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brrh Personalized Breast Care DCA

by Kathy Schilling, MD
Medical Director, Imaging and Intervention
Women’s Center– Center for Breast Care at BRRH


Mammography remains the most important tool for early detection of breast cancer. With the advent of digital mammography, we can expect to continue seeing improvements in survival. However, with medical technology and science advancing every year, we should all ask the question, “What else can I be doing?”

At the Women’s Center– Center for Breast Care at Boca Raton Regional Hospital, we have developed a new philosophy. The philosophy is a personalized approach to care. More and more often in our daily lives we are making choices that make sense for each of us. We have individualized exercise programs, individualized investment plans—even individualized cosmetic makeovers!

We believe it makes sense to offer a more personalized approach to breast care.

For example, the standard for breast imaging is a mammogram that includes four images, or views, of the breast. Some women, however, have very dense breast tissue that appears as patchy white areas on the mammography images. New ultrasound technology can be used as a screening tool for these women and has been shown to successfully find cancers that were not detected through mammography.

While ultrasound is an important test for women with dense breasts, different women need different screenings. Women should be aware of the density of their breast tissue so that they get all the screenings that are appropriate for their individual needs.

Another example of personalized care comes from women who have had breast surgery, such as augmentation with breast implants. While they are believed to be safe, implants can make it more difficult to find extremely early breast cancers on a mammogram. This may be true for implants in front of or behind the muscle.

Breast MRIs are performed with a specialty breast magnet that can see through implants to the chest wall and can maximize breast cancer identifi cation in women with breast augmentation. This imaging tool can also assess the implant itself. Women with breast implants who are at a higher risk for breast cancer may especially benefit from breast MRIs. The Women’s Center–Center for Breast Care offers clinical services to evaluate and develop personalized recommendations for breast implants and imaging.

Finally, while all women are at risk for developing breast cancer, that risk is higher in some women who have family history, genetic predisposition, prior radiation or atypical biopsies. These women may also benefit from an individualized approach to breast screening, including clinical breast exams by a breast health specialist.

New detection technologies are evolving, and at the Women’s Center–Center for Breast Care, we are participating in research and offering women opportunities to enroll in clinical trials. Digital mammography and MRI studies and breast cancer prevention trials are all part of our research efforts. Most recently, hundreds of women participated in a study of a specialized PET scan of the breast called a PEM scan. The exciting results from that study should be available in the coming year. Our next study will offer special imaging to women who are at a high risk for breast cancer. These women will be imaged with a mammogram, MRI and PEM scan to compare the accuracy of all three of these tests.

For more information about the individualized programs offered at the Women’s Center–Center for Breast Care at BRRH, the latest in our state-of-the-art technology or to learn how you can be a part of our clinical trials, please call 561- 955-5000.

For a free physician referral, please call 561-955-LEARN (561-955-3276).

Our Approach to Breast Care

The Center for Breast Care of Boca Raton Regional Hospital meets the breast health care needs of more than 25,000 women each year. The Center is accredited by the American College of Radiology and certified by the FDA. It is also a research affiliate of the Sylvester Comprehensive Cancer Center at the University of Miami. This relationship allows the Center to participate in national research protocols, thus bringing the latest, most promising approaches to patients in our community.

The Center for Breast Care has developed a unique, patient-oriented way of screening, diagnosing and treating breast cancer. Its goal is to work with the 25,000 patients it sees each year to devise a map for the road ahead, making sure patients are as informed and comfortable as possible every step of the way.

Instead of asking breast-care patients at one of the most frightening times in their lives to sort through the opinions and advice of different doctors, the Center for Breast Care advocates a team approach. The Center ensures that staff professionals from all related disciplines- radiologists, oncologists, breast surgeons, plastic and reconstructive surgeons, pathologists, nurses, technologists and therapists review breast cases at a weekly oncology conference. These specialists have group discussions to devise an individualized, cohesive plan of action for each patient. The Center also offers a second opinion service to help women sort out the information they receive.

A high-quality, cost-effective method, the team approach improves the quality of medical treatment by bringing together the best minds and the best resources in the best way to serve each patient. At the center of this team approach is a patient-care coordinator- a nurse (assigned to a patient throughout her experience at the Center) who provides guidance and information at every turn. The patient care coordinator serves as a liaison between doctors, as well as between patient and staff. She is available for questions, education, guidance, and reassurance. It helps provide as much peace of mind for the patient as possible.

