Breast Care Requires a Team Approach

(October 2008) - There was a time, in the not too distant past, when the type of care you received mostly depended on the specialty of the physician you saw. For example, if a breast cancer patient talked to a surgeon, she would be told to have surgery. But, if she first saw a medical oncologist, she’d be told to start chemotherapy. Not to be outdone, a radiation oncologist might have recommended radiation therapy first. It was confusing and difficult for patients.

Fortunately, the days of having a single physician make all of the decisions is quickly becoming a thing of the past. The dawn of disease management teams and site-specific tumor boards, like those found at the Curtis and Elizabeth Anderson Cancer Institute (ACI) at Memorial University Medical Center, have changed all of that.

At the ACI, patients are now treated with a comprehensive plan developed by physicians in multiple specialties and based on the most current medical findings. Breast care at the ACI takes a team approach and includes surgeons, mammographers, pathologists, radiation oncologists, medical oncologists, and geneticists, to name just a few. The ACI’s team approach offers the most comprehensive care for women with breast diseases. This article highlights just a few of the services our team provides.

The Center for Breast Care
The Memorial Health University Physicians -- Center for Breast Care was the first and remains the only surgical practice in coastal Georgia dedicated to the treatment of breast conditions. My colleague Paula DeNitto, M.D., and I started the practice in 2001. The Center for Breast Care offers complete breast evaluation, second opinions, breast ultrasound, ultrasound guided core needle biopsy, and cyst aspiration.

Dr. DeNitto and I were members of the Department of Defense Trial, a multi-institutional study that proved the feasibility of sentinel lymph node biopsy. Our practice brought high dose rate partial breast irradiation (PBI) to the region through the MammoSite registry trial. We are one of 25 centers nationally contributing to the Contura Trial using the first multilumen catheter for PBI. We are able to study and test these leading-edge technologies because we focus solely on breast care.

We treat for more than 400 newly diagnosed breast cancers each year. We believe in caring for women in a manner and environment that maintains their dignity while providing the most current science and technology available. Our practice is built on the following principles:

·Women must be part of their own treatment.
·Optimal healing requires a balance of physical, mental, and spiritual care.
·When ill, patients expect and deserve compassion and communication.

The Breast Imaging Center
Any good breast surgeons will tell you they are only as good as their breast imaging. The experience at the Breast Imaging Center at Memorial is second to none.

Lesia Jackson, M.D., the director of breast imaging, came to Savannah from Charlotte, N.C., where she headed up the premier breast imaging center in that city. Dr. Jackson works exclusively with breast imaging and does no other radiology. She completed a fellowship in mammography and MRI after her radiology residency. She performs a physical exam on every patient coming in for a diagnostic mammogram and discusses the results with the patient immediately.

Dr. Jackson provides screening and diagnostic mammography, second opinions, stereotactic biopsies on the newest stereotactic table in the region, and ultrasound- and MRI-directed biopsies.

Radiation Oncology
Many women undergo radiation treatment for breast cancer. The newest member of the ACI’s Breast Cancer Disease Management Team is Krystina Keil, M.D., an exceptional radiation oncologist. She trained at Harvard and the Joint Center in Boston before beginning a successful career at Northwestern in Chicago. Dr. Keil’s specific expertise is in the radiation treatment of breast cancer. She recently served on the breast disease site committee for the NCCN, which makes recommendations to the nation concerning the management and treatment of breast cancer.

The Genetics of Breast Cancer
Many women with breast cancer worry about the health and safety of their daughters and sisters. They want to know if their disease is caused by a genetic trait. The Center for Cancer Genetics at the ACI offers thorough genetic testing that involves much more than just a blood test. Each patient receives extensive counseling by a certified genetics counselor before and after testing. In addition, Memorial is the home of the region’s only genetics laboratory. A team of scientists in our research division is actively studying the molecular genetics of cancer. They work closely with physicians in the ACI.

The Team Approach
It’s encouraging to hear that breast cancer survival rates are improving. Nonetheless, the disease still affects one in eight women in this country. Future advances in breast cancer care will not come from surgeons, radiation oncologists, or medical oncologists alone. They’ll come from teams of physicians and scientists working together to find the very best treatments. I’m proud to be part of the ACI’s team approach and I look forward to seeing and implementing new developments in breast care.

Written by breast surgeonRay Rudolph, M.D., MPH, FACS. Rudolph is co-founder of Memorial Health University Physicians -- Center for Breast Care.