March 3, 2018 is Triple-Negative Breast Cancer Day. We have known for a while that not all breast cancer is created equal. Most breast cancer is ‘hormone-fueled’, meaning that the cancer cells have estrogen and variably progesterone receptors on their cell surface, and are stimulated to replicate by circulating hormones in the blood. When these hormone receptors and another type of receptor (called HER2) are missing, the cancer is termed “Triple-Negative Breast Cancer.” Because of its triple negative status, triple negative tumors generally do not respond to receptor targeted treatments. Depending on the stage of its diagnosis, triple negative breast cancer can be particularly aggressive, and more likely to recur than other subtypes of breast cancer, hence chemotherapy is almost always used in its treatment.
A breast biopsy is a procedure performed while in the office while you’re awake to obtain a sample of tissue to evaluate a breast lump or an abnormality that was seen on a mammogram, ultrasound or MRI. Copious amounts of local anesthetic (numbing medicine) are used to the numb the skin and deeper tissue in the breast to minimize discomfort. A needle is then placed in the abnormality in the breast to obtain tissue. A small marker is usually left to mark the location where the biopsy was taken. The tissue is then sent to the pathologist to be evaluated under the microscope and obtain a diagnosis. Breast biopsies are usually performed using breast imaging guidance, usually an ultrasound or a mammogram machine. Results from the biopsy usually are available in one or two business days.
We are excited to announce that Centegra Health System’s Comprehensive Breast Program at Gavers Breast Center has earned its third consecutive award as a breast program of excellence from the National Accreditation Program for Breast Centers (NAPBC).
When a breast center achieves accreditation by the National Accreditation Program for Breast Centers (NAPBC) you can be assured that it is held to the highest standards of care for patients with diseases of the breast. The NAPBC is administered by the American College of Surgeons (ACS), which for more than 100 years has led national and international initiatives to improve quality in hospitals.
The National Accreditation Program for Breast Centers (NAPBC) represents a consortium of national, professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. This mission is pursued through standard-setting, scientific validation, and patient and professional education. The NAPBC Board of Directors works diligently to ensure multidisciplinary leadership representation, and to include nationally recognized breast cancer quality performance measures in the NAPBC standards that serve as a platform for measuring quality improvement.
The NAPBC accreditation process includes comprehensive evaluation of 28 specific breast cancer quality standards performed during a full day site survey in the field of breast surgery, breast radiology, medical and radiation oncology, patient education, outreach, lymphedema management and physical therapy, nutrition counseling, complementary therapies such as yoga, water therapy, and physical exercise. All 28 standards were met and our program was nominated for several best practices.
This honor validates the quality and passion that our breast cancer team constantly displays and is an impressive addition to our growing list of national awards and recognition. Exhaustive hours of preparation, precise attention to details and teamwork were the perfect recipe for a successful re-accreditation of our breast program.
On Thursday October 17, I was invited to the studio of Star 105.5 FM to discuss new approaches to breast cancer care live on Joe and Tina’s Morning Show. The hosts, Joe Cicero andTina Bree were excellent interviewers and it was great to meet them in person. They were both born and raised in the Chicago area and they do a great job on the show.
We discussed the concept of a breast program multidisciplinary team where the patient first meets the breast navigator after a cancer diagnosis. The breast surgeon is then the first physician that the newly diagnosed patient encounters. During the first personalized consultation, the patient’s entire medical history including family history of cancer is discussed with the patient to determine how this affects the management of the cancer with respects to the patient’s individual needs. Management also is determined by the specific type of breast cancer.
We also discussed the concept of genetic testing to evaluate if certain women (and men) are at high risk of breast cancer and what they can do about it. We discussed Angelina Jolie and her choice to undergo bilateral prophylactic mastectomy. We discussed the newer types of mastectomy specifically nipple sparing mastectomy and the enhanced cosmetic results.
We finally talked about the newest recommendations about breast cancer screening and breast self exams.
Our 2017 October Breast Cancer Awareness T-Shirts for Centegra Comprehensive Breast Program have arrived! They will be worn by Centegra Gavers Breast Center staff during the month of October to raise awareness for breast cancer.
One in eight women will be diagnosed with breast cancer. Some women have a genetic predisposition, but most breast cancer is not caused by genetic factors. Daniel J. Farrugia, MD, PhD, a fellowship-trained breast surgeon with Centegra Physician Care and medical director of the Comprehensive Breast Program at Centegra, will discuss the newest research into the causes of breast cancer and what you can do to minimize your risk.