With early detection as the single most powerful tool in fighting breast cancer, the Center for Breast Care places strong emphasis on diagnosing cancer early. Staff members know that in order to do this they have to make it convenient for women to schedule a mammogram. Thus, the Center also provides convenient evening and Saturday hours for mammography screening. A clinical breast exam performed by a nurse practitioner can be scheduled immediately following a mammography to ensure a complete exam. Additionally, the Center has a mobile mammography van that travels to pre-arranged and publicized worksites, condominiums, senior centers, shopping malls, civic groups, etc.--allowing us to reach the underserved population.

If the mammogram or breast exam indicates a suspicious area, the Center uses a variety of methods to accurately diagnose a patient's individual situation including, ultrasound, fine needle aspiration, percutaneous stereotactic and ultrasound-guided Mammotome breast biopsy.

One of the procedures mentioned above-percutaneous breast biopsy-has been very well-received by women in the Center for Breast Care's immediate and extended service area. Records at the Center indicate that many women travel well beyond a health care facility's typical service area to undergo this procedure. Many have cited accuracy, convenience (the procedure takes only one-hour and can be performed on an outpatient basis), and aesthetics (there is no breast deformity) as the primary reasons for choosing percutaneous breast biopsy over a traditional surgical biopsy.

The Center was the second facility in Florida and the first in Palm Beach County to employ this advanced technique-and to be accredited by the American College of Radiology in its use. In fact, radiologist and Medical Director of Breast Imaging and Intervention at the Center for Breast Care, Kathy Schilling, M.D., is one of the most experienced physicians in the nation to perform these techniques, including the newer vacuum assisted Mammotome" breast biopsy procedure and also trains other physicians around the world in its use.

When biopsies indicate the presence of cancer, Center for Breast Care patients can choose to have their surgery, radiation therapy or chemotherapy at Lynn Regional Cancer Center of Boca Raton Regional Hospital-just steps away from the free-standing Center for Breast Care. Of special note are several of the ongoing research projects in which the Center for Breast care is participating. In conjunction with Berlex Laboratories, the Center conducted a research study, along with four other breast centers across the United States on the use of magnetic resonance imaging to evaluate the accuracy of breast MRI in women with breast abnormalities scheduled for biopsy.

Under the direction of oncologist and Medical Director, Louise Morrell, M.D., the Center was selected as a participating institution for the new national research study called the STAR Prevention Trial. This is a breast cancer prevention trial comparing Tamoxifen and Raloxifene in postmenopausal women who are considered to be at increased risk for developing breast cancer. The Center is one of 400 centers in the United States to be chosen to participate in this study.

The Center for Breast Care rounds out its health-care program for patients by providing comprehensive risk assessment and genetic testing, wellness education, rehabilitation programs, and counseling. In addition to physical therapy, including lymphatic massage therapy, the Center for Breast Care also offers psychosocial counseling and a variety of support groups for patients and their families. There are many breast cancer support groups offered at Boca Raton Community Hospital. One for young breast cancer survivors, newly diagnosed patients, senior patients, and those who have had a recurrence. We also offer a "men's meeting" for the significant others of the young women diagnosed with breast cancer.

The Center provides a resource and referral network, as well as a health resource library. The Educare Breast Health Series patient teaching sheets have been an invaluable tool in educating the women who come to our Center on all aspects of breast health and breast cancer issues.

The Center for Breast Care at the Women's Center of Boca Raton Community Hospital has been able to assume a leadership role in the screening, diagnosis and treatment of breast cancer. It extends its leadership position via marketing by inviting breast cancer experts and high profile breast cancer survivors to speak at its facility to physicians and/or the general public. Some of those invited include: renowned Swedish mammographer and researcher Laszlo Tabar, M.D.; Chief Breast Surgeon at Memorial Sloan-Kettering, Patrick Borgen, M.D.; lead researcher of the endostatin and angiostatin studies with mice, Michael O'Reilly, M.D.; cancer survivor and television personality, Linda Ellerby; and advocate, Susan Ford Bales, and Assistant U.S. Surgeon General, Susan Blumenthal, M.D.

From its innovative team approach to its research affiliation with nationally renowned facilities and individuals, the Center is dedicated to providing the best possible care for patients.

For more information about the
Center for Breast Care of Boca Raton Regional Hospital,

call (561) 955-5000.

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