BayCare’s breast health service line has evolved into a highly organized, fine-tuned symphony of care, with a variety of strengths and unique capabilities. Strategically located across the Tampa Bay region, BayCare’s health system comprises 11 hospitals, seven comprehensive breast centers and 14 imaging centers where patients gain access to the latest advancements available in diagnostic imaging, the newest surgical techniques, and personalized oncological treatment plans designed by teams of physicians and compassionate Nurse Navigators. Referring physicians and patients can be assured that BayCare is committed to the decree that NO patient will be lost to follow-up. The BayCare Outpatient Imaging centers are gateways to its Breast Centers, and the imaging facilities operate in concert with the rest of the health system to notify both the patient and his or her physician if a follow-up mammogram is recommended.
Early Detection Saves Lives
The Center for Disease Control (CDC) and the United States Preventive Services Task Force recommend every other year mammographic screenings beginning at age 50. For women ages 40-49 it is recommended that she and her doctor discuss when and how often she should have a screening mammogram. Dr. Rafael Rocha, a medical oncologist at St. Anthony’s Hospital, is quick to clarify, “These guidelines are for the average risk patient. For a person with a family history of breast cancer, or other high risk consideration, screening mammograms may start earlier, depending on the individuals’ personal risk.”
Communication and education are key goals at BayCare. Based on certain eligibility criteria, some women are assessed for breast cancer risk with the Gail model tool. Created by the National Cancer Institute, these questions help mammography technicians assess risk factors while educating the patient face to face. According to Dr. Angela Sroufe, a diagnostic radiologist at South Florida Baptist Hospital’s Breast Center, “The numerical results are communicated to the radiologist along with the patient’s scan, and we take the time to discuss the results with our patients. Some women with a moderate to high risk for developing breast cancer may benefit from additional screening tests, and specific recommendations of this type are shared with both the patient and referring physician as appropriate.”
3D Mammography Reduces Return Visits
Digital mammography, utilized for screening mammograms across all BayCare imaging facilities, is the first of a wide spectrum of tools used to detect breast cancer early. At BayCare, when a radiologist detects an abnormality in a mammogram, immediate diagnostic options are discussed with the patient. For women with dense breasts, or with an abnormality in a mammogram or ultrasound, two advanced technologies are presented: 3D breast tomosynthesis and Breast Gamma Imaging. Dr. Mia Jackson, a fellowship trained breast radiologist at St. Joseph’s Women’s Hospital, describes the merits of 3D mammogram technology, breast tomosynthesis. “Since the breast is composed of pockets of dense tissue surrounded by fat, overlapping tissue in a digital image makes it difficult to see subtle signs of early cancer. With 3D scans, we can evaluate breast tissue one layer at a time, at all different angles, in one millimeter layers. While digital mammography gives us a 2D view, with 3D breast tomosynthesis we can evaluate a questionable area to determine if it is breast tissue superimposed upon itself or if the area requires a biopsy.” Due to its amazing clarity, Dr. Jackson has seen this technology diminish the need to call patients back for additional scans.
Breast Gamma Imaging detects malignant tissue
Dr. Michael Portillo, a diagnostic radiologist at Morton Plant Hospital, uses Breast Gamma Imaging (BGI) for identifying tumors in dense tissue that often aren’t visible with mammography and for accurate evaluation of indeterminate mammograms or ultrasounds. He explains, “BGI provides an opportunity to detect lesions undetected by a mammogram. It can also be a method of screening high risk patients and can be used for further evaluation of patients with a new breast cancer diagnosis (particularly those who cannot tolerate breast MRI due to pacemaker, claustrophobia, or contrast allergy).” This technology is especially effective in differentiating between malignant and benign tissue, as it is a nuclear medicine procedure that images the metabolic activity of breast lesions by utilizing radiotracer uptake.
Communication with patients enhances their experience
Dr. Claudia Bundschu, a diagnostic radiologist at St. Anthony’s Hospital, believes that communication with the patient can be as important as the tools she uses to evaluate scans. “When a patient comes in for a diagnostic mammogram, we discuss positive or negative findings with them right away, before they leave. Patients really appreciate this immediate feedback. It is an emotional time for them, of course.” Dr. Bundschu has a personal passion for early detection of breast cancer. Her mother, who was a breast surgeon in Brazil, is a breast cancer survivor who was diagnosed at age 39. Dr. Jackson, at St. Joseph’s Women’s Hospital, also agrees with the importance of speaking to as many patients as possible while they are in the breast center. She believes, “How you make a patient feel is more important than the words you are delivering to them.”
Cohesive Breast Health Teams
When imaging findings point to a breast cancer diagnosis, a comprehensive breast health team springs into action. These multi-disciplinary teams used across the BayCare system include radiologists, oncologists, surgeons, pathologists and others. Dr. Arvind Soni, a radiation oncologist at St. Joseph’s Hospital, describes these weekly meetings, Tumor Boards, as “the most effective way we can treat the challenging cases.” He explains, “There is good communication between providers as we create treatment plans, formulate options and collaborate on all the support we can offer to each patient.” Dr. Anthony Rossi, a surgeon at South Florida Baptist Hospital, concurs with Dr. Soni, “Through a team approach with our radiology department, surgical services and medical and radiation oncologists, we are able to provide comprehensive breast cancer treatment at our community hospitals at levels often associated with academic institutions.”
