Texas Health Presbyterian Hospital Dallas
Vol. 2, No. 2 — October 2011
In this Issue
Understanding Your Cancer Risk
By Sharon Hillgartner, APRN, WHNP-BC
The Center for Cancer Risk Reduction and Genetics helps individuals understand their risk of developing cancer by combining advanced science and technology along with a personalized, hands-on, prevention plan that targets an individual's specific risk. Along with accessing advanced imaging and genetic testing technology, the medical providers at the center work with individuals to help them reduce their risk by conducting a detailed physical exam, taking a complete medical history and providing education on prevention options. Many options are available ranging from biannual assessments, targeted imaging, recommendations for surgical or chemo-prevention and physical examinations provided experts in the field. In addition, all patients are instructed on fitness and nutritional guidelines set forth recently by the American Cancer Society and are encouraged to make these a part of their personalized fight to prevent cancer.
Adapting specific lifestyle changes not only reduces the risk of cancer in those at increased risk, but can reduce the risks associated with sporadic cancers in most individuals. These recommendations include moderate to vigorous exercise five or more times per week for at least 30 minutes, with 45 to 60 minutes being ideal. Nutrition recommendations include five or more vegetables and fruits a day, choosing whole grains over more processed grains and limiting processed or red meats and limiting alcohol to less than four to six servings per week for women and to less than two servings a day in men. For some these recommendations may seem overwhelming. If that's the case for you, pick one change to focus on and once you've mastered that tackle something else on the list. The lifestyle changes you make not only reduce your cancer risk but also those associated with heart disease, diabetes and osteoporosis. What will be the 1st habit you focus on to reduce your risks?
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Patient Success Story
Mary Ajzenman — Breast Cancer
"We only think we know what a day holds," said Mary Ajzenman, age 60, a home health nurse who has experienced many days marked by occurrences, including stage 2, then stage 4 breast cancer. She remains positive and views cancer as a great teacher. "Accept and learn from each day," she said, reflecting on her own cancer, and other personal experiences.
Ajzenman identified a breast lump and was diagnosed with stage 2 breast cancer while living in New Orleans. She underwent chemotherapy, radiation and a lumpectomy, and was receiving weekly Herceptin therapy in 2005 when her treatment was interrupted by Hurricane Katrina. She and her husband left the area and evacuated to Baton Rouge, La., moved to Houston, then to Dallas, all the time continuing therapy thanks to her therapeutic port still being in place and medical records from memory. Later, her cancer came back having progressed to stage 4 — her tumor markers were escalated, side effects of therapy worsened, and the cancer had metastasized to her spine and liver. "With survival rates so grim, I really thought I was looking at the end of my life," she said.
Upon a friend's suggestion, Ajzenman switched to Texas Health Dallas and began a new phase of her care with Kristi McIntyre, M.D. of Texas Oncology. "It's the best thing I could have done," she said. "Dr. McIntyre and her staff gave me confidence and a lot of support as I joined phase II of an experimental treatment (Trastuzumab-DM1 or TDM1) that had not yet been named. I believe no one survived phase I. I got in at just the right time as phase II started, and then the study closed to new patients."
That was 3 1/2 years ago, and Ajzenman has responded quite favorably. She experiences some mild neuropathy; otherwise she says treatment seems more like managing chronic disease than stage 4 cancers. Her disease is being managed with this treatment, along with extensive support and genuine compassion from her family and friends. Ajzenman says the chemotherapy is keeping her tumor markers 'in the middle of normal' and her tumors have shrunk.
At Texas Health Dallas, Ajzenman now receives her specialized chemotherapy treatment every three weeks, as well as quarterly CT scans of her mid-body and heart ultrasounds, since chemotherapy can have a negative impact on heart function. She also continues working a full case load, making home health visits to others in need.
"With cancer, you can feel alone, that the world is passing you by," she said, recalling an inspiring message she once saw posted at an assisted living facility: "Worrying does not empty tomorrow of its troubles, it empties today of its strength." Ajzenman advises others not to 'sweat the small stuff' and hold each day as a gift.
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Breast Cancer in the Digital Age
By Lee Bourland, M.D.
Living in the digital age has been a liberating experience for the modern consumer. If you hear of an appealing book, you download on your Kindle or Nook. If you missed last week's Desperate Housewives, it's available on Netflix. The U.S. Postal Service is bankrupt because sending a letter has become a quaint vestige of the past and costs one thousand times more than an email. So what's the digital revolution got to do with breast cancer? Plenty, if you're a health care consumer of the breast care program at Texas Health Dallas.
That last mammogram just completed in the Peggy A. Bell Women's Diagnostic and Breast Center was all-digital and it was done in half the time with 20 percent less breast compression than traditional mammography. That breast MRI showing such an incredible a level of detail in the breast is a marvel assembled from thousands of images reduced to digits and transported via the Texas Health Dallas servers to your physician's office. Same goes for CT, PET imaging, and every other scan we do when indicated to guide therapy.
