“You have breast cancer.” No woman—or, for that matter, man—wants to hear those words, yet the number of new breast cancer cases in the United States continues to climb each year. As many as 232,300 new cases of invasive breast cancer were diagnosed among women in 2013, in addition to more than 2,200 new cases among men, according to the American Cancer Society.
Significant breakthroughs in the areas of detection, treatment and recovery continue to improve the outlook for survivors in Philadelphia and its suburbs, according to Thomas G. Frazier, M.D., FACS, medical director of the Barbara Brodksy Comprehensive Breast Center at Bryn Mawr Hospital in Bryn Mawr. The advent of digital breast tomosynthesis, which takes multiple images of the entire breast, has improved the sensitivity of breast cancer detection compared with traditional digital mammography. Main Line Health breast health centers, including Bryn Mawr Hospital, added the technology in July. It has not only helped physicians find more cancers at earlier stages in their development but also reduced the number of false positives.
“These are mammograms that take pictures in multiple-cut fashion, and it gives a much clearer view of the breast tissue,” Dr. Frazier says. “It’s interesting to watch the looks on patients’ faces when we show them their pictures from last year compared to this year, how much better we can see the breast tissue. … Three-D mammography is also the best way to evaluate women with dense breast tissue, which used to make it much harder for the mammographer to see into the breast.
“Mammography works,” he continues. “It’s our best form of early detection, and if you diagnose [breast cancer] as early as possible, you have a lot more options and a much better outlook. … In my opinion, it’s best to have a baseline mammogram at 35 and then annually after the age of 40.”
If a mammogram does come back as abnormal, a patient next faces diagnosis and treatment, where equally significant breakthroughs now offer more and less invasive options for fighting the disease. Depending on the type of breast cancer, this could include everything from precisely targeted radiation treatment and tissue-sparing surgical procedures, to radio-frequency ablation and targeted pharmaceutical therapies such as Herceptin and Perjeta, which have helped slow the growth of tumors. Essentially, breast cancer treatment has gotten to a point where physicians can provide individualized care based not only on the patient’s wishes but also on her specific cancer.
“Advances in breast cancer treatment and diagnosis have helped us be more selective with therapy,” says Catherine Porter, D.O., a breast surgeon with the Women’s Specialty Center at Chester County Hospital in West Chester. “We’ve gone from the days of the radical mastectomy in the ’50s, ’60s and the early ’70s … to today, when technology has helped us understand the nature or biology of the cancer.”
One such breakthrough has come in the area of genetic testing. This applies not only to testing the patient for mutations of genes such as BRCA1 or BRCA2, which raise the risk of her developing breast and ovarian cancer—actress Angelia Jolie had a preventive double mastectomy in 2013, after testing positive for the BRCA1 mutation—but also the genetic analysis of malignant tumors. The latter essentially helps physicians predict how a tumor will “behave” and then recommend a course of treatment.
“Chemotherapy can be a great thing, but if we can spare you chemotherapy we would really like to do that,” says Dr. Frazier. “The genetic testing gives us a good idea of how aggressive [a tumor] is and also if it’s one that’s going to respond to chemotherapy. It’s a major advance.”
‘Some Piece of Hope’
Most health care networks that specialize in breast health have invested in not only technology but also patient-care resources known as nurse navigators. These women and men help patients navigate their treatment path before their admission for treatment, during their hospitalization and, often, even after they have gone home. Cindy Brown, R.N., who started her career as an oncology nurse at Hahneman University Hospital in Philadelphia, became a nurse navigator at Chester County Hospital in April 2008. Whether she is answering a patient’s questions or helping family members coordinate appointment logistics, Brown cherishes the opportunity to “give them some piece of hope.”
“I’m the mediator between the doctor and the patient,” says Brown, whose mother was diagnosed with breast cancer in her 30s and died from the disease 13 years later. “I tell the ladies and men I deal with, ‘Call me whenever. I’ll find the answer.’ … [Before nurse navigators] I imagine the process was more disorganized, more anxiety ridden, and the process of care was a lot longer, with a lot more unknowns. Once you have no more unknowns and you know the plan, you can move ahead and deal with what’s in front of you.
“A lot of [the job] is individualizing each person, understanding not just the cancer but who the person is and was prior to the diagnosis: a mother of three, someone who likes to travel,” she continues. “It’s a disease of emotions; they’re not sick a lot of the time, so you’re helping them deal with the emotional in addition to the physical. … You can’t help but get some degree of intimacy with someone when you’re helping them through the roughest part of their life.”
When surgery is deemed necessary, breast surgeons are increasingly proficient in preserving tissue, without sacrificing the effectiveness of treatment, through more precise lumpectomies. Also, if a mastectomy is preferred because of concerns over a genetic mutation and the risk of developing a second cancer, plastic surgeons have made great strides in breast reconstruction, according to Dr. Porter.
“Breast conservation has come a long way,” she says. “The ability to recognize the biology of a tumor has changed the management of breast cancer. In the past, surgeons thought to take more tissue and that would fix it. That’s no longer the case.”
