By Nancy Devault, Staff Writer
Breast cancer is the second most common type of cancer among women in the United States, following skin cancer. According to the American Cancer Society, this year an estimated 227,000 women and 2,200 men will receive a diagnosis of breast cancer. Established in 1997, Florida Hospital Celebration Health, part of the not-for-profit healthcare system operated by Seventh-day Adventist Church, specializes in the health and wellness of women, with a new concentration on providing premier care surrounding breast health.
The resort-style hospital located in the Disney-planned town of Celebration focuses on ‘treating the mind, body and spirit’ of patients with a 172-bed, state-of-the-art facility by offering a broad range of services for diabetes, heart health, orthopaedic well-being, spine care, weight management and bariatric surgery, in addition to Seaside imaging, emergency services and prevention programs. Celebration Health has quickly earned a trusted reputation for delivering highly efficient care through several dedicated female-specific centers such as The Baby Place, Endometriosis Center, and Center for Complex Abdominal and Pelvic Pain Syndrome (CAPPS). The most recent designated center, the Comprehensive Breast Health Center at Florida Hospital Celebration Health, opened its doors in October 2011 to serve residents of Osceola, Orange, Polk and Lake counties, and patients from around the world.
With 15,540 new cases of breast cancer in Florida alone, Florida Hospital Celebration Health sought innovative leadership to launch the area’s first comprehensive breast center. Olga Ivanov, MD, FACS, a board certified and fellowship-trained breast surgeon, was named Medical Director of the expanding center. Recently becoming a fellow of the American College of Surgeons, Dr. Ivanov has received national distinctions earning honors in the 2010 Consumers’ Research Council of America’s Top Surgeons and 2010 Patient’s Choice Award as one of Illinois’ Favorite Physicians.
“Breast cancer has an extremely high survival rate with an excellent chance for a high quality of life, yet there is still always a sense of emergency initially felt by the patient and her family. The fear of the unknown is two-fold igniting concerns impacting not only the physical health of the breast and body, but many aspects of her psychological health as well,” said Dr. Ivanov, who received her medical degree from the Medical College of Ohio, completed her residency in general surgery at Loyola and, in 2005, completed her fellowship training at Northwestern Memorial Hospital.
The Operation of Cooperation
In recognizing the ‘whole-body’ implications of breast cancer, Dr. Ivanov established a multidisciplinary plan for fast and effective treatment through a devoted collaborative approach involving an array of medical specialists. This eleven person squad includes Pathologist, Radiologists, Medical Oncologists, Radiation Oncologists, Plastic Surgeons, Nursing and Genetics Teams, Patient Navigators, Dietitians and Exercise Physiologists.
“I am in constant communication with my team of medical partners every day. Thanks to Celebration Health’s ultimate cooperative approach, paired with our rapid treatment plans, these update-to-date conversations impact the actions saving the lives of our patients,” expressed Dr. Ivanov.
The Comprehensive Breast Health Center at Celebration Health provides a full range of care aiming to combat breast cancer through an early stage diagnosis, either identified onsite (through abnormal mammograms) or through referring associates at area imaging centers, primary care physician offices and Obstetrics and Gynecology practices.
“After the initial early diagnosis, we work to ease their anxiety by reassuring that they will be fine. It is important to stay positive during treatment and about life,” said Dr. Ivanov, who says that she takes the time to explain a detailed outline of exactly what will happen during the patients course of care. “It can be one of the most traumatic times in her life with so many questions. I explain who they will see, when steps will take place, what we will do starting from time of diagnosis through the five-year mark (a survival milestone). Most importantly, we work to educate my patients on their treatment choices.” This discussion, paired with her expert advice on achieving optimum results, starts the prompt implementation of treatment interventions.
Dr. Ivanov says that early stage intervention (categorized as stage 0, I and II) accounts for approximately seventy-seven percent of her patient population, with the remaining twenty-three percent of patients initial treatment commencing after a late stage breast cancer diagnosis (stage III or IV). Currently the majority, about seventy percent, of those diagnosed with early stage breast cancer opt to have a lumpectomy, a breast conserving surgery combined with radiation; with the remaining thirty percent choosing a more aggressive approach with a mastectomy, removal of the entire breast containing the tumors or cancerous cells.
“A patient’s lifestyle can play a big part in deciding which option is best for them; especially considering the advantages and disadvantages of each method,” Dr. Ivanov adds. Women sometimes select a mastectomy to avoid weeks of follow-up and radiation therapies. “Sometimes a woman elects for the mastectomy over a lumpectomy because she doesn’t feel she can commit to the needed time of radiation. Patients who are mothers often think ‘who will take care of my family during that time’; especially if she experiences side effects that temporarily impact quality of life.”
A Radiating Evolution of Radiation
The medical community is constantly striving to enhance treatments, techniques and procedures for improved outcomes and added benefits to patients. Despite the success of traditional radiation therapy, Dr. Ivanov says that developments were essential for patient convenience, a contributing factor in one’s care.
