How refreshing for a physician to go to a prestigious conference and come away feeling that we really do a good job managing our patients right here in Auburn! I recently had the opportunity to attend the Lynne Sage Breast Cancer Symposium in Chicago, one of the largest breast cancer conferences annually in the United States. Northwestern University was the sponsoring academic institution for the conference. While many ideas for the future were presented, it was good to know that for day-to-day care of breast cancer patients in 2009, Auburn really does offer state-of-the-art care.

Women in Auburn have their mammograms performed on digital mammography units. These machines have high-quality pictures and give the radiologist the opportunity to “wander through the breast tissue” using computer-generated images. Abnormal areas seen on mammogram can be assessed by ultrasound if needed. Ultrasound helps to distinguish cysts from solid masses and may be used to guide certain biopsy procedures. A woman may need a stereotactic biopsy - a minimally invasive needle biopsy of an abnormal area seen on mammogram. These are done every Friday at Auburn Memorial Hospital. MRI-directed biopsies should soon be available.

High-quality pathology services are extremely important to a breast cancer program. Auburn Memorial is fortunate to have an efficient and accurate pathology department. Not only does the pathologist identify if a tumor is present, but information is given regarding grade, stage, type of tumor, presence of hormonal receptors and information regarding HER2, a protein that controls cell growth and repair.

Once a diagnosis of breast cancer is made, qualified surgeons can perform needed interventions. More advanced tumors may require a mastectomy (removal of the entire breast), but most breast cancers are now being found in early stages where removal of the whole breast is not necessary. Lumpectomy (partial mastectomy) is combined with a sentinel lymph node biopsy - a procedure using tracer dyes that identify the immediate lymph nodes draining from the breast so that all the nodes under the arm do not have to be removed. This limits a patient's potential for arm swelling after surgery.

Breast cancer is truly a “team sport.” Usually a primary care physician or gynecologist obtains the mammogram. Radiologists perform the imaging studies. Surgeons do the biopsies and whatever surgery is indicated. After surgery, patients usually see a radiation oncologist and/or medical oncologist.

Women who have lumpectomies all need radiation therapy to the remaining breast tissue. This can be given to the whole breast right here in Auburn. Some women are candidates for a MammoSite catheter, a special catheter inserted at the time of surgery for radiation directed specifically at the tumor bed (the area where the tumor was removed). These catheters are implanted at the time of surgery. Whereas whole breast irradiation takes about 30 days (five days a weeks for five to six weeks), radiation given via a MammoSite catheter takes only five days. The actual radiation dose with a MammoSite must be given in Syracuse, but all preliminary care and radiation follow-up can be done in Auburn.

Every woman with breast cancer should also see a medical oncologist. This intervention is also available right in Auburn. This may involve chemotherapy or hormonal therapy or a combination of both.

For women with a strong family history of breast or ovarian cancer, genetic testing (BRCA evaluation) is available to help determine if there is a special genetic mutation. Intervention for very high-risk women (bilateral mastectomies or removal of the ovaries) can then be discussed. Genetic markers on actual breast tumors can be assessed (Oncotype DX). This allows targeted treatment to know which patient may or may not benefit from chemotherapy.

There is much to be learned about breast cancer and particularly what causes it, as well as possible means of prevention. Really not much is known about the “why” of breast cancer. For now, we can best be comfortable knowing that state-of-the art care is available to the women of Auburn who do develop this dreaded disease. Auburn truly does get an A+ in breast cancer care.

Dr. Deborah Geer is a general surgeon with a special interest in breast surgery. Reach her at 253-4536