Increasingly, breast cancer treatment includes a focus on nonmedical therapies, including yoga, nutritional guidance and acupuncture, as well as psychosocial counseling. Jun J. Mao, M.D., the director of the integrative oncology program at Abramson Cancer Center of the University of Pennsylvania in Philadelphia, has found electroacupuncture—a form of acupuncture where a small electric current is passed between pairs of acupuncture needles—to be helpful. This emergent therapy, Dr. Mao’s research suggests, produces significant improvements in fatigue, anxiety and depression for early-stage breast cancer patients who experience joint pain related to the use of estrogen-depleting aromatase inhibitors.
“I think it has really become obvious that the diagnosis of breast cancer really affects the person and their family as a whole,” says Dr. Mao. “We need the best medical treatment, but we also need a complementary alternative approach, as well as a self-care approach to help women regain a sense of self and find wholeness after a diagnosis. The more we understand the biology of cancer, hopefully we can minimize the toxicity of traditional treatment, while providing more innovative approaches to help women deal with the psychological and emotional impact of cancer.”
From Dr. Frazier’s vantage point, progress is being made in virtually every aspect of breast cancer treatment. Even so, much work remains to be done.
“The good news is that these changes we’re seeing now are helping so many women,” he says. “The bad news is that we’re still seeing a couple hundred thousand women being diagnosed with breast cancer every year. Hopefully, we will see the focus come around to prevention very soon.”
Skin Deep
Although National Skin Care Awareness Month ended on September 30, maintaining the health and beauty of one’s skin should be a year-round job. Thankfully, as the list below suggests, the Philadelphia area boasts a number of excellent physicians who practice in dermatology (the treatment for diseases and cosmetic issues associated with the skin, hair and nails) and skin rejuvenation (minimally invasive procedures, such as Botox treatments and dermal fillers, laser skin resurfacing and microdermabrasion to repair sun-damaged skin and reduce fine lines, as well as pharmaceutical-grade skincare products).
Dermatology
Dr. Anthony V. Benedetto
Dermatologic SurgiCenter
Philadelphia
215-546-3666
Dr. Eric F. Bernstein
Main Line Center for Laser Surgery
Ardmore
610-645-5551
Dr. Edward E. Bondi
Perelman Center for Advanced Medicine
Philadelphia
215-662-2397
Dr. George Cotsarelis
Penn Medicine at Radnor
Radnor
610-902-2400
Dr. Leonard M. Dzubow
Georgetown Building
Media
484-621-0082
Dr. Joel Mitchell Gelfand
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Steven S. Greenbaum
Skin and Laser Surgery Center of Pennsylvania
Philadelphia
215-735-4994
Dr. Tatyana R. Humphreys
Main Line Center for Skin Surgery
Bala Cynwyd
610-664-1414
Dr. William D. James
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Ellen J. Kim
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Mark Levenberg
Dermatology & Mohs Surgery Center
Doylestown
215-345-6647
Dr. David J. Margolis
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Marlene J. Mash
Marlene J. Mash, M.D., & Associates
Plymouth Meeting
484-351-8268
Dr. Christopher J. Miller
Perelman Center for Advanced Medicine
Philadelphia
215-662-6534
Dr. Michael Eudene Ming
Perelman Center for Advanced Medicine
Philadelphia
215-662-6926
Dr. Nianda M. Reid
Dermatology & Mohs Surgery Center
Doylestown
215-345-6647
Dr. Alain Rook
Perelman Center for Advanced Medicine
Philadelphia
215-662-7610
Dr. Randi M. Rush
Dermatology & Mohs Surgery Center
Doylestown
215-345-6647
Dr. John R. Stanley
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Susan Taylor
Society Hill Dermatology
Philadelphia
215-829-6861
Dr. Jouni J. Uitto
Jefferson University Physicians
Philadelphia
215-955-6680
Dr. Abby Van Voorhees
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Cynthia Gregg Webster
Webster Dermatology
Hockessin, Del.
302-234-9305
Dr. Guy F. Webster
Webster Dermatology
Hockessin, Del.
302-234-9305
Dr. Victoria P. Werth
Perelman Center for Advanced Medicine
Philadelphia
215-662-2737
Dr. Robert J. Willard
Dermatology & Mohs Surgery Center
Doylestown
215-345-6647
Dr. Dorota Wilson
Wilson Dermatology and Skin Care
Langhorne
215-486-8272
Dr. Gil Yosipovitch
Temple Health Center City
Philadelphia
800-836-7526
Dr. Toby Frank Zachian
Bala Cynwyd
610-667-6277
Skin Care and Rejuvenation
Dr. Earl Bryant
Physician Transformations
Newtown Square
484-420-4407
Dr. Anna Buinewicz
Le Medspa
Doylestown
215-230-4013
Dr. Glenn A. DeBias
The Institute for Laser and Aesthetic Medicine
Doylestown/King of Prussia
215-230-1804
Dr. Timothy M. Greco
Timothy M. Greco, M.D.
Bala Cynwyd
610-664-8830
Dr. Michael C. Luciano
Healthy Solutions Medspa
Horsham
267-388-0300
Dr. Jonathan Pontell
The Aesthetic Facial Plastic Surgery Center
Media
610-405-6303
Dr. Robert J. Skalicky
Bucks County Plastic Surgery
Newtown
215-702-8600