“Following a lumpectomy, patients typically would require six weeks of radiation treatment. The logistics of following up every day for what is just about a minute procedure can be a strain for many patients. As a result, up to one-third of patients nation-wide instructed to receive radiation do not complete this follow-up treatment,” she explains. “Unfortunately the health of these women can then be compromised. Thirty-five to forty percent of such patients who did not complete radiation experienced a reoccurrence of breast cancer, compared to the possible five percent of those who did.”
The Comprehensive Breast Health Center at Celebration Health typically has an impressive 24 – 48 hour turnaround time in assessing the breast health condition, devising a course of action (with input from the ‘Tumor Board’ comprised of the team of medical specialists) and scheduling of appropriate procedures. “Though the early stage of breast cancer for the most part may not be a life or death emergency, we know that our ‘no wait time’ is best for the patient, especially emotionally.”
One of the cutting-edge approaches spearheaded by Dr. Ivanov at Celebration Health is treatment utilizing Intraoperative Radiation Therapy (IORT), a relatively new cancer technique performed at only about twenty sites nationally. One of the first, Little Company of Mary Hospital in Chicago, was launched by Dr. Ivanov, who served as Medical Director and her previous colleague, Adam Dickler, MD, Radiation Oncologist. Dr. Ivanov says that during breast surgery, she first will ‘remove the cancerous tumor, and then the radiation oncologist administers the Intraoperative Radiation Therapy during the surgical procedure.’ A high dose of radiation is delivered within minutes through concentrated electron beams directly into the affected tissue area. Including IORT into a lumpectomy procedure can add approximately thirty minutes to total surgery time.
“With IORT, we radiate the area around the lump after removing it, but before closing the incision,” Dr. Ivanov explains. “It gives women the same effective dose of radiation in one 20-minute session as they would get in six weeks of daily radiation therapy after surgery.”
Dr. Ivanov and Dr. Dickler completed a clinical study showcasing data collected over a four-year trial period involving seventy-five patients treated with IORT. The results of their research, published in Annals of Surgical Oncologyin February 2011, mirrored similar positive outcomes conducted in larger scale European research trials which illustrated that IORT was as effective as or better than traditional external beam radiation therapy in eliminating residual cancer cells and reducing the risk of breast cancer reoccurrence.
Dr. Ivanov says there are many benefits for eligible patients who receive IORT treatment. Since higher, yet tolerable, radiation dosages are delivered directly into cancer bed, healthy tissue is shielded from exposure; hence a safer application for other organs compared to traditional radiation treatments. Additionally, IORT is a faster procedure that administers the necessary amount of radiation needed or can boost the radiation process to limit the length of external radiation follow-up. Thus, Dr. Ivanov’s completion rate of radiation is 95 percent, greatly higher than the national average.
Dr. Ivanov and her multidisciplinary team of experts at the Comprehensive Breast Health Center have begun another Intraoperative Radiation Therapy clinical trial at Celebration Health. “Our initial IORT clinical studies seem to be standing the test of time however, we are looking forward to gathering more data and achieving success rates a decade out.” Eligible candidates to be considered for inclusion in the research study will match specific selection criteria such as diagnosis level (early stages) and age (60+ years of age). Sites throughout the country are now exploring the use of IORT to treat other forms of cancer including cervical, colon, esophageal, ovarian, pancreatic and skin. “If I can offer patients fighting cancer the option to forgo the hassle and pain associated with radiation and chemotherapy, I know that I’m making a difference in that person’s life – the overarching goal of any doctor.”
Fluent in Ukranian, Russian, French and Spanish, Dr. Ivanov is excited to now be receiving international referrals to the Comprehensive Breast Center at Celebration Health. “There used to be a misguided understanding that cancer was a guaranteed death sentence, so getting mammograms was viewed as pointless. We still may not know how to fully prevent getting breast cancer, but we now know better ways to treat and cure cancer, especially when identified in the early stages of the disease.”
Currently specialties, in addition to IORT, included at the Comprehensive Center for Breast Health at Celebration Hospital are consultation and clinical examination, abnormal mammogram evaluation and management, breast surgery, ultrasound and stereotactic breast biopsy, oncoplasty, high-risk management, benign and malignant breast disorders, gynecomastia and Accelerated Partial Breast Irradiation (APBI).
“While these specialties are essential to our program, our wellness strategy is a comprehensive mind, body and spirit approach. This ‘whole-body’ method incorporates individualized plans inclusive of fitness, nutrition and massage. I do actually write prescriptions for Yoga,” says Dr. Ivanov. She is coordinating with Florida Hospital leadership to expand upon these female-specific comprehensive opportunities. “Our vision is to open a Celebration Health Institute for women, a fully inclusive medical facility. The project could break ground as early as summer of this year and open its doors the following summer in 2013.Breast Health Center at Celebration Health 400 Celebration Place Suite A240
Celebration, FL 34747 Phone: (407) 303-4760 www.celebrationhealth.com