Rise of the Breast Surgical Oncologist
The specialty is key to helping patients navigate complex breast surgery options.
The good news about breast cancer is that as awareness campaigns have enjoyed rampant success, the number of early detections have increased. Unfortunately, even with the world painted pink each October, about 1 in 8 women — or 12 percent of the population — will still experience invasive breast cancer. That’s a quarter of a million cases this year alone. And lest we forget, males get breast cancer too — about 2,600 cases per year.
In the wake of the controversial double mastectomy Angelina Jolie chose to prevent breast cancer, breast surgical oncologists are fielding more questions than ever about the complex options for treating breast cancer.
John Colfry, M.D., a Breast Surgical Oncologist at Touro Medical Center, completed a prestigious fellowship at the University of Texas MD Anderson Cancer Center and now shares his knowledge with breast cancer patients in New Orleans and the Gulf South region.
Q: Dr. Colfry, why should women consider breast surgical oncology care?
A: Guidelines for the management of breast cancer change several times per year. Intimate knowledge of these changes is essential for proper oncologic care. Breast cancer is no longer a vanilla diagnosis. From a biological standpoint, every patient’s cancer behaves differently. Breast surgical oncologists dedicate all of their efforts to navigating breast cancer patients not only through surgery but also chemotherapy, radiation and reconstructive surgery. In 2016, the buzzword for cancer care is “multidisciplinary.” This means that the entire oncology team meets on a regular basis to discuss newly diagnosed cancer patients and develop a plan tailored toward their specific cancer.
Q: What surgical options do women diagnosed with early stage breast cancer have?
A: Early stage cancers are typically smaller cancers and are more amenable to breast conservation (lumpectomy). This allows most women to keep their breast. Previous reservations about undergoing lumpectomy revolved around defects in the breast where tissue was removed. However, with the advent of oncoplastic surgery (combining plastic surgery with oncology), I am able to rearrange tissue in the breast to help fill the defect and smooth the breast for a natural look.
Q: What about surgery for later stage cancers?
A: For women beyond stages I or II, typically the tumor size is larger and the cancer has likely spread to the lymph nodes. Many of these patients will undergo chemotherapy first, followed by surgery. This allows for possible down-staging of the cancer and possibly converting patients who were not lumpectomy candidates into possible lumpectomy candidates. If down-staging does not occur or if the patient prefers mastectomy, there are several different types of mastectomies in which nipple preservation may be a possibility.
Q: What are some circumstances where a breast surgical oncologist can help a woman navigate their surgical options?
A: One of the biggest decisions breast cancer patients have to make is the choice between lumpectomy versus mastectomy. This is a very tough decision for some patients. I help guide patients on choosing the correct type of mastectomy: traditional; skin sparing; and nipple sparing. When women have breast cancer in just one breast, most patients believe a double mastectomy is the appropriate choice. In actuality, this is rarely the appropriate choice. Double mastectomies are appropriate for patients with a genetic mutation, patients with aggressive cancer biology or very young patients.
Q: What innovations are we seeing in surgery for breast cancer?
A: Oncoplastic surgery and nipple sparing mastectomies are greatly improving cosmetic results. Radioactive seed lumpectomy is a new technique that I perform in my practice. Instead of placing a wire in the breast to localize the cancer, a radioactive seed is placed in the cancer before surgery. A special probe is used that allows identification of the seed. All of the tissue around the seed (and the cancer) is removed, allowing less native tissue to be disturbed with better cosmetic results. Targeted chemotherapy has been another significant advance. When chemotherapy is administered in the preoperative setting, breast cancer has the potential to be completed eradicated 40 to 70 percent of the time.
Q: Is it challenging to be a physician who works every day with a potentially fatal condition?
A: It’s a privilege to care for patients with breast cancer. My team and I see patients at their lowest point, their most fearful point. It’s emotional for us too. At times my navigator, Terri Riecke, and I both tear up. We try to keep a good poker face, but sometimes that’s hard. I think it humanizes us. We connect with our patients; they are a part of our family. It’s my mission to see them alive and well for a long time to come.
To learn more about breast cancer treatment and breast surgical oncology at Touro, visit touro.com/cancer.
JOHN COLFRY, M.D.
Breast Surgical Oncologist
3434 Prytania St., Ste. 320
New Orleans, LA 70115