Where Do You Go When You Have Breast Cancer?
Spring-Summer 2014 | Page 1
Judi Garland is thriving after breast cancer treatment (pictured here with her children).
When Judi Garland of Alexandria was diagnosed with triple negative breast cancer, her primary care physician understood that she would need a wide range of medical services and support. “She knew I would likely need chemotherapy in addition to surgery and also have to make emotionally-charged decisions quickly,” recalls Judi, a 41-year-old mother of two children, ages four and one and one-half. “My doctor recommended I go to a comprehensive breast center—where I could have all my doctors’ appointments, tests and treatments in one place. She referred me to The Reinsch Pierce Family Center for Breast Health at Virginia Hospital Center.”
Breast surgeon Molly Sebastian, MD, FACS spent an extensive amount of time with Judi during her initial consultation reviewing her treatment options. Dr. Sebastian is Associate Medical Director of the Center and a member of the Virginia Hospital Center Physician Group.
“When we first meet with newly diagnosed patients like Judi, we help them understand their diagnosis and lay out the big picture in terms of what kinds of treatment they may need along the way and why,” explains Dr. Sebastian. “It is such a surprise to receive a breast cancer diagnosis, and we want to prevent further surprises. Patients need to know what to expect.”
“Dr. Sebastian was so thorough, I just knew this was the right place for me,” Judi says. “She gave me all the information I needed to make decisions right off the bat. As a mother of small children, it took some of my fear away to know that there was a roadmap for my treatment. It made me feel more in control.”
Patients at The Reinsch Pierce Family Center for Breast Health may require consultations with several different specialists, including breast surgeons, medical oncologists, plastic and reconstructive surgeons, and radiation oncologists, as well as many appointments for lab tests, imaging and procedures. “It can be overwhelming,” says Dr. Sebastian. “Our staff at the Center schedules and coordinates all the services our patients need. We are a one-stop center. We do everything we can to make it easier for our patients.”
About 10 to 20 percent of breast cancers are classified as triple negative breast cancer, which does not respond to hormonal therapy or therapies that target HER2 receptors. Chemotherapy is frequently recommended for patients with triple negative breast cancer—sometimes it precedes surgery.
Neelima Denduluri, MD, a dedicated breast medical oncologist, was part of Judi’s treatment plan from the beginning. After her initial meeting with Judi, Dr. Sebastian consulted with Dr. Denduluri to determine whether Judi should have chemotherapy before or after surgery.
“The decision to have chemotherapy is very complex and involves many considerations, including when it should be administered, short-and long-term toxicities, and its impact on future child-bearing, among others,” notes Dr. Denduluri.
For Judi, Dr. Denduluri recommended eight cycles of chemotherapy over 16 weeks prior to surgery. A pre-chemo training class helped her prepare for the possible side effects and plan ahead for the help she would need with her family. During her chemotherapy treatment, Judi says, “The nurses were like mothers and sisters to me. They were so gracious, kind and cheerful.”
Judi opted to have bilateral mastectomies. Prior to surgery, she met with plastic and reconstructive surgeon Mazen Bedri, MD to discuss her plan for breast reconstruction, including the placement of temporary implants at the time of her mastectomy procedures.
After her surgery, the pathology results showed an area where her tissue margins (the edges of tissue surrounding the removed tumor) were not clear. Because of the aggressive nature of this type of cancer, Dr. Sebastian recommended an additional procedure to remove more tissue to obtain clear margins. During that surgery, Dr. Bedri worked closely with Dr. Sebastian to make sure everything would be optimal for Judi’s final breast reconstruction with implants, which would occur after all of her treatment was completed.
Even with the bilateral mastectomies, Judi’s risk factors put her at a 40 percent risk of cancer recurrence. As a result, she also underwent radiation therapy with Robert Hong, MD, Chief of Radiation Oncology.
“I was already aware of Judi’s situation. Her case was reviewed during our multidisciplinary group discussion at our weekly tumor board meetings,” Dr. Hong says. “Going over the pathology and biology of disease, we were able to tailor her radiation treatment plan so that her risk of recurrence was reduced significantly.”
Helping Judi throughout her treatment was Kerstin Perini, Oncology Patient Navigator.
“Kerstin was there for me from the beginning,” Judi says. “She helped me get organized, figure out who my support group was going to be, and who I would tell at work. She suggested exercise and other activities to help mitigate side effects, tension and stress.”
Dr. Sebastian points out that having all the breast cancer specialists and services in one location makes it much easier to create and follow each patient’s treatment plan.
“Judi’s journey illustrates how well our breast cancer team collaborates. Careful, frequent communication across all disciplines is critical to achieving the best possible outcomes for our patients,” Dr. Sebastian says. The coordinated care gave Judi a strong sense of connection with the team throughout the months of her treatment.
“I never felt like I was a number or a chart,” she said. “I felt very special. I knew I was important to them.”
Breast Health | Plastic & Reconstructive Surgery
Oncology | Radiation Oncology | Cancer Support Services
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