Nurse Navigators are often incorporated into the care of breast cancer patients. Navigators, specially trained RNs, personally meet with patients to explain biopsy procedures, schedule and organize follow-up visits, present resources such as transportation, financial assistance and help with surgery questions and concerns. The Navigator’s goal is to help patients deal with their personal breast cancer journey in a caring, supportive way, improving the experience for patients and their families. At BayCare, they are the bridge between clinical excellence and warm, emotional support.
Most Accurate Biopsies Possible
Image-guided biopsy procedures are conducted at all BayCare Breast Centers using stereotactic, ultrasound and MRI. Dr. Angela Sroufe, a diagnostic radiologist at South Florida Baptist Hospital, explains how the new stereotactic table in the Breast Center improves the accuracy of the tissue extraction. “Patients lay face-down with the breast compressed for mammography. We use the mammogram images in real time to guide the needle more precisely to the suspect area.” Dr. Steven Mandel, a diagnostic radiologist at St. Joseph’s Hospital-North, says, “After the exact needle injection location is calculated, the vacuum-assisted needle draws out tissue to be analyzed. Then, it is either sent directly to a pathologist or digitally scanned first to verify the correct tissue was removed. Our mobile Faxitron®, at St. Joseph’s Hospital-North, can be moved from the Breast Center to the operating room in minutes. It produces a digital image of the biopsied tissue in seconds that confirms the targeted lesion has been excised.” This reduces the likelihood of having to repeat a biopsy.
High-resolution ultrasound-guided biopsies provide details too subtle to see in mammography, and they can be faster and more comfortable for patients than MRI-guided biopsies. With all of the different imaging modalities deployed throughout BayCare, breast cancer is being detected earlier than ever before. “There are still a few cases when it breaks your heart,” according to Dr. Sroufe, “because cancer spread that could have been caught earlier if the patient had been getting regular mammograms.” Dr. Claudia Lago-Toro, a fellowship trained breast surgeon at St. Joseph’s Women’s Hospital and St. Joseph’s Hospital-North, agrees with the trend toward earlier diagnoses. “Because of increased awareness and surveillance, we are not seeing as many metastatic cases. Less than five percent are metastatic, thankfully,” she estimates.
When a biopsy confirms a breast cancer diagnosis, a team of specialists discuss the best way to orchestrate treatment during Tumor Board meetings. Dr. Lago-Toro explains, “Whenever possible, a breast conserving procedure is the goal, removing the cancer with a safe margin of surrounding non-cancerous tissue. Skin-sparing mastectomies with immediate breast reconstruction, as well as nipple-sparing techniques, are wonderful advancements in breast cancer treatment.” Plastic surgeons work alongside breast and general surgeons to attain the most natural result for the patient. Dr. Lago-Toro describes why Oncoplastic Reconstruction is so popular. “We are able to perform a lumpectomy on the afflicted breast, and at the same time, do a reduction on the healthy breast in order to give our patient a more balanced result with just one surgical procedure.” This seems to greatly help the patient’s emotional healing process following breast cancer surgery.
Cutting Edge Treatment Advances
One of the newest treatments available to eligible patients is accelerated partial breast irradiation (APBI). Dr. Kathleen Allen, a breast surgeon at Morton Plant Hospital, explains the procedure, “While undergoing a partial mastectomy, a catheter is implanted in the breast. About a week after surgery, radiation is delivered through the catheter into the partial mastectomy bed twice a day for five days. The catheter is removed at the completion of radiation. This cloud of radiation affects only the surrounding tissue and not the entire breast. Since traditional treatment would require radiation therapy to the whole breast five days a week for six and a half weeks, this is a huge gain for an eligible patient with a small breast tumor.” Normally this is a collaborative decision between the radiation oncologist, surgeon and the patient.
In addition to the sentinel node biopsy procedure that is used to determine if cancer has spread to the lymph nodes under the arm, there is a trend toward analyzing the molecular and genetic composition of the tumor. Across the BayCare system, both Oncotype DX and MammaPrint® are being used to more accurately formulate the best course of treatment for each patient. Dr. Kathleen Allen and Dr. Peter Blumencranz, both fellowship-trained breast surgeons at Morton Plant Hospital, have employed the MammaPrint® diagnostic test for about two years in the analysis of tumors to determine the likelihood of recurrence for a patient. Dr. Blumencranz is extremely passionate about researching the latest breast cancer treatments and applying the newest innovations in his practice. He is currently involved in more than three clinical trials. With regard to MammaPrint®, he says, “Often the results of this test shape the oncologist’s prescription for chemotherapy. About 70 genes are analyzed to determine the chances for systemic (distant) recurrence and what might be the best way to treat it.” A similar test, Oncotype DX, is often employed by Dr. Lago-Toro, of St. Joseph’s Women’s Hospital. She explains, “Oncotype DX test results help us to determine the rate of recurrence expected with the tumor so we can formulate more customized chemotherapy treatment options for patients.”