Sign up below and bring your friends!
Date: October 10, 2017
Time: 6.30 pm
Location: Centegra Hospital – Huntley, Lower Level
Foglia Family Foundation Education Center
10400 Haligus Road, Huntley, IL
Or Call 877-CENTEGRA (877-236-8347)
See you there!
Here are two recent insightful articles published in the British press regarding things that one may unwittingly say to people suffering from cancer that blames the sick person for society’s discomfort with their reality and shifts any accountability back on to them.
In general, there are no contraindications to receiving vaccinations before or after surgery.
Streptococcus pneumoniae (Pneumococcal) vaccine
Pneumococcal vaccine is recommended for patient > 65 yrs of age. It is also recommended for patients 18 yrs and older with chronic heart, lung, renal, or metabolic disease, immunosuppressed patients and asplenic patients.
Revaccination with a second dose should be given if it has been > 5 year since the first dose AND the patient was < 65 years when first vaccinated, OR the patient continues to be at high risk for serious pneumococcal infection due to a chronic condition. If the patient received the 1st dose after age 65 and has no comorbidities, a second dose in not recommended.
Influenza Vaccine (available October through March)
Influenza vaccine is recommended for patients > 50 yrs of age. It is also recommended for patients 18 yrs of age and older with chronic heart, lung, renal or metabolic disease, immunosuppressed patients, and asplenic patients. Revaccination is annually. Influenza vaccine is only given during the yearly published vaccine season, usually October – March.
Follow the instructions of your Radiologist.
If you had a pain block, do not drive for eight hours following your procedure. We advise resting at home the first evening after your procedure. The local anesthetic medication may cause weakness or numbness in the area affected by the injection (e.g., arm or leg). You may gradually increase your activity as tolerated the next day.
You may experience a local pain in the area, and possibly an exaggeration of the pain being treated. This is not unusual and should decrease in one to two days. Continue to take your pain medications as previously ordered by your primary physician.
You may shower and/or bathe in 24 hours. Avoid pools and/or spas for four days.
Keep the injection site clean and dry. Remove bandage 24 hours following your procedure.
Effects of Procedure
If you received a steroid medication with a pain block injection, it may take PaiDdanywhere from five hours to three days to take effect.
Notify your primary care physician if:
- you experience prolonged numbness
- you develop severe pain
- you develop a fever greater than 100.4 degrees Fahrenheit or 38 degrees Celsius
- your injection site develops increased redness, swelling or has a pus-like discharge.
Avoid hot water or heat application until numbness is gone.
This week, the journal Modern Pathology, a Nature Publishing Group journal, published Dr. Farrugia’s research that proposes a novel algorithm that can predict the effectiveness of chemotherapy to shrink breast cancer tumors prior to surgery and the risks of tumor recurrence. Presently, a molecular test that costs $4,175 (Oncotype DX) is used to predict the chance of a breast cancer recurring. At the University of Pittsburgh Medical Center, Dr. Farrugia embarked on a study to come up with a much less expensive test that gives essentially the same information about risks of cancer recurrence after chemotherapy by looking at certain pathological features of the tumor such as its rate of cell replication and the presence of hormone receptors on the surface of tumor cells. This score predicts both the chance of a breast tumor to respond to chemotherapy, and also the risks of the tumor to recur after chemotherapy. This inexpensive test gives equivalent information as the $4,175 test called the Oncotype DX, and is an attempt to provide new clinical tools that avoid the spiraling costs associated with breast cancer care.Dr. Farrugia presented this study at the American Society for Clinical Oncology annual meeting in Chicago, and for this work was honored with the American Society of Clinical Oncology Conquer Cancer Foundation Merit Award.
Farrugia DJ, Landmann A, Zhu L, Diego EJ, Johnson RR, Bonaventura M, Soran A, Dabbs DJ, Clark BZ, Puhalla SL, Jankowitz RC, Brufsky AM, Lembersky BC, Ahrendt GM, McAuliffe PF, Bhargava R. Magee Equation 3 predicts pathologic response to neoadjuvant systemic chemotherapy in estrogen receptor positive, HER2 negative/equivocal breast tumors. Mod Pathol. 2017 May 26. doi: 10.1038/modpathol.2017.41.