Specialized Program Benefits High-Risk Patients
A breast-health practice established at Christian Hospital is improving care for underserved patients in north St. Louis County. Washington University breast surgeon Virginia Herrmann, MD, established the practice in 2014 and has since increased the volume of breast cancer patients at the hospital, engaged in community outreach and started a program for women at high risk for breast cancer.
Herrmann was co-director of the Washington University Breast Surgery Program at Barnes-Jewish Hospital from 1998 to 2004 and then served as medical director of the Breast Health Center at Hollings Cancer Center in Charleston, South Carolina. Now back in St. Louis, she treats many patients who are uninsured or underinsured and have a broad spectrum of health conditions and risk factors for breast cancer: The average body mass index is between 38 and 41 (over 30 is obese), and common conditions include diabetes, hypertension and high cholesterol.
“Sixty-eight percent of my patients are African American,” says Herrmann. “While African-American women have a lower incidence of breast cancer than white women, their mortality is higher. That’s largely because African-American women are more prone to getting triple-negative disease — meaning they are estrogen negative, progesterone negative and HER2 oncogene negative — which is more aggressive, harder to treat and has a higher mortality rate.”
Herrmann makes a special effort to identify women at high risk for breast cancer, sending them to the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine for genetic testing and tracking their appointments. Women with aggressive cancer are reported at the Siteman and Christian Hospital tumor boards, so they are eligible for clinical trials.
Herrmann also visits individual physician practices to promote her practice and hopes to hire a nurse navigator to help patients who have barriers to making appointments. She is encouraged about her efforts to build permanent programs in the community for low-income women with breast cancer.
“On a good day, I feel absolutely energized and excited,” says Herrmann. “On a bad day, I know this is meaningful work.”
About 300,000 cases of breast cancer are diagnosed each year in U.S. women. Of these, roughly 180,000 women are treated with breast-conserving surgery. About 20 percent require second surgeries to remove residual cancer cells. Breast surgeon Rebecca Aft, MD, PhD, worked with Caltech biomedical engineer Lihong Wang, PhD, to apply photoacoustic imaging microscopy for better visualizing tumor tissue. Photoacoustic imaging pulses light into tissue, generating a sound wave that is then converted to an image. The technology, used with a computer algorithm, was successful in identifying cancer at the margins of breast tumor specimens. The researchers believe it could be used during the operation to help avoid second surgeries.
Patients with multiple endocrine neoplasia type 2 (MEN2) have genetic mutations that nearly always cause medullary thyroid carcinoma. The routine preventive treatment — removal of the thyroid and parathyroid — yields excellent long-term results but for 6 percent of patients leads to hypoparathyroidism. A study by section chief Jeffrey Moley, MD, and colleagues found that leaving the parathyroids in place along with selective central node dissection is a safe alternative that reduces the rate of hyperparathyroidism to 1 percent.
William Gillanders, MD, Amy Cyr, MD, Rebecca Aft, MD, PhD, and Julie Margenthaler, MD, were co-authors of a study that found axillary ultrasound (AUS) provides accurate screening for clinically significant axillary lymph node disease in patients with early-stage breast cancer. The authors concluded that AUS could be used as an alternative to sentinel lymph node biopsy, which is invasive and is the standard of care.