Clinical Trials are valued at BayCare
Part of a Breast Center’s criteria for achieving the National Accreditation Program for Breast Center’s (NAPBC) designation is that it must have two percent of patients participating in a clinical trial. Though that requirement may seem low, the criterion for each clinical trial is extremely stringent, and it is often challenging to find eligible patients.
Dr. Peter Blumencranz is perhaps BayCare’s most seasoned clinician in the breast cancer clinical trials arena. He is currently involved with four different studies: NSABP B-43, ACOSOG Z11102, NSABP B-49 and MINT I. “One of the trials, B-43, involves testing patients with Ductal Carcinoma In Situ breast cancer to determine if the cancer is HER2 Positive. If it is HER2 positive, we are administering two doses of Herceptin as opposed to the one year treatment plan we prescribe for patients with invasive breast cancer. Hopefully, we will be able to see if the Herceptin deters recurrence over the course of 10 years,” explains Dr. Blumencranz. The clinical trial, known as B-49, involves collaboration between Dr. Blumencranz’ surgical team, radiation oncologists and medical oncologists. Together, the cohesive group tracks patients after surgery and through various combinations of chemotherapy.
Dr. Blumencranz is seeing positive outcomes of many clinical trials after long term observation. “We are mandated to practice evidence-based medicine,” he says, “and if we do the research, we create the evidence. We are witnessing progress and making huge strides here in breast cancer treatment.”
Dr. Kathleen Allen describes clinical trial Z11102, “This study is cutting edge because it studies the patient with more than one focus of cancer in their breast. Specifically, we are looking at prognosis, treatment, tumor heterogeneity and cosmesis in breast conservation in this setting.”
Reconstruction Surgery for Emotional Healing
We know the cosmesis of a patient is important, and BayCare has several plastic surgeons who specialize in breast surgery. Dr. Melanie Aya-ay, a plastic surgeon at St. Joseph’s Women’s Hospital who has a family history of breast cancer, maintains that “plastic surgeons help to restore shape and symmetry in the breast cancer patient.” She often accompanies the breast surgeon performing the mastectomy and performs immediate breast reconstruction, but she explains, “There are times when a delayed immediate reconstruction is required, and the first stage of reconstruction is performed two to three weeks after the mastectomy. In patients with more advanced disease or in cases that require radiation therapy, breast reconstruction can be completed months or years after the mastectomy.”
Emotional healing goes beyond the realm of great cosmetic results or BayCare’s compassionate team members at its infusion centers. BayCare offers support groups, cancer resource centers, fitness classes and many other seminars and events designed to provide patients with the latest advancements both clinically and emotionally. The goal is always toward recovery, health and happiness for patients who take advantage of our comprehensive breast health services as well as those who may only look to BayCare for a segment of care.
Breast cancer is most treatable when tumors are found early, so mammograms play a key role in monitoring your breast health. At BayCare, we offer digital mammograms at the following outpatient locations which are all accredited by the American College of Radiology for mammography and breast ultrasound. For detailed information, go to EmbraceYourHealth.com or call (888) 906-8892.
BayCare Outpatient Imaging (Carillon) • BayCare Outpatient Imaging (Riverview) • BayCare Outpatient Imaging (St. Anthony’s) • BayCare Outpatient Imaging (Van Dyke) • BayCare Outpatient Imaging (Westchase/Hampton Lakes) • BayCare Outpatient Imaging Center (Bardmoor) • Imaging Services at Mease Dunedin Hospital • Hinks and Elaine Shimberg Breast Center at St. Joseph’s Women’s Hospital • South Florida Baptist Hospital Breast Center • St. Joseph’s Hospital – North Breast Center • Susan Cheek Needler Breast Center at Mease Countryside Hospital (Medical Arts Building) • Susan Cheek Needler Breast Center at Morton Plant Hospital (Axelrod Pavillion) • Susan Cheek Needler Breast Center at BayCare Outpatient Imaging (Trinity) • Susan Sheppard McGillicuddy Breast Center at St. Anthony’s Hospital
American College of Radiology (ACR) Breast Imaging Centers of Excellence
These BayCare facilities were named Breast Imaging Centers of Excellence by the American College of Radiology (ACR) for mammography, breast ultrasound, ultrasound-guided biopsy and stereotactic biopsy.
- St. Joseph’s Hospital-North
- Morton Plant’s Susan Cheek Needler Breast Center
- St. Anthony’s Susan Shepard McGillicuddy Breast Center
National Accreditation Program for Breast Centers (NAPBC)
A breast center that achieves NAPBC accreditation has demonstrated a firm commitment to offer its patients every significant advantage in their battle against breast disease.
- Morton Plant Hospital’s Susan Cheek Needler Breast Center
- St. Anthony’s Susan Sheppard McGillicuddy Breast Center
- St. Joseph’s Women’s Hospital’s Shimberg Breast Center
By Debbie Trujillo