While October may be the month when social awareness of breast cancer is heightened, for those in the medical trenches of radiology and oncology, it’s a yearlong priority.
Inspira’s Breast Cancer Program includes a nationally accredited breast center in the Frank and Edith Scarpa Regional Cancer Pavilion at Inspira Medical Center Vineland, recognized for providing the highest level of quality breast care. Its multi-disciplinary team includes medical and radiation oncologists, surgeons, radiologists, genetic counselors and more, all of whom meet regularly to discuss each patient’s treatment and progress.
A few of these team members include Dr. Nandini Kulkarni, medical director of surgical oncology; Blissa Usher, advanced practice nurse (APN), surgical oncology; and Dr. Allison Lawyer, radiologist. Each plays an important role in the different stages of caring for breast cancer patients—a process that has made great strides over the past several decades.
“Mammogram screening became widespread in the ’80s,” says Dr. Lawyer. “Prior to that, the established rates of death with breast cancer were constant. Mammogram screening took those rates of women dying down by 43 percent. The rate in men who were not routinely screened for breast cancer did not decline, showing that screening has a positive effect on catching cancers earlier.”
Statistics show that one in eight women in the U.S. will develop breast cancer, and contrary to popular belief, 85 percent of cases are sporadic, meaning a previous family history does not exist. Screening— including breast self-exams, clinical exams performed by a physician and imaging (mammogram or MRI)—can detect cancer at the earliest stage, leading to more treatment options. Women are often confused about when to begin receiving routine mammograms. Dr. Lawyer says they recommend beginning at age 40 or even 35 if desired. In the case of a first-degree relative who was diagnosed, the recommendation is to start screening 10 years earlier than the age the relative was diagnosed.
Those with a family history are considered high risk, says Usher. “Before they even have an abnormal finding or diagnosis, we will talk to them about adding another layer of surveillance, such as an annual breast MRI six months between mammograms,” she says.
Inspira has implemented technology called Cancer IQ, an evaluation that identifies high-risk patients when they come in for their annual mammogram. “Patients have always needed to fill out a form with family history, but this is smart technology on an iPad that goes right into our system and will automatically flag them if high risk, at which time they are given the opportunity to schedule an appointment with a high-risk coordinator such as myself,” says Usher. “It’s unique how we’re capturing these patients and that mammogram appointment is where it all starts.”
There are many benefits of patients coming to Inspira, where every stage of their treatment can be handled by a collaborative team. If something is spotted on a mammogram, the patient is brought back within a week or less and may need a focused breast ultrasound. “If there is something concerning, we recommend a biopsy and would start to work with other clinicians to coordinate, including Dr. Kulkarni’s staff, for the next steps,” Dr. Lawyer says.
This thoroughness leads to better care as the patient progresses. “Kudos to radiology because they are very much on top of each step, making sure the team is coordinated—they inform the primary care physician and me personally. This ensures the patient won’t fall through the cracks,” says Dr. Kulkarni. After discussing the ideal treatment plan and before the patient even leaves the office, all follow-up appointments are scheduled.
In the event surgery is necessary, Dr. Kulkarni says this is another area where advancements have made an impact on patient outcome and comfort. “In the 1950s, doctors performed radical surgery to remove the entire breast and the underlying muscle, including lymph nodes. Now we can perform a lumpectomy or partial mastectomy, sparing healthy breast tissue. Advanced localization techniques like the SAVI Scout help us to target affected tissue with better accuracy,” she says. “Chemotherapy and radiation are also more individualized and targeted to the tumor, which has fewer side effects and is better tolerated by patients.”
Genetic testing is also a component of the screening process—something more women are interested in ever since Angelina Jolie publicly tested herself for BRCA 1 and 2—genes linked to breast cancer risk.
“Those with BRCA1 have a risk of breast cancer upwards of 73 percent in their lifetime,” Usher says. “Genetic testing can also show us what other genes are at an increased risk, such as Lynch syndrome which is associated with colon cancer but can also increase the risk for breast cancer in women. … Again, for these instances we could discuss prophylactic measures, increased screenings and medication that could be taken daily. Through medical oncology and genetic testing, results can guide our care of the patient.”
Care is only expected to improve as Inspira’s new hospital in Mullica Hill and the adjacent cancer treatment center continue construction. “This new center will be similar to the level of institutions you’d find in Philadelphia, with the potential for expedited treatment with radiation, surgical oncology and an infusion center in one place,” says Dr. Kulkarni.
Inspira Medical Center Vineland
Frank and Edith Scarpa Regional Cancer Pavilion
1505 West Sherman Ave. | Vineland
Photography by Alison Dunlap
Published (and copyrighted) in Suburban Family Magazine, Volume 10, Issue 8 (October 2019).
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