What's Best for the Breast

It's good to have all the services in a single hospital-based facility.

Should a hospital be concerned about what might happen to patients 30 years from now? At The Breast Center at Saint Peter’s University Hospital in New Brunswick, the answer is a resounding yes. Because some cancer treatments can affect long-term cardiac risk, clinicians at the center are meticulous about preparing patients for every precaution they should take in decades to come.

“There are more and more long-term survivors,” says breast surgeon Susan McManus, M.D., who directs the center. “Many patients have already survived 20 years or more.” That’s why its Survivorship Program, run by advanced practice nurse Melissa Martinez, gives each departing patient a summary of all the treatments she had, a chart of possible future side effects and guidelines for appropriate screening as the years go by—and the patient’s primary care physician gets a copy too.

That’s just one of the many features that mark The Breast Center at Saint Peter’s as a place prospective patients can turn to with confidence for comprehensive care. The hospital isn’t alone in having a breast center, of course—in recent years, many such institutions have created these centers to provide all breast-related health services.

But in 2009 the Saint Peter’s facility became the first in central New Jersey to earn a full three-year accreditation from the National Accreditation Program for Breast Centers (NA PBC), a program of the American College of Surgeons. (See “The Meaning of Accreditation” on page 19.) And it earned another such three-year designation in 2012.

At The Breast Center, surgeons, oncologists, pathologists, nurses, social workers and others pool their expertise to design a customized treatment program for each patient from its full range of state-of-the-art services.

Patients find it convenient that the center is located right next to the hospital itself. “We’re on the third floor of the Center for Ambulatory Resources (CARES ) Building, adjacent to the Women’s Imaging Center and just down the hall from the CARES Surgicenter, so it’s easy for patients to find their way,” says Dr. McManus. “And being next to the hospital means that if anyone needs more extensive treatments or services —for example, radiation oncology, lymphedema prevention and treatment, or nutrition or genetic counseling— they’re all right here.”

As Saint Peter’s breast surgeon Lisa Hopkins, M.D., explains, breast care demands a multidisciplinary approach. “There is no single treatment you use to care for breast cancer—nobody just has surgery,” she says. “Patients need all the services and support we provide.”

Adds Dr. McManus: “This is one of the state’s original multidisciplinary breast care teams, and we’re committed to that approach. None of us says, for example, ‘This is my patient’ to the exclusion of other clinicians. That attitude helps us ensure a patientcentered approach to medicine, as opposed to a doctor-centered approach. If one of our surgeons decides that you need a biopsy, he or she will get input from the team about how best to approach your case.”

They do this at weekly meetings that have been held every Wednesday since 1991. There they review and discusseach case and formulate treatment recommendations for every aspect of care, from treatments to counseling to insurance coverage. “That is the right way to do medicine,” Dr. McManus says.

Drawing on diverse talents is especially important because the breast health field is remarkably dynamic. “Things are changing from week to week and even from day to day,” Dr. Hopkins says. An understanding of patients’ differing genetic makeup and how it affects disease, for example, is quickly advancing. “As recently as two years ago we might have said, ‘You have a 1-centimeter tumor; here’s your treatment,’” adds Dr. Hopkins. “Now we look at the genetics of the cancer itself, and that drives treatment.”

In fact, The Breast Center team works closely with the Saint Peter’s Department of Medical Genetics and Genomic Medicine, under the direction of Deborah Day-Salvatore, M.D. “Genetics will become ever more important in the coming years,” says Dr. McManus.

Another aspect of medicine with a growing profile is postsurgical exercise— a fact reflected in The Breast Center’s “Moving On” exercise class, which helps recent surgical patients become rehabilitated and helps to prevent lymphedema—swelling caused by the buildup of excess fluids, which can follow the removal of lymph nodes. “People are often scared to do anything, even jumping jacks, after their lymph nodes are removed,” says Dr. McManus. “Our exercise program is run by a dynamo named Katalin Domotorffy, a certified lymphedema specialist.”

Finally, The Breast Center isn’t just for cancer, and it isn’t just for women. Says Dr. McManus: “We also treat benign tumors, infections and abscesses in women—and in men and children too.”

—David Levine

Services offered at The Breast Center at Saint Peter’s University Hospital

• screening and diagnostic mammography services
• bone-density testing
• breast surgery
• radiation oncology
• survivorship services
• “Moving On” therapeutic exercise program
• nutrition and social services
• lymphedema prevention and rehabilitation
• wellness
• genetic counseling

What’s recommended for routine breast cancer screening?

Current American Cancer Society guidelines recommend that women who are 40 or older have a routine screening mammogram every year, in addition to an annual clinical breast exam by a doctor or nurse. (The U.S. Preventive Services Task Force calls for mammograms to begin only at 50 in women with no special family risk, and suggests that the test be repeated every two years.)

Women who have a family history or genetic tendency for breast cancer may need to start the screening process at an earlier age. It’s important to discuss this information with your physician to determine the best time to start screening mammography.

Women between ages 20 and 39 should have a clinical breast exam by a doctor or nurse at least once every three years.

To schedule an appointment for a mammogram at the Saint Peter’s Women’s Imaging Center, please call 732.745.6686. Walk-in appointments for screening mammograms are available Monday through Friday between 8 a.m. and 3:30 p.m. A doctor’s prescription is required.

THE MEANING OF ACCREDITATION

The Breast Center at Saint Peter’s University Hospital is accredited by the National Accreditation Program for Breast Centers (NAPBC), a program of the American College of Surgeons. NAPBC recognizes only centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. They must demonstrate compliance with standards established by the NAPBC for treating women who are given diagnoses across the full spectrum of breast disease, malignant or benign. Standards include proficiency in clinical management, research, community outreach, professional education and quality improvement.

“Over the last three years the Saint Peter’s University Hospital Breast Center has demonstrated a commitment to the guidelines and standards set by the NAPBC to effect positive change,” says NAPBC evaluator Dean T. Nora, M.D. “It’s had important impact in the community.”

Learn about your breast cancer risk

The Breast Center at Saint Peter’s encourages women who have not already been diagnosed with breast cancer to take an online breast cancer risk assessment that calculates lifetime risks of developing breast cancer and categorizes their individual risk levels as low, moderate or high. It takes into account women’s lifestyle and hereditary risk factors and personal history. 

The online risk assessment, found at saintpetershcs.com/Breast Center/Assessment, takes about four minutes to complete. The finished “result report” can be printed and shared with your primary care physician—or call The Breast Center at 732.846.3300 to schedule a consultation appointment.