Areas of Care

Breast Care A Comprehensive Continuum of Care

A Personalized, Proactive, Patient-Centered Approach to Care

East Jefferson General Hospital takes great pride in providing a comprehensive continuum of care in the screening, diagnosis, staging and treatment of breast cancer. No other center in the region combines state-or-the-art technologies, individualized care plans, advanced treatment options, surgical/reconstructive capabilities and personalized care including nurse navigator services to ensure you have the best care possible.

Breast Cancer Care at EJGH

Breast Cancer Facts

(based upon 2017 data from the American Cancer Society)
  • 255,180 new cases of breast cancer will be diagnosed in the United States this year.
  • 40,610 American women and 460 men will die of the disease this year alone.
  • 1 of every 8 women in the U.S. will be diagnosed with breast cancer during her lifetime.
  • Early stage breast cancer produces no visible symptoms, which is why screening is so vital.
  • Any lumps in your breasts or armpit area, changes in breast/nipple size/shape/color and any nipple discharge should be reported promptly to your physician.
  • Early detection is the key: The survival rates of breast cancer improve dramatically when caught early. 5-year survival rates are 99% for localized cancer, 85% for regionalized cancer and 27% for distant stage cancer.

Breast Cancer Risk Factors

  • Family or Personal History – Having a first degree relative (mother, sister, or daughter) diagnosed with breast cancer doubles a woman’s risk of developing breast cancer. Women with 2 first degree relatives with the disease have a 5 times increased risk compared to a woman with no family history.
  • Reproductive Factors – Pregnancy, breast feeding, birth control and some hormone treatments all factor into raising or decreasing your risk of breast cancer.
  • Obesity/Physical Activity — Women who have a BMI that classifies them as obese (>30) doubles their risk of breast cancer versus women classified as lean. In addition, regular exercise has been shown to have a protective effect in decreasing one’s chances of developing breast cancer.
  • Environmental Factors — Research is ongoing as to the effects of environmental chemicals and the development of cancer. In general, minimizing consumption of processed foods and eating plenty of fresh fruits and vegetables (organic if possible) is recommended. Research has also shown that breast cancer risk increases with higher alcohol consumption.
  • Visit the American Cancer Society website at cancer.org for a more complete discussion of risk factors.

Screening

Mammography – Mammography is the most widely available and scientifically validated screening test that exists today in the fight against breast cancer. Varying sources report different ages when women should begin regular mammography. Most of the physicians at EJGH believe that annual screening should begin at age 40, especially if you have a family history or have any of the other risk factors associated with the disease. In 2017, EJGH expanded our breast center, significantly increasing the number of women we can screen annually. Each year, we perform more than 11,000 mammograms. Our Breast Care Center is staffed with caring, dedicated team members who strive to deliver the best experience possible. Our radiologists specialize in reading mammograms and providing screening that is conducted and interpreted in the best manner available in our region.

Today, we offer digital mammography with tomosynthesis and computer-aided detection. Tomosynthesis (3D) provides our radiologists a more detailed view of the breast and has been shown to increase the accuracy of mammography in numerous clinical studies.

For some patients, supplemental imaging of the breasts with ultrasound or MRI is appropriate. We offer high quality breast ultrasound performed by experienced technologists, as well as state of the art 3T MRI.

If your screening does detect an abnormality, we provide a comprehensive and effective continuum of care built specifically around you, and your particular diagnosis.

Schedule a mammogram by calling: 504-503-6289

 

Diagnosis/Staging

Once we suspect that you may have a malignancy (cancer), the first step is generally to obtain a sample of the breast tissue by performing a biopsy. The biopsy may be performed with mammographic guidance (a stereotactic biopsy), in ultrasound, in MRI, or in surgery. Our breast center staff will work with your physician to expedite this process, as we know how anxiety-provoking this time can be. Once a cancer diagnosis is established, your doctors will determine which (if any) additional tests for staging are appropriate for you. Should you need additional imaging tests for staging (MRI, CT, bone scan, PET/CT), these exams are available in the EJGH radiology department.

