Breast Cancer: Expert Care Gives High-risk Patient Excellent Outcome

Liz Lopez received the call she had feared for years on Christmas Eve.

The growth in her right breast was cancerous, Karen Rogers, APRN, a nurse practitioner and nurse navigator at Saint Luke’s South Hospital’s Goppert Breast Center, reported.

Her mother had died from breast cancer at age 56. Liz was the fourth of five sisters to get the disease. It was the sister most recently diagnosed who’d told Liz, “Mammograms aren’t enough. You’re going to have to do more.”

All in the family

So Liz made an appointment with Saint Luke’s High-risk Breast Clinic. After an evaluation and genetic counseling, Liz underwent a baseline MRI. It detected a 1-centimeter nodule that hadn’t shown up on her recent mammogram.

Liz had the same disease as her sisters, but her treatment experience would be much different. While her sisters had struggled to find the right doctors and wrangle appointments on their own, Liz turned to Karen.

As nurse navigator—the patient’s primary point of contact, Karen can recommend doctors, schedule appointments, make sure patients understand treatments, and guide them to helpful services.

“We don’t leave patients with a bunch of phone numbers to call,” Karen said. She booked Liz for a consult with breast surgeon Tammy K. Neblock-Beirne, M.D., two days after Christmas.

Measure twice, cut once

Sitting on the exam table, Liz’s heart pounded, but Dr. Neblock-Beirne immediately made her feel comfortable. The doctor took time to explain the diagnosis: Micropapillary carcinoma caught at Stage 1 before it was palpable or visible on a mammogram.

Dr. Neblock-Beirne went over treatment options, so Liz could make a decision that was right for her. Liz didn’t want to go through multiple surgeries and reconstruction, so she opted for a lumpectomy—unlike her sisters.

Six days later, Dr. Neblock-Beirne removed a 7-millimeter growth. A few days later, Liz learned the margins around the tumor were clear, which meant no more surgery.

Nationally, almost 40 percent of breast cancer patients need repeat surgeries. At Saint Luke’s, the rate is less than 10 percent.

“We work hard for clear margins and a good cosmetic result,” said Dr. Neblock-Beirne.

She uses preoperative MRIs to guide the procedure and ultrasound during surgery.

Liz spent a couple of days recuperating at home. The next stage went just as smoothly.

Thrive, not just survive

Liz had radiation treatments at Saint Luke’s East Hospital because it was more convenient to her job and she was able to work through a shortened treatment course.

New data show that four weeks are as effective as the traditional six weeks that most centers offer, said radiation oncologist O. Kenneth Macdonald, M.D.

The latest knowledge also spared Liz unnecessary treatment.

Her oncologist, Nisreen Haideri, M.D., at Saint Luke’s Cancer Institute, ordered a test to determine whether Liz would benefit from chemotherapy. Her low score spared her. Instead, Dr. Haideri prescribed an aromatase inhibitor (AI), a hormonal blockade, to lessen the chance of recurrence. But first, she checked to make sure Liz didn’t have any bone-thinning, a side effect of AIs.

“We don’t aim just to have our patients survive cancer, but to return them to an optimal quality of life,” Dr. Haideri said. That means using multiple strategies to minimize side effects and treat symptoms, such as fatigue, muscular and skeletal pain, fluid buildup, and depression.

Complete care

Dr. Haideri encouraged Liz to take a nutrition and survivorship class offered at Saint Luke’s Cancer Institute, which helped lift her spirits. And her doctors continued to monitor her closely.

“I couldn’t have asked for better help and support than I got at Saint Luke’s,” Liz said.

Her sisters back in New Jersey couldn’t believe how quick and painless the process was.

Liz had taken vacation time for Christmas, not expecting to spend it undergoing cancer treatment. When she returned to work, her colleagues asked, “How was your break?”

“I had a nice holiday,” she told them. “And thanks to Saint Luke’s, it was the truth.”