast surgery to remove a tumor.
Anything that happens before surgery, such as chemotherapy given to shrink the tumor, is called “neo-adjuvant” therapy. Any therapies that happen afterwards are considered “adjuvant.”
Which breast cancer patients need adjuvant therapy?
It really depends. All adjuvant treatments are based on the chances of a patient not being cured of a particular cancer by surgery and any therapy they may have received before surgery (i.e. neoadjuvant therapy). Additional therapies are offered to reduce the risk of recurrence.
How is the need for adjuvant breast cancer therapy determined?
The first thing that happens at MD Anderson is staging. That’s how our doctors learn how large and advanced a patient’s cancer is, usually through imaging.
The next step is genomic testing for certain hormone receptors. The presence of these can be favorable for two reasons. One is that they could indicate a patient is already at relatively low risk for a cancer returning. But the other is that we might be able to correlate the receptors with various genomic studies, and lower a patient’s risk even more by offering hormonal therapies.
At some point during every staging process, we will ask the following questions:
- What is the risk of the cancer coming back without this therapy?
- How will this therapy reduce that risk?
- Are the risks of this therapy worth the benefits?
The last question can only be answered fully after talking with a patient, because everyone is different. And one patient’s level of acceptable risk might be very different from another’s.
What types of adjuvant therapy are typically used to treat breast cancer?
Again, that depends. It used to be that the first line of treatment for breast cancer was always surgery. Then, chemotherapy came along, and doctors learned that if they gave that first, sometimes even tumors deemed too big to remove initially could be shrunk down enough to do that successfully.
Eventually, someone discovered that estrogen drives cell growth in estrogen-receptor-positive (ER+) tumors, and the development of hormonal therapies like tamoxifen began. Today, we’ve also got targeted therapies, aromatase inhibitors and immunotherapies to consider.
Why is it important to know a breast cancer’s subtype?
Because it helps us personalize your therapy. Subtyping breast cancer allows doctors to tailor adjuvant therapy specifically to you, based on both your response to neo-adjuvant treatment and our pathology findings, such as biopsy results.
Almost all patients with a hormone-positive breast cancer diagnosis will be offered hormone therapy. But the type they’re offered depends on whether they’re pre- or post-menopausal. And, if you’ve got an HER2+ mutation, we might offer you chemotherapy first, to shrink the tumor and make surgery simpler. Doing it in that sequence, rather than performing the surgery up front, can often reduce the number of lymph nodes we have to remove. And that, in turn, can reduce your chances of developing lymphedema.
In patients who only need a lumpectomy, meanwhile, we can make their risk of recurrence comparable to those who’ve had a full mastectomy, by giving them radiation therapy afterwards.
And, if your cancer is considered very high-risk, you may benefit from both chemotherapy and hormone therapy after surgery, and/or irradiation of the chest wall and any un-dissected lymph nodes.
In any event, you’ve got to know the breast cancer subtype to figure out which adjuvant therapies are appropriate.
What’s the most exciting development right now in the field of adjuvant breast cancer therapy?
In July, the Food and Drug Administration (FDA) approved an immunotherapy drug called pembolizumab for the treatment of breast cancer. It’s showing the most promise against triple negative breast cancer, which lacks the three most-common receptors that make hormone-positive cancers easier to treat.
Is there anything else people should know about adjuvant therapy for breast cancer?
As with any type of cancer treatment, adjuvant therapies can sometimes cause side effects, such as dry skin, mouth sores, and neuropathy.
Our goal is to get people back to where they were before cancer as much as possible, so tell your doctor if you start developing any side effects. Your care team can usually offer tips and suggestions on how to ease or resolve them. MD Anderson patients can also ask for a referral to one of our specialists.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.