Treatment/Care/Response

At East Jefferson General Hospital, we have doctors specializing in every facet of breast cancer treatment, including surgeons, radiation and medical oncologists, and plastic surgeons, all working together to create an all-encompassing treatment plan specifically built around you and your particular cancer. We use a multidisciplinary approach. This is a system that allows all these physicians along with other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others to become a cohesive team working in a unified manner with only one goal in mind…defeating your cancer.

Navigators

EJGH was the first hospital in our region to launch a navigator program. These specially trained nurses are here to guide you, and your family through every aspect of your cancer journey. They can help coordinate appointments, explain new terminologies/procedures, refer you to reliable resources, be a sounding board and, in the case of our financial navigator, even sometimes find grants to help ease the financial burden of treatment. Ask your doctor to set up a consultation with one of our navigators. It will be one of the most important and helpful meetings you will ever enjoy.

Call our Cancer Care Navigators at 504-503-6250 or 504-503-5594.

Personalized Care

Your treatment team will develop a specific treatment plan for you and your cancer. This plan is built around a number of factors including the stage, histologic grade and size of your cancer along with factors about your current health, background and more. We want you to know you are an active participant in this process. Please ask questions. An informed patient is a better patient. The biology and behavior of each breast cancer affects the treatment plan. Some tumors are smaller but grow quickly, while others are larger and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including:

  • The tumor’s histologic grade
  • The stage of the tumor
  • The biology of the tumor (cell type and receptor status)
  • The patient’s age, general health, menopausal status, and preferences
  • The presence of known mutations in inherited breast cancer genes, such as BRCA1or BRCA2

Even though the breast cancer care team will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating early-stage and locally advanced breast cancer.

For early-stage invasive breast cancer, surgery is performed to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor, called a margin.

Personalized Care cont.

For larger cancers, or those that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant therapy. There may be several benefits to having other treatments before surgery:

  • Women who may have needed a mastectomy could have breast-conserving surgery (lumpectomy) if the tumor shrinks before surgery.
  • Surgery may be easier to perform because the tumor is smaller.
  • Your doctor may find out if certain treatments work well for the cancer.
  • You may also be able to try a new treatment through a clinical trial.

After surgery, the next step in managing early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells. These cancer cells are undetectable but are believed to be responsible for a cancer recurrence, as they can grow over time. Treatment given after surgery is called adjuvant therapy. Adjuvant therapies may include radiation therapy, chemotherapy, and/or hormonal therapy.

For recurrent cancer, treatment options depend on how the cancer was first treated and the characteristics of the cancer mentioned above, such as receptor status.

Descriptions of the common types of treatments used for breast cancer are listed below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. It is also important to check with your health insurance company before any treatment begins to make sure it is covered.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is also used to examine the nearby axillary lymph nodes, which are under the arm.

The types of surgery include the following:

Lumpectomy. This is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor. Most of the breast remains. For invasive cancer, radiation therapy to the remaining breast tissue is generally recommended after surgery.

Mastectomy. This is the surgical removal of the entire breast. There are several types of mastectomies. Talk with your doctor about whether the skin can be preserved, called a skin-sparing mastectomy, or the nipple, called a total skin-sparing mastectomy.

Lymph Node Removal

The first pathway of tumor cell spread out of the breast is to the axillary lymph nodes. It is important to find out whether any of the lymph nodes near the breast contain cancer.

Sentinel lymph node biopsy. In a sentinel lymph node biopsy, the surgeon finds and removes a small number of lymph nodes from under the arm that receive lymph drainage from the breast. The pathologist then examines these lymph nodes for cancer cells. To find the sentinel lymph node (the first node receiving lymph drainage from the breast), the surgeon usually injects a dye and/or the radiologist injects a radioactive tracer behind or around the nipple. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. The surgeon can then identify this node at the time of surgery.

If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer. This means that no more lymph nodes need to be removed. However, in cases in which there is extensive involvement of axillary lymph nodes with tumor, an axillary lymph node dissection may be necessary.

Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. These are then examined by a pathologist for cancer cells. The actual number of lymph nodes removed varies from person to person. This procedure is associated with more potential side effects such as lymphedema (swelling of the arm) than a sentinel lymph node biopsy, and therefore is reserved only for situations in which the benefit clearly outweighs the risk of complication.