The diagnosis of breast cancer begins in a pathology lab. You probably don't know the pathologists at Texas Health Dallas, but we do. We also know how to reach them for "clarification". It seems so obvious, but for the point of emphasis, I'll say it again, accurate pathology and timely reporting are essential in breast cancer diagnosis and treatment. Those results are posted in the patient's digital health record right there when you and your doctor need them.
Texas Health's implementation of a digital health record has been a tremendous advance. It greatly facilitates the management of a complex disease like breast cancer by assembling in a single, searchable, database pertinent information providing one's health providers a top-to-bottom view of breast cancer. I can't imagine making recommendations to the newly diagnosed patient without data describing proliferation rate, hormone receptor status or HER2 over-expression. Likewise, on many occasions I am looking at MRI images on a computer screen while advising a patient in real time about a critical decision such as breast conservation versus mastectomy.
In short, Texas Health Dallas has streamlined the journey through breast cancer treatment with technological advances that place all of a patient's pertinent data in front of the surgeon or oncologist at the time the critical decisions regarding treatment strategy are made.
Texas Health Dallas has the tools you need for comprehensive breast cancer care. To learn more, visit TexasHealth.org/DallasBreast.
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Texas Health Dallas Earns National Accreditation
By Matt Schneider, Administrative Director, Oncology
Congratulations to the physicians, nurses, technologists and others that helped our breast program receive full accreditation from the National Accreditation Program for Breast Centers (NAPBC). NAPBC-accredited centers demonstrate excellence in 27 criteria including prevention, early detection, rehabilitation, surveillance for recurrent disease and support services.
The final step in achieving accreditation through the NAPBC included an on-site review of the entire breast care program. The surveyor, a breast surgeon from a large teaching institution, found that Texas Health Dallas excelled in many areas of breast care. In his report, he wrote, "The strengths of this program are obvious with review of all standards. These participants are leaders in the region and even nationally. The facilities and access to care are spectacular."
The physicians, nurses, staff, and administration at Texas Health Presbyterian Hospital Dallas are obviously very pleased with the new accreditation. "We have a large team of experts with refined clinical expertise working together and we have been doing this for a very long time," said Dr. Lee Bourland, medical director of the breast program. "We know we do good work but it is always great to have our program reviewed by someone from the outside and confirm we are as good as we think we are."
"Our clinical team, paired with the latest imaging technology, including our new Tomosynthesis 3D mammography, makes this a truly comprehensive breast program," said Dr. Katherine Hall.
Last year, Texas Health Dallas and physicians on the medical staff completed more than 36,000 breast imaging studies and performed more than 1,500 breast surgeries. They also treat more than 2,300 new cancer diagnoses each year.
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The Power of Pink
By Vickie Ramsey, Texas Health Presbyterian Foundation
Who knew that shopping could help save a breast cancer patient's life?
For the fifth consecutive year, Brighton Collectibles in NorthPark Center (located near Dillard's) has designated the breast care program at Texas Health Dallas as the beneficiary of a portion of the proceeds from its annual "Power of Pink" jewelry promotion during October. Proceeds help support advanced research and treatment initiatives at the hospital.
Dr. Archana Ganaraj, a breast surgeon on the medical staff of Texas Health Dallas, was at the Brighton store on Oct. 1 for the launch of the "Power of Pink" event. Free online breast cancer risk assessment questionnaires from the Center for Cancer Risk Reduction and Genetics were available.
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Breast Tomosynthesis Arrives at Texas Health Dallas
By Katherine Hall, M.D.
The Peggy A. Bell Woman's Diagnostic and Breast Center at Texas Health Dallas is the first breast center in North Texas and the fourth in the United States to make, newly FDA approved, breast tomosynthesis commercially available to patients. Tomosynthesis is a 3D digital mammogram which evaluates the breast in layers much like a CT scan looks at the body. For nearly three years Texas Health Dallas has been a key participant in the breast tomosynthesis clinical trial, making it the most experienced facility in North Texas in using this technology.
Looking at the breast in slices allows evaluation of dense breasts by removing overlapping densities which can hide cancers. This type of mammogram is beneficial for women who have dense breast tissue, a family history of breast cancer, take hormone replacement therapy or have fibrocystic changes. Looking at the tissues in layers will allow detection of small structural changes and microcalcifications normally hidden by dense overlapping breast tissue.
The procedure takes about the same amount of time as a regular digital mammogram and the tomosynthesis machine is ergonomically designed to make the procedure more comfortable when compared to other mammogram machines. The radiation dose has been kept low and is comparable to a routine digital mammogram.
A physician referral is required. For further information, please visit TexasHealth.org/DallasBreast.
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