Providing Breast Cancer Patients With Comprehensive Care, Every Step of the Way

September 10, 2010

At Floyd Memorial, our multidisciplinary team focuses on providing each woman with the complete program of care and treatment that best suits her unique needs.

Detection and Diagnosis

Screening and Diagnostic Mammograms

Kelly Colomb, MD, a board certified radiologist, explained that women see her for two types of mammograms. “First is the screening mammogram,” she said. “This is for women with no symptoms.” For women at high risk of breast cancer or with certain types of breast tissue, breast MR screenings may be recommended in addition to annual mammograms. “The other type of mammogram,” said Dr. Colomb, “is the diagnostic mammogram, in which the woman either has symptoms or has been called back following a screening.”

Kelly Colomb, MD

“There are several ways to perform a biopsy, including an advanced image-guided procedure. We want to maximize our chance of getting the diagnostic information we need with the least patient discomfort and shortest recovery time.”

Kelly Colomb, MD
Board Certified Radiologist
Radiology Associates, Inc.

According to Dr. Colomb, “In about one out of ten cases, we see something on the screening mammogram we want to evaluate further. A woman may then be called back for an additional study. Often, she will get an ultrasound as well as a more focused mammogram. Only a small percentage of these women need to go to the next step, which is a biopsy.”

Biopsy

A biopsy, in which a small sample of tissue is removed so that cells can be examined, is the only way to determine whether a tumor is malignant or benign.

“The decision of what type of biopsy a woman needs is based on many factors,” explained board certified General Surgeon Carolyn Day, MD. “She may require an open procedure. But often, we can use an outpatient procedure called image-guided biopsy, which avoids the incision and recovery period of an open biopsy.” Using mammographic, ultrasound or MR-guidance to determine the exact location of the abnormal tissue and verify needle placement, the radiologist can numb the immediate area of the breast with local anesthetic, insert the biopsy needle and remove tissue samples for examination. “Recovery is faster, and there is little to no scarring,” said Dr. Day.

Carolyn Day, MD

“A major advance in lymph node biopsy is minimizing the extent of many women’s surgeries. It used to be that we removed all of the lymph nodes in the armpit. Today, however, we do a sentinel node biopsy. During surgery, we inject a dye and tracer into the breast and look for the first one to three lymph nodes to which the dye travels. We then remove and biopsy those nodes while the patient is still asleep. If there are no suspicious cells, it is likely that we can avoid removing the rest of the lymph nodes in the area, decreasing the possibility of lymphedema, shoulder weakness and numbness.”

Carolyn Day, MD
Board Certified General Surgeon
McCullough, Hutchinson and Day
General Surgeons

Treatment – a unique combination of surgery, radiation and/or chemotherapy.

Surgery

If the biopsy shows a tumor is malignant, the breast cancer specialists at Floyd Memorial work closely with each other, and with the patient and her primary care physician to make the decisions that will bring about the best results based on the patient’s unique needs.

Lumpectomy and Radiation vs. Mastectomy

“When we see a new diagnosis of breast cancer,” said Dr. Day, “we first must decide whether to treat it with a lumpectomy and radiation or with a mastectomy.” As Anthony Dragun, MD, a board certified radiation oncologist explained, “Over 40 years of experience has let us compare the results of mastectomy with a more breast conserving lumpectomy. Not all patients are good candidates for lumpectomy. But when it is an option, the cure rate is virtually the same for lumpectomy as for mastectomy, as long as the lumpectomy is accompanied by radiation therapy.”

Radiation Therapy

The latest radiation therapy technology not only allows radiation oncologists to customize radiation to more accurately target the cancerous area and spare surrounding healthy tissue, but it also allows them to customize the course of the treatment to meet specific needs.

Contura® Can Reduce the Course of Radiation to Just Five Days
Contura® is the newest advance in brachytherapy, which places the source of radiation inside the breast. A tiny catheter is used to insert a balloon into the space from which the tumor was removed. Channels in the balloon focus radiation away from healthy tissues. It requires just ten outpatient treatments, twice a day for five days, after which the balloon is removed.

“For example,” said Dr. Dragun, “many patients we treat live in outlying areas. Some think they can’t choose lumpectomy and radiation because they can’t travel back and forth every day for six weeks, which is the length of traditional treatment. But we may be able to offer them a program that reduces the length of treatment and makes lumpectomy a viable option.” He added, “Brachytherapy is a treatment in which we temporarily implant a seed within the breast that provides radiation from the inside rather than the outside. Treatment can be completed in five days. There is a trade-off, however, in that it is more invasive. So the choice is between longer therapy from the outside that ranges from three to six weeks, or five days of therapy that is slightly more invasive.”

Anthony Dragun, MD

“The days of a cookie-cutter treatment and a mastectomy for all patients with breast cancer are gone. We are in the era of tailoring therapy to the individual’s medical and practical needs using leading-edge treatments and careful consideration from a team of multidisciplinary professionals.”

Anthony Dragun, MD
Board Certified Radiation Oncologist
Cancer Center of Indiana

Chemotherapy

Yasoda Dev, MD, is a board certified medical oncologist and hematologist, and an expert in treatment with chemotherapy. As she explained, “Treatment varies based on factors such as the size of the mass and whether or not there is lymph node involvement. We also test the tumor to check for specific genes that can be targeted to make the chemotherapy more effective.” Chemotherapy is very carefully tailored to the individual’s particular type of cancer. It may be used in the following circumstances:

  • Before surgery, to decrease the size of the tumor and to allow surgeons to operate and likely preserve the breast, and also to evaluate the tumor’s response to chemotherapy
  • After surgery, to reduce the chance that the cancer will come back in the same place
  • In all instances of metastatic disease, in which the cancer has spread

Yasoda Dev, MD

“At the Cancer Center of Indiana, our multidisciplinary Tumor Board discusses each breast cancer patient’s case at length to develop the optimal plan of treatment, looking at the many options available in surgery, chemotherapy and radiation therapy.”

Yasoda Dev, MD
Board Certified Medical Oncologist and Hematologist
Cancer Center of Indiana

Genetic Testing

“A mutation of two specific genes is a strong predictor of cancer of the breast and ovary,” said Dr. Dev. “If a person is diagnosed with breast cancer under the age of 50 or when two or more relatives on the same side of the family have the same type of cancer, genetic testing is suggested. If no genetic abnormality is found, there is no need for family members to be tested. But, if the person has the mutation, testing may be offered to their close relatives. That kind of knowledge gives people difficult, but potentially life saving options.” She added that genetic testing is not recommended for girls under the age of 18.

Dr. Dev stressed that not all cancers are caused by a genetic abnormality. In fact, only 20% of breast cancer patients have a family history of the disease, and of the 20% with a family history, only a very small number have the genetic mutation.

Reconstruction

Michelle Palazzo, MD, is a board certified plastic and reconstructive surgeon with a unique perspective on treating breast cancer patients. “I’m a breast cancer survivor myself,” said Dr. Palazzo. “I know that when you’ve had breast reconstruction, there’s less of a reminder of what you’ve been through each morning when you get dressed. Most women are glad they have the choice to restore their appearance.”

“Some women are good candidates for immediate reconstruction, so they should visit a plastic and reconstructive surgeon after their diagnosis, but before their treatment,” said Dr. Palazzo. “However, some women are too distraught to make any more decisions right after their diagnosis. Or, if they need a significant amount of radiation, it may be better to be reconstructed after their treatment. Either way, it’s always better to be seen for an evaluation earlier rather than later. Whenever a woman comes in, we consider her options, which includes the use of expanders and implants, using the woman’s own tissue to rebuild her breasts, or a combination of both. During a consult, I evaluate each patient and describe the different options available. Together, the patient and I come up with a reconstructive plan that is best for her.”

Michelle Palazzo, MD

“Right after diagnosis, many women are primarily concerned with treating their cancer. But as they begin the treatment process, they think more about restoring their appearance and getting back to their lives. Reconstructive surgery is now looked at as part of the recovery process.”

Michelle Palazzo, MD
Board Certified Plastic and Reconstructive Surgeon
Kleinert Kutz and Associates

To schedule a mammogram at Floyd Memorial’s Women’s Imaging Center, call 812-949-5570. Patients who receive mammograms during the month of October will receive a free gift in honor of Breast Cancer Awareness month (supplies are limited).

The Diagnostic Breast Center is open extended hours with evening and Saturday appointments available.