Reconstruction/Prosthesis

RECONSTRUCTIVE BREAST SURGERY

Many women who have a mastectomy follow that procedure with breast reconstruction, either at the time of the mastectomy or delayed, depending on the overall treatment plan for the cancer. EJGH offers all modalities of advanced breast reconstruction. This includes all the latest technologies involving microsurgery and tissue perfusion assessment (SPY). Techniques and recommendations will vary depending on the type of tumor, the age and health of the patient, and overall goals to restore the most normal breast. Specific types of reconstruction available are the DIEP flap (deep inferior epigastric perforator flap) where skin and fat are taken from the lower abdominal area, tissue expander-based reconstruction, and direct-to-implant reconstruction using a dermal sling (acellular dermal matrix). The DIEP flap is an “all natural” reconstruction. Tissue expansion involves the insertion of an implant which is gradually filled with saline over several months to gradually create the breast mound. Direct-to-implant reconstruction involves the immediate insertion of a permanent prosthesis at the time of the mastectomy. Specialized plastic surgeons tailor the reconstruction based on each patient’s unique needs and expectations. Your surgical team will discuss options with you and together make appropriate recommendations.

As a community hospital where the needs and interests of the patients come first, EJGH and the Breast Care Center are pleased to offer these services on most healthcare plans.

PROSTHESIS

An external breast prosthesis or artificial breast form provides an option for women who plan to delay or not have reconstructive surgery. These can be made of silicone or soft material, and fit into a mastectomy bra. Breast prostheses can be made to provide a good fit and natural appearance for each woman.

Radiation Therapy

RADIATION THERAPY

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. There are several different types of radiation therapy:

  • External-beam radiation therapy. This is the most common type of radiation treatment and is given from a machine outside the body.
  • Intra-operative radiation therapy. This is when radiation treatment is given using a probe in the operating room.
  • This type of radiation therapy is given by placing radioactive sources into the tumor.

Although the research results are encouraging, intra-operative radiation therapy and brachytherapy are not widely used. Where available, they may be options for patient with a small tumor that has not spread to the lymph nodes.

A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time. Radiation therapy often helps lower the risk of recurrence in the breast. In fact, with modern surgery and radiation therapy, recurrence rates in the breast are now less than 5% in the 10 years after treatment, and survival is the same with lumpectomy or mastectomy. If there is cancer in the lymph nodes under the arm, radiation therapy may also be given to the same side of the neck or underarm near the breast or chest wall.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. It may be given before surgery to shrink a large tumor, make surgery easier, and reduce the risk of recurrence, called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy.

A chemotherapy regimen, or schedule, usually consists of a combination of drugs given in a specific number of cycles over a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every 2 weeks (also called dose-dense), once every 3 weeks, or even once every 4 weeks. Our new Infusion Center is built to optimize your treatment time with your privacy and dignity taken into consideration.

The side effects of chemotherapy depend on the individual, the drug(s) used, and the schedule and dose used. These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, constipation, early menopause, weight gain, and chemo-brain. These side effects can often be very successfully prevented or managed during treatment with supportive medications, and they usually go away after treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers such as leukemia and lymphoma. Many patients feel well during chemotherapy and are actively taking care of their families, working, and exercising during treatment, although each person’s experience can be different. Talk with your health care team about the possible side effects of your specific chemotherapy plan.

Hormonal Therapy

Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors. This type of tumor uses hormones to fuel its growth. Blocking the hormones can help prevent a cancer recurrence when used either by itself or after chemotherapy.

Hormonal therapy may be given before surgery to shrink a tumor, make surgery easier, and lower the risk of recurrence. This is called neoadjuvant hormonal therapy. It may also be given after surgery to reduce the risk of recurrence. This is called adjuvant hormonal therapy.

Integrative Medicine

With the introduction of our Integrative Medicine Program, EJGH became the first hospital in our region to offer a comprehensive menu of holistic offerings specifically chosen because of their preventive capabilities or their ability to work effectively in conjunction with other cancer treatments. From special massage techniques that are safe for cancer patients to acupuncture to Reiki Therapy, the offerings of our Integrative Medicine Program have been shown to be effective in helping patients decrease the stress associated with a cancer diagnosis, and the fatigue, nausea and other potential side effects of therapy. Through a grant we offer free nutritional counseling to our oncology patients. This can play a tremendous role in helping you throughout treatment and in living a healthier life